resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
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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