resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
February, 2014, Vol. 14, Issue 02
What Does an MRI Tell the Therapist? A Closer Look at Cervical Pain
By Debbie Roberts, LMT
There are more than six million car accidents every year in the United States alone. Worldwide, an estimated 1.2 million people were killed and fifty million injured from a car accident. There is a very big chance you will treat a whiplash injury over the course of your career.It is important not to treat these potentially serious trauma cases blindly. Even if you work in a chiropractic office ask to see their MRI report. The MRI and his prognosis for the case will give you a more precise treatment strategy. This will also help you determine how severe the injury is. You can divide a whiplash prognosis into three categories. Minor whiplash injuries usually resolve within one to two weeks. Moderate whiplash injuries with muscle spasm or ligament strains may take up to four to eight weeks to resolve. Severe whiplash injuries, or those that involve nerve damage or ligament or disc injury to the spine, may result in chronic or permanent disability. These injuries may require more drastic measures to resolve.
How many times has a patient said to you, "I feel like I am crazy?" Massage therapy is sometimes so much more than the physical portion of manual therapy. Massage therapy can be the gap of empathy, education and evaluation between the patient and their physician. Where does the process start? It starts with how well you assess and evaluate the situation. Evaluation takes a level of judgment, necessary to make sense of the clinical findings in order to correlate a relationship between the symptoms and the signs of dysfunction. This kind of thinking takes you away from treating symptom-based massage therapy into cause and affect therapy. Having real tangible evidence helps the therapist decide which techniques are necessary to help the client regain their previous level of health or even a better state of health.
Where is the easiest place to start? Start with the facts and not speculation. If the client has had a MRI, ask them to bring it to their first appointment. If you have never read a MRI report it can look and sound daunting, but it will actually help you make a more sound therapy session. The information this report can lend to you as a therapist is insight into what is really going on with the client. There may be certain range of motion movements you will not want to do with this client knowing their history. Also, now you will have a better idea on what you can expect from your treatment plan.
There are well over 100 types of massage and massage modalities to choose from these days so it is even more important to have a system on which to base the appropriate technique or tool from the tool box. I bring this up to help our community of massage therapists understand that although some techniques such as stretching, elongating fascia and helping with mobilization are good at times, certain directions of movements may not be appropriate after reading the clients MRI report. Holding ourselves accountable for knowing standard orthopedic joint range of motion measurements are critical in making sound stratagem for massage therapy. Just because you learned that a stretch in lateral side bending will lengthen the trapezius muscle, will that technique or modality be appropriate for this cervical patient? And without looking at their MRI report, you are trapped at speculating instead of correlating the facts.
It is not hard to read a MRI report of findings. You simply go to the end of the report and find the word IMPRESSION. This is where the basic conclusion of what the testing results showed. Taking the time to ask for the report and reading the report demonstrates to the patient you have knowledge and understanding as well as empathy. It also demonstrates you really want to know what to do and what not to do during their treatment session. Massage therapists have an opportunity to educate the client by showing charts of the muscles, joints and nerves involved that were indicated in the report. The patient doesn't understand why their muscles are still going into spasms one month, two months, even a year later, but you do. Giving the needed educational and emotional support when someone is in pain can immediately reduce their anxiety which in turn reduces their pain levels and an opportunity for healing can begin. When you take the time yourself to understand what a MRI report is saying, your treatment plan can be much more precise.
Here is the exercise for this article. I am going to give you the subjective information and the results of one of my cervical patients MRI report. Read the report all the way through. Jot down what you understand and then what you don't understand. Google it! Based on the subjective, how would you treat? Now, based on the facts how would you treat? Which technique or modality would you be comfortable using. Is there range of motion movements you would avoid? What muscles would you do manual muscle testing on?
Case Study Subjective
In total tears, over lunch my girlfriend relays she has been in neck and headache pain now for the past six months and can't workout. She had chiropractic care which included adjustments, ultrasound, hot/cold and electric stimulation which offered some relief.
Past Medical History
She had an accident one year prior to this car accident. She fell off of a ladder that tore her ACL, MCL, the medial meniscus and fractured her tibial plateau. She was found on the ground in a pool of blood.
Here is a beginning list of the muscles innervated at the different spinal roots. C5/6 innervate the Deltoid, Teres minor, Biceps, Brachioradialis, Subclavius, C4,5,6 Infraspinatus, Supraspinatus, C6/7 innervate Coracobrachialis, Pronator teres, Flexor Carpi Ulnaris, Triceps, C7 innervate the Latissimus dorsi. Let's look at a few terms that were in the report.
Spinal stenosis is an abnormal narrowing of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. There can be either sensory or muscular weakness. Cervical spinal stenosis is dangerous because it involves compression of the spinal cord.
A bulging disk extends outside the space it should normally occupy. The bulge typically affects a large portion of the disk, so it may look a little like a hamburger that's too big for its bun. The part of the disk that's bulging is typically the tough outer layer of cartilage. Usually bulging is considered part of the normal aging process of the disk and is common to see on MRIs of people in almost every age group.
A herniated disk, on the other hand, results when a crack in the tough outer layer of cartilage allows some of the softer inner cartilage to protrude out of the disk. The protrusion of inner cartilage in a herniated disk usually happens in one distinct area of the disk and not along a large component of the disk, which is more typical of a bulging disk. Herniated disks are also called ruptured disks or slipped disks. A herniated disc is more likely to cause pain.
Relief In The Findings
Because she didn't understand the report of findings, she was not making the necessary adjustments to her lifestyle to help with relief of long term pain and dysfunction. Her neck seems like a train wreck and is the third type of whiplash discussed previously. We treated her with ice and heat, performed soft tissue work to tolerance. No deep tissue was used. She was treated in supine, prone and side lying. Other treatments included some craniosacral therapy, light traction, and no range of motion movements instead the use of isometrics in all directions and again to tolerance. I managed to take her pain level from a 10 down to a 3 with soft tissue work, home contrast therapy, lying down as often as possible during the day while she was working. Also, she made modifications to her workout routine. The focus was not to let the pain cycle get started.
Understanding the MRI helped her make the necessary lifestyle corrections to allow the chiropractic and massage therapy to be successful. Although both kinds of care lowered her pain levels, it still remained a constant nagging dull ache with limitations to her standard of living. On the advisement of her lawyer she sought care from an orthopedist. The orthopedist recommended a series of facet injections to help break her pain cycle and he felt strongly that it would eliminate her pain. The injections were successful and this allowed her to resume closer to her previous way of living and working out. To make sure she doesn't get into that pain cycle again she presently maintains herself on as needed bases of both massage therapy and Chiropractic care.
Because the disc does not always protrude in the same direction in relation to the nerve root there is no way to know for sure which motions or positions will aggravate a nerve root compression. A safe rule of thumb is that if any motion or position or technique further aggravates the client's symptoms, it should be immediately stopped.
Click here for more information about Debbie Roberts, LMT.
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