resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Ever Heard of the Lateral Raphé?
We have all had acute patients enter our offices listing laterally to the side at the level of the lumbar spine or expressing pain on lateral lumbar bending.
Giving Testosterone Levels a Boost (Part 3)
Since testosterone and insulin status are inversely correlated, it's important to keep insulin low so testosterone will remain high.
Grape Seed Extract: A Multifaceted Herb for Promoting Healthy Circulation
One of my favorite herbs is grape seed. Modern research has identified some intriguing health benefits attributable to the seed of this ancient fruit. I particularly use grape seed as an extract standardized for OPCs (oligomeric procyanidins).
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
The Power of Words: DCs Share Drug-Free Approach
There's no doubt that words are powerful and important – especially in the chiropractic profession, where we have been struggling for years to find the right words to describe who we are and what we do.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
Diagnosing Flexion-Intolerant Lower Back Pain (Part 2): Exercise Rehab
One of the things that has puzzled us for years is the presentation of the flexion-intolerant patient. We have realized there is a large overlap with sacroiliac indicators. In acute lumbar pain, the SI often twists, subluxes, goes haywire.
Asymmetrical Pronation: Effect on Adjustments
When your patients don't respond as well as expected to their chiropractic adjustments, oftentimes there is a source of interference in the pedal foundation – asymmetrical pronation.
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
Managing Hallux Hypomobility Disorders (Part 2)
In part one of this series we discussed the unique properties and significance of the first toe in the propulsive phase of gait. In particular, we discussed the importance of the first metatarsophalangeal joint (MPJ).
Eucommia Bark Helps Maintain Strong Bones
Eucommia bark is a major tonic herb used in Asia, and now throughout the world, that supports and helps mend the skeletal structure and its related tissues. Eucommia bark is collected from Eucommia ulmoides trees that are more than 10 years old.
Weighing in on Weight Loss
If your practice trends anything like the U.S. population, you are probably noticing over two-thirds of your patients could benefit from weight reduction, particularly if their main complaints include chronic back or joint pain.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
News in Brief
Patriot Project: Serving Those Who Served; CTCA Chiropractor Receives Clinical Innovation Award.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Don't Believe It
One of our staff came into my office last week, very concerned about an article she had just read on a news media website. The article suggested researchers found "no health benefits" associated with taking multivitamins.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
VA Names Sites for Pilot Chiropractic Residency Program
The Veterans Administration has announced the five VA medical facilities that will serve as initial sites for the administration's recently established pilot chiropractic residency program.
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
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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