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What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
April, 2013, Vol. 13, Issue 04
Massage Improves Range of Motion for Children with Burn Injuries
By Massage Therapy Foundation Contributor
Contributed By Jolie Haun, PhD, EdS, LMT, Derek R. Austin, MS, CMT, Beth Barberree, BA, RMT
Understanding the effects of massage is critical to advance the field. Yet, understanding the impact for a child with burn injuries is critical to improving the quality of life for someone who has experienced considerable trauma. This month's research review by the Massage Therapy Foundation looks into a pilot study conducted to examine the effect of massage on mood and range of motion (ROM) in eight children post recovery from severe burns.
Many children with burn injuries undergo considerable care in recovery. Treatment options are limited, so often patients with burn injuries pursue alternative therapies such as massage to address issues related to psychological and physical outcomes associated with burns. Little research has examined the effects of massage in children with burn injuries. Those published suggest that massage decreases distress related to change in wound dressing and may decrease severe itching. Now, Morien and colleagues extend current research with children by examining the effect of massage on mood and range of motion (ROM). Based on research conducted with adult burn survivors, the research team predicted massage would increase mood and ROM.
Participants were eight children attending a camp for pediatric burn survivors, with a mean age of 13.5 years (range 10–17 years). Five children participated in the study for 4–5 days and three participated for 3 days. All participants had thermal burns to several body parts, including arms, legs, trunk and face. Massage was provided on healed third degree burns that had previously required skin grafts. The authors defined third degree burns as the loss of skin structures at a depth that reaches the subcutaneous fat and fascia, which includes epidermis, dermis and all skin organs. Areas receiving massage were well-healed, with 2–16 years since the burn.
Four therapists participated in data collection and were blinded to the results until the end of the study. Therapists with advanced training in massage for burn scars offered massage sessions that lasted 20–25 minutes once daily, for up to 5 days. Massage provided on scar tissue consisted of 5 minutes of lengthening using long light strokes (effleurage); 5 minutes of stretching and rolling strokes between hands, fingers or thumbs (petrissage); and 2–5 minutes of small cross fiber movements (friction) to loosen the scar tissue. The last 5 minutes of the massage session included general lengthening and rolling movements. Massage therapists discussed possible needs or concerns regarding the massage before and after the sessions.
Participants reported their mood before the first massage session and after their last massage session. A visual scale using "smiley faces" that corresponded to a numerical scale was used for data collection. This method is common when conducting research with children. ROM of the knee, neck and shoulder joints was measured in degrees using a goniometer. ROM measurements were also taken on non-massaged tissue contralateral to scarred tissue to serve as a control comparison. The authors conducted a statistical analysis to determine differences in ROM and mood from pre- to post-massage.
Findings of the study indicate ROM increased after the massage sessions, in contrast to the contralateral control tissue. An objective scar assessment was not conducted; however, subjective observations by the massage therapists noted that scar tissue was red and firm before massage, while participants' scars post-massage were flesh colored, softer and the skin was more easily stretched. There was no significant difference in mood across time.
Authors concluded massage increased ROM in children with burn scars, which is consistent with studies showing that massage increases ROM in patients with injuries not resulting from burns. The authors were surprised to find no change in mood following massage considering findings of improved mood in previous studies with adult participants. The authors contend mood findings may have resulted from a "ceiling effect" because participants already had an elevated mood upon arrival to the camp.
The authors noted some study limitations including: small sample size; a quick and easy mood instrument that was likely too simple and lacked the sensitivity to measure changes accurately; and because the participants were 2–16 years post burn injury, their emotional coping strategies toward their scars had already occurred. An additional limitation, that the authors failed to note, was their sample size was too small to appropriately apply a t-test statistic; such that the authors cannot make assumptions about the data being normally distributed with equal variances, as assumed when applying parametric statistics. A non-parametric analysis method such as the Mann-Whitney U-test would be a more convincing basis for the authors to conclude significant changes in ROM with such a small sample size.
The authors do suggest more research using larger samples is needed, with measures to include affective states such as anxiety. They also propose that further investigation should address whether massage effects vary depending on stage of recovery (i.e. new versus old burn scars). The authors are planning a follow-up study to address research questions related to attitude, anxiety and self-esteem.
Though the study sample is small, this work provides good information to support the advancement of therapeutic massage for children with severe burn injuries. First, though this area of research is lacking in conclusive findings, this study does support the need for subsequent work to further explore the use of massage therapy for this vulnerable population. Second, massage therapists should use these findings as a basis for recognizing that this vulnerable population can in fact benefit from massage therapy. Finally, this research supports the expansion of scope for the application of massage therapy.
Similar to other serious conditions like cancer, there was a time when massage therapists may have avoided providing massage therapy to severe burn scar tissue for fear of causing more harm than good. However, through evidence-based research such as this reported study, we are learning as a profession when and how to appropriately apply massage therapy for individuals with burn injuries. When considering providing massage treatments for someone with severe burn scarring, it is strongly recommended that massage therapists acquire special training and consult with a physician before providing treatments.
Editor's note: For more information about massage therapy research, visit the Massage Therapy Foundation at www.massagetherapyfoundation.org.
Click here for more information about Massage Therapy Foundation Contributor.
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