resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
October, 2013, Vol. 13, Issue 10
Training Myths and Young Athletes
By Debbie Roberts, LMT
As a massage therapist, I think you would agree the most frequently requested therapy is for relief of back pain. Recently, I had three different cases of that exact client. The one I want to discuss with you is a young boy home from college wanting to get big or as he put it, "bulk up." His injury occurred while using a leg press machine to help him increase the size of his thighs.
In his youth mentality, he wanted to accomplish this goal as fast as possible because he would be heading back to college in a short couple of months. From a tendon and ligament standpoint, getting big quick means a quick road to injury. It is such a myth in our thought process about fitness that you can lose real weight overnight, that there is a fat-burning zone or that you can add muscle bulk and density in a few short weeks.
So, what did he do? Probably the worse lumbar sprain-strain I have ever taken care of; in fact, after the assessment (risk should they be in my office), I referred him out to a chiropractor and a physical therapist. So what happened and how did I assess it? First, let's gain a little education on the leg press machine for all of you out there who don't frequent the gym. It is a fixed-axis machine, so there is less recruitment of our stabilizing muscles. The danger with any machine is that they are designed to accommodate as many body types as possible, i.e., the one-size-fits-all scenario. However, each person has a different pulley and lever system which no machine is designed to accommodate. The other problem is no activity is performed sitting or lying down so there is no reason to train that way with the exception of rehabilitation and teaching a beginner controlled movement. All movement takes place on our feet. Once learning has occurred, it is time to get up and oppose gravity so muscles can respond, not just push against them. What my client did is the typical way to get hurt. He put too much weight on the machine, went to almost failure (another myth in fitness to gain mass), loaded the machine with over 900 lbs, rolled his pelvis under at the last moment because his legs and stabilizing muscles were failing him and, can you guess who had to help get him out of this mess? Ouch! His lumbopelvic complex is made up of 29 muscles, the fascia over this complex and the bones they are attached to. This is a very common mistake made by young athletes: training the movement system first and not the stabilizing system, which does not make structural or biomechanical sense. To quote Ida Rolf, "Consider fundamental movement before specific movement." Anything can hurt you, but weight machines force the body into a pre-determined movement pattern. The danger is present if forces exceed your structural capacity which in this case was more than 900 lbs.
The first assessment was taking the health history. Seems like a no-brainer, I know, but I want to help you determine all of the questions that need to be asked in this case; as well as what the answers would reveal to you as a massage therapist. All roads do not lead down to treatment; some roads lead out to making an appropriate referral.
The second assessment was asking him to perform certain movements while asking the question, "Pain or no pain?" Non-painful dysfunctional movement is just as important and, in some cases, more important than the painful movement. The third assessment was looking at bony land marks both stationary and during the action of movement. The fourth assessment was palpation to determine how much muscle spasm was present. First, take out a piece of paper, re-read the case study, see if you would have asked the same questions and arrived at the same resolution. With each question, write down what this would reveal to you about the client. Then ask yourself, would you treat this client or would you refer out? By doing this short, simple exercise we can help facilitate real learning.
How did you do it? "Leg Press" This told me I have a potential for a serious lumbar injury. Herniated disc, fracture, bulging disc, tendon-ligament damage, nerve involvement, severe subluxation and inflammation, etc. Knowing the action of the leg press is very important to the thought process of the amount of probable damage.
How much weight did you have on the machine? "Over 900 lbs." Back to all of the above; because of the load down through the lumbar spine, the likelihood of major damage is there.
Have you been doing this much weight all along? "No, I just increased it." Back to all of the above because now you know there was an increase in percentage of weight distribution through the lumbar spine, which its stabilizing muscles were not used to handling.
Did you feel anything at the time? "Not right away, but it started tightening down after I did squats." Were you doing back squats? "Yes." Back to all of the above and red flag for higher potential of increased damage. This is the beginning of the cumulative injury cycle: tissue trauma, inflammation, muscle spasm, adhesions, altered neuromuscular control, followed by muscle imbalance. He had an injury that he now had put a concrete block on top of. Back squats, which means the bar is loaded onto the back and the weight is distributed down through the entire spine, is a recipe for disaster.
How long ago was the injury? "A week ago and I tried to play basketball, but my back wouldn't let me." A well formed cumulative injury cycle includes lots of inflammation and muscle spasm which is not a good scenario for some forms of massage therapy. Using anything other than a very light massage such as MLD could cause more inflammation and spasm. At this point, there should be so many red flags going off in your mind that the only thing you can think to do is not treat until another higher medical professional looks at him.
Have you seen anyone for this? "Yes, a massage therapist but I didn't have any relief, but my Mom knows you and wanted to see if you could help me." After all of the above, I wasn't sure how, because I didn't have the whole story (x-rays, MRI, chiropractic opinion, orthopedic exam, etc).
Have you used ice or heat? "Ice, three times a day." This will give you a picture of how far into the cumulative cycle they are. If pain is starting to alleviate, then they might be on the road to recovery; if the pain remains the same, they should be on their way to your referral source.
I asked him to do two movements for me, squat and toe touch. The question was enough; he couldn't think about squatting because of the lumbar pain. Red flag! Normal motion has been lost and this is a fresh injury. The attempt at the toe touch was the most revealing. When you ask a patient to bend forward to touch the floor, combined motions of the lumbar vertebrae, pelvis and hip joints are put into play. Are you ready for this: he could only bend to about the T3 level, and you might as well say his toe touch was a chin tuck. This means the thoracic, lumbar spine, pelvis and hip joints should all be considered and further evaluated for damage. He could rotate the thoracic spine, but there was no flexion or extension at all because of limitation in the movement and pain over the lumbar and sacral region. That was more than enough for me to make a referral to the chiropractor, orthopedist and physical therapist immediately. The problem was that he had never been to a chiropractor and didn't really want to go. So, I took out the spine model, curled the pelvis under, rotated each vertebra in opposite directions and showed him what he had done, explaining the numerous possibilities of damage. His response: "Oh, not good."
I encourage you as the massage therapist to remember we are all educators. This was an opportunity to lead a youth into a better understanding about how the injury occurred, why he should stop and let the body heal, and why other professionals will probably be necessary to obtain more information and hopefully get him better quicker.
Seeing is Believing
One of the evaluation tools I use is a forward bend while looking at the movement of the PSIS. He was unable to do the test because it would have caused too much discomfort. Red flag! Loss of normal motion, but again the question is why. It is not ours to determine at this stage of treatment; we just confirmed the risk should they be in our office.
I will go into more detail on how to perform this assessment in the next article, which will discuss the other two cases of lumbar pain I mentioned earlier. Being careful and asking the right questions with a simple health history form will reveal a lot before getting on the table. Knowing the action of the injury helps you determine your next course of action. I hope I showed you that the way to help in some cases is to recruit a team of professionals to accomplish the goal. The only treatment I did that day was a lymphatic type of massage to help reduce inflammation and spasm. I kept him on his side to avoid any strain to the lumbar region with pillows between his knees. I did alternating massage between my hands and an ice cup the entire one hour. He felt better after the treatment, which relieved the symptoms but not the cause.
I saw him two more times after the exam with the chiropractor. The chiropractor called me and concurred with everything I had found, but didn't think he needed an MRI. He wasn't responding to chiropractic care and after two more massages the progress seemed slow. So, I called his mom and discussed getting physical therapy three times a week and having an orthopedist exam. This was a better route for their insurance. After six more weeks of receiving physical therapy, he was still in discomfort and insurance would not pay for an MRI. The orthopedist gave him a course of prednisone and his mother is happy to report he is now once again back to his "sexy self." Now, as an educated youth, he assured me he "will never do that again."
Click here for more information about Debbie Roberts, LMT.
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