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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.
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.
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.
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.
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.
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.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
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.
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.
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.
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.
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.
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?
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
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.
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.
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.
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."
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.
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 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
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.
December, 2013, Vol. 13, Issue 12
Using TDR Massage When Treating Sciatic Nerve Pain
By Linda LePelley, RN, NMT
A new client called, asking to be seen as soon as possible. She was experiencing severe right-sided low back pain. Her chiropractor had sent her to a joint and spine specialist. She was diagnosed with Sciatica and given an injection containing pain relievers and steroids, with no abatement of her pain. Diagnostic tests concluded there were no disc problems, so her doctor gave her permission to seek massage.
I palpated the tissues of her right sided glutes, pirifomis and hip joint. Together, we determined the precise locations of the pain. I was careful to ascertain that my client agreed with my findings as I went along. For example, I would say, "This spot feels denser than the tissues around it. It feels to me there is a border here where the tissues thicken, how does it feel to you?" And, "I feel a thick strand of tissue right along here, is this tender?" I was able to feel with my fingers the hardened, dense tissue at the places that were hurting her. She guided me to the areas that were the most involved with her pain and discomfort. I generally find the tissues which are most dense will also be the ones which hurt the most, although this is not always the case. While I have consistently found tissues that hurt have elevated tissue density (TD), not all dense tissue hurts. In this case, however, the most firm tissues were the most painful.
I found what felt like a thick, fibrous pad, approx 3' by 5", over the client's SI joint, which she identified as the location of the worst pain. The second worst area, and the one most responsible for my client's inability to lay on her right side, was another thickened mass of dense tissue which had formed over the greater trochanter, approx 9" by 4". Both felt to be variably ¼ to ¾ inches in depth, with the thickest part over the most firm, dense area (I consider these hardened pads to be Adventitious Tissue Structures (ATS) (see "Adventitious Tissue Structures of Elevated Tissue Density," Massage Today, June 2013). Other involved tissue was noted to follow the probable course of the sciatic nerve behind her thigh on down to her knee; also involving a notably tender ATS at the medial aspect of the knee; and finally, the distal lateral portion of her right leg, which felt as firm as a rubber tire.
Tissue Density Restoration (TDR) Massage is based on my observation and theory that musculoskeletal pain and dysfunction increases in direct association with an elevation in TD. I find this method to be very effective. Over my years of clinical observation and experience with TDR Massage, I have developed a few principles of application:
Having determined that the worst of my client's pain involved the ATS at the SI joint and the greater trochanter, and using a massage cream with excellent glide; I began massaging the areas with wide handed, circular motions, reminding my client to let me know if her pain level reached or surpassed a 3 on the 1/10 pain scale. At the beginning of a treatment, the overall area may feel uniformly tight and firm. As the tissues warm with the friction of the circular massage movements, the least affected tissues will begin to relax and soften. At this point, the outlines of the hardened, painful areas will become more apparent and easily palpable. As you are able to do so without causing pain, increase the intensity of the pressure and movement. Use your thumbs, knuckles or the ulnar side of your hand to target and focus on the boundaries of the hyper-dense tissue.
As you work, the tissues will eventually begin to feel as if they are becoming smoother, then softer. I checked with my client often, making sure I was still at the right level of pressure and that I was still working on the area that hurt. As dense tissues are warmed and moved, they become softened, resulting in pain relief. So, you will find that over the course of the treatment, the area of focus will often slowly shift into adjacent areas. As you are able to use more pressure and movement, you will find tissues that felt quite firm and solid at the outset become malleable to the point that you will be able to gently grasp and squeeze the area of focus without causing pain. It is at this point that the density of the deeper tissues may be reached through the increased pressure and mobilization you will be able to implement. Eventually, the tissues will be restored all the way to the bone.
Throughout the course of the massage, I explained to my client that my goal was to soften all of the overly dense tissues. As her pain levels and elevated TD areas were relieved, she was amazed to see there was indeed a relationship between the density and pain. I explained to my client that, once cleared, there are things she can do to help prevent the return of the elevated TD. They include staying appropriately hydrated, using warm packs or baths for sore muscles whenever they occur, massaging any area that feels tight and sore, being as active as possible and getting a regular, full body massage.
The worst of my client's pain was resolved at the first massage, giving her a great deal of relief and allowing her to sleep. She had a second massage three days later and then once a week for the next 10 weeks. At the point in time when the thickened pads at the hip and SI joint were no longer palpable, I worked my way down her leg to restore the density, ending at the calf. The tissues are now malleable and pain-free.
Clients often feel proud of the hardness of their muscles; they believe it is a sign of strength. I recall a gentleman who pounded his fist into his thigh, telling me, "This is all muscle! I don't want to lose my muscle, I just want the pain to go away!" I explain that as the tissues become denser, they crowd, engulf, squeeze, and compress the nerves and nerve endings within them. These nerves are no longer able to slide and glide around with movement, so they end up being tugged, pulled and pinched – which hurts and eventually causes dysfunction. My evidence is the repeated observation that dense tissue that hurts is relieved of the pain once it has been restored to an uncompressed state.
Linda LePelley, RN, NMT is a registered nurse and licensed massage therapist with 19 years of clinical massage experience. She developed Tissue Density Restoration (TDR) Massage, an effective treatment for the pain found in hyper-dense tissues. For more information, visit www.MyHealingHands.com.
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