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News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
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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