resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
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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