resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
August, 2013, Vol. 13, Issue 08
The Theory of Orthopedic Massage, Part 1
By Ben Benjamin, PhD
Orthopedic massage is an extension of orthopedic medicine, a field that originated in the early 20th century with the work of Dr. James Cyriax. Dr. Cyriax developed a system of precise methods for assessing and treating soft-tissue injuries that do not require surgery.The term orthopedic massage was first coined by Whitney Lowe, a leading massage therapy educator (and Massage Today columnist). This modality has several distinguishing features that set it apart from other forms of massage. They fall into three major categories: theory, assessment and treatment. Here, we'll focus on the theory, and in part 2, I'll cover assessment and treatment.
To practice orthopedic massage effectively, therapists must possess a thorough background understanding of anatomy, physiology, kinesiology and body mechanics. They must also understand a variety of additional core concepts, including five I'll discuss here: adhesive scar tissue, myofascial restrictions, ligament laxity, direct vs. indirect causes of pain and referred pain.
Adhesive Scar Tissue
Many people don't realize that the cause of most chronic pain in muscles, tendons, ligaments, fascia and joints is the poor healing and repeated tearing of adhesive scar tissue. A little bit of scar tissue, located in the right places, is a normal part of healing. It acts as the glue holding torn fibers together. But when tissues heal by forming a random, jumbled matrix of adhesions, constant re-tearing and pain usually follow.
When we use an injured part of the body and experience pain, it is often a sign that we are re-tearing malformed scar tissue, which then stimulates the formation of additional scar tissue. The secret of effective therapeutic treatment is breaking this cycle of tearing and re-tearing. In addition to removing any adhesive scar tissue that has already formed, we must prevent the formation of future adhesions by ensuring that healing takes place in the presence of a full range of movement.
Every cell, every muscle spindle, every muscle, every tendon and every ligament is wrapped in fascia. Myofascial restrictions result from every injury, as well as from poor posture or movement habits, and they predispose a person to suffering from more pain and injury problems in the future. Therefore, the ability to identify and effectively treat fascial restrictions is important for any orthopedic massage practitioner.
Ligaments are supposed to be tight in order to hold our bones together in the proper alignment and limit movements in directions that would hurt us. There should be a little bit of flexibility in these structures, but not much. When ligaments are abnormally loose, we lose the integrity of our joints. The bones they hold together rock around and make us unstable, making us more vulnerable to injuries. Ligaments may be lax due to hereditary factors; they may become lax suddenly as the result of an accident; or they may distend slowly over time through poor posture and the stretching of old adhesive scar tissue from previous injuries.
When ligament laxity is due to hereditary factors, a skilled practitioner will advise the client to avoid hyperextending their joints, to work on developing and maintaining good skeletal alignment and posture, and to keep their body physically strong. When the laxity is due to adhesive scar tissue resulting from an accident or injury, the therapist will work to locate this tissue and suggest treatment to eliminate or diminish it so that further injury can be avoided. Such treatment might include friction therapy, myofascial work, stretching, fitness training, massage, injection therapy and so forth.
Direct vs. Indirect Causes of Pain
A comprehensive plan of treatment must address not only the direct cause of a client's pain, but also any indirect causes. Direct causes of pain are physical injuries, such as strained fibers of a tendon, an inflammation of the bursa, a disc compressing a nerve and so on. When you relieve that problem, the pain disappears. Indirect causes of pain are the contributing factors that predisposed the person to become injured. For example, an exaggerated kyphosis in the thoracic spine makes it difficult to raise the arm overhead without some strain; the last 15 degrees of this movement occurs in the thorax. In a person with a thoracic kyphosis, this condition might be an indirect cause of a shoulder tendon strain. Similarly, poor knee and foot alignment in a young athlete might be the indirect cause of a sprained ankle. Simply improving the person's alignment would not make the injury go away; however, following successful treatment of the ankle, it would help prevent future injuries from occurring.
Referred pain is pain felt at a distance from the source — for instance, pain from a neck injury that is felt in the shoulder or all the way from the shoulder to the hand, or pain from a low back injury that is experienced only in the thigh or low leg. We learn from orthopedic medicine that no matter where referred pain originates, it follows four basic guidelines:
Referred pain creates confusion for many healthcare practitioners. However, once you learn about the specific patterns in which particular injuries refer pain, the confusion quickly diminishes. For example, the sacrotuberous ligament in the pelvis refers pain down the back of the thigh and calf and into the heel, the gluteus medius muscle refers pain to the lateral calf, and the TP7 ligament (intertransverse ligament at C7) refers pain down one side of the lower neck to the medial border of the scapula.
Together, these five core principles guide both assessment and treatment in an orthopedic massage practice. Stay tuned for my next article, when I'll discuss these topics in detail.
Click here for more information about Ben Benjamin, PhD.
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