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Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
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.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
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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