resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Don't Trust What Your Patients Say
When a patient presents to the office for care, they typically have a specific complaint – lower back pain, whiplash, sinus congestion, sciatica, etc. They are often not interested or engaged in what they consider "unrelated" personal health history.
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
December, 2013, Vol. 13, Issue 12
Timing is Everything: Shoulder Instability and Labral Tears
By Debbie Roberts, LMT
The greatest thing about being a massage therapist is you never know who you will help next. One minute, you could be holding the hand of a hospice patient and the next, a strained quadriceps muscle of a 6-year-old.I know all of you understand what I am talking about because, in our field, we have such an opportunity to treat a very diverse clientele. I had the opportunity to help a young football player hold onto his dream of being a quarterback, his future college scholarship and the opportunity for scouts to see him throw. My goal is to help you understand the mechanisms of shoulder instability, how to access for instability and possible tears and most importantly, why your understanding of timing can be critical.
The Shoulder Joint
The shoulder joint often has been referred to as a cup hanging on a saucer or a golf ball on a tee. What this describes is how vulnerable the glenohumeral joint is. The glenohumeral joint has the largest range of motion of any joint in the human body. The shoulder ball (humerus) and socket (glenoid) have little inherent stability. The lack of stability results in a GH joint prone to instability and dislocation.
The labrum, which is a fibrocartilage tissue that forms a ring around the glenoid, adds stability to this inherently unstable joint. The labrum is connected to the capsule that links the socket loosely to the ball. The biceps tendon also attaches to the top of the labrum ring. Together with the muscles of the shoulder, the capsule/labrum complex affords stability to the glenohumeral joint. Any injury to the capsule/labrum complex causes a patient to have shoulder pain and instability (dislocation or subluxation). Damage to the labrum and capsule is a common occurrence as a result of an instability event; the damage causes the labrum to detach from the glenoid and predisposes the shoulder to future events of instability and dislocation.
There are many kinds of labral tears, but this discussion will focus on one of the most common types involving throwing athletes called the SLAP tear: "Superior Labrum Anterior to Posterior." SLAP tears usually develop over time following repetitive use like in some of our golfing clients. But they can also occur when an athlete suffers direct trauma to the shoulder, just like my young quarterback.
He sustained two different tears as a high school quarterback. The first injury sustained was a small labral tear which the doctor told him he could continue to play with. The second tear wasn't yet discovered until his visit with me. Both happened as he was getting ready to release the ball. He described that his arm was externally rotated and raised to 90+/- degrees of abduction in the loaded position of cocking for a throw. Another player tackled him making contact with the arm which forced the arm backwards and further into external rotation. The blow took the glenohumeral joint beyond its normal joint range of motion. This type of impact causes the humerus to sharply rotate within the glenoid stressing tendon and ligament structures beyond their tensile strength. Tensile strength is the maximum stress that a material can withstand while being stretched or pulled before failing or breaking. Tendons have great tensile strength, but are practically inelastic and resistant to stretch. In injuries that involve a severe stretch, the muscle most likely is affected, and sometimes the tendinous attachment to the bone is affected. Tendons can also rupture. An example is when the Achilles tendon ruptures and the Gastrocnemius retracts with the soleus muscles going into spasm and acute pain.
Red Flag On The Play
The first red flag to take notice of is the way the injury happened. Anytime the shoulder is taken beyond its normal range of motion, there is potential for serious musculotendinous junction or ligament damage. I helped this boy's father out with some nagging elbow pain a couple of years ago so when his son was complaining of shoulder pain, he called me. They came into the office and told me he was having pain on certain movements, nagging pain in the back of the shoulder and the chief complaint was instability. He complained he could no longer do a bench press in his workout even when he lowered his weights. (Extra tidbit: A bench press exercise is not a good idea anyway for a valuable throwing shoulder because the bar doesn't allow for the natural rotation of the shoulder joint. The use of free-weights in a dumbbell press accomplishes the same strength goal without the potential risk of damage to the shoulder joint.)
It is always interesting to me the details left out by a client because they don't think it is necessary information to the treatment of massage therapy. He didn't tell me he had a previous tear. It was revealed during the assessments. Based on the red flags the assessments threw up, I asked him if he had ever been diagnosed with a labral issue. He looked at me and said, "yes, last year but the doctor said it was so small I could play. But this feels different and I can't throw as far or as hard (loss of power)."
Second red flag for you to take notice of is that instability is the main complaint and loss of power. This indicates a possible tear of either a muscle or the labrium.
The first assessment I performed was a length test asking him to show me his range of motion in abduction, adduction, flexion, extension, internal rotation and external rotation. I also asked him to stop at any range that caused pain and to point where he felt the pain was coming from. "There isn't any real pain it just feels unstable and aches in the back of my shoulder." I compared his active range of motion with his passive range of motion. On external rotation, he had a clunk and a slippage sensation. This is an orthopedic assessment called the "clunk" test. The third red flag for you to take notice of is a clunk, snap or pop which are signs and symptoms of a possible labral tear.
The second assessment was the use of manual muscle testing examining the strength of the shoulder complex. Manual muscle testing is used to determine the capability of muscles or muscle groups to function in movement and their ability to provide stability and support. I performed manual muscle testing to the shoulder complex of muscles which included supraspinatus, infraspinatus, teres minor/major, anterior deltoid, middle deltoid, posterior deltoid, upper trapezius, middle trapezius, lower trapezius, latissimus dorsi, pec major/minor and serratus.
When you perform manual muscle testing, there should be a definite feeling of a muscle locking into place without quivering. He had a trembling or shuddering feeling against my resistance not a firm locking in of the joint (instability).
The fourth red flag for you to take notice of is that during the manual muscle test, there was not a definite locking in place there was more of a wavering when the muscles were subjected to pressure. This can be an indication of a tear and/or extreme inflammation. For more information on how to perform manual muscle testing, I suggest reading, MUSCLES Testing and Function with Posture and Pain, Fifth Edition, Lippincott Williams & Wilkins, by Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, May McIntyre Rodgers, William Anthony Romani.
I explained to his father and to him the objective findings. I also explained that underneath my scope of practice, I am not allowed to diagnose. The reason for the assessment is to make sure they are a candidate for massage therapy and there are no contraindications to treatment. I explained that based on the instability, the poor muscle function test and his past medical history, I would recommend they go back to their orthopedic surgeon. There is always a possibility he might have done further damage since he received another direct blow to the shoulder. I told him, the sooner you get this taken care of, the faster you will be ready to play football next season and not miss out on your senior year of high school.
I received a phone call a week later from his mother thanking me immensely. She explained the new MRI showed an additional labral tear and a partial supraspinatus tear. She told me he was scheduled to have surgery right away so he would have time to rehabilitate and be able to play in his senior year. They were very grateful because they were hoping for a football scholarship to help out with the college tuition.
Without doing an assessment, you are guessing. Timing and rehabilitation are always critical when it comes to sports. Delaying the surgical intervention would have prolonged the client's recovery and return to play. He may have lost his window of opportunity to earn his chances of an athletic scholarship.
All red flags are contraindications for treatment and are indications for a medical referral. He has completed physical therapy. He is seeing me once a week for maintenance and is leading the way with his high school football team. Everything indicates he will get that college scholarship and who knows what is next. The scouts are looking at him!
Click here for more information about Debbie Roberts, LMT.
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