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News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
March, 2014, Vol. 14, Issue 03
The Tissue Density Grading Scale: A Communication Tool
By Linda LePelley, RN, NMT
Most of my years of clinical work as a nurse massage therapist have been focused on exploring the density of tissues. I've consistently observed that the client's areas of subjective pain are closely associated with an objective increase in tissue density (TD) and, when that elevated TD is reduced or restored, the pain is resolved.Several therapists have contacted me since I began writing about elevated TD, to let me know that they have experienced the same phenomenon, and appreciate that I have introduced and described it. More of the relationship between elevated TD and pain is discussed in "Tissue Density's Relationship to Pain and Dysfunction" (Massage Today, April, 2012).
In the course of treating musculoskeletal pain, a therapist needs to document the care that has been given for the purpose of assessing the efficacy of the treatment provided, and for sharing that information with the client and others, such as the referring physician/therapist; other members of the health care team; or for insurance reimbursement purposes. While it is not definitive, I've developed the Tissue Density Grading Scale to be that practical communication tool. Regardless of the treatment modality utilized, TD grading is a useful way to compare treatments and assess their effectiveness.
Tissue Density Grading Scale
Grade 0 (Yellow) = Tissue is flaccid, hangs from attachments and has little to no resistance to gravity.
Grade 0 (Yellow) – depicts advanced wrinkling; the hanging tissues found on some chins and underarms and the sagging, drooping tissues often noted on persons who have quickly lost a great deal of weight. It is important to note that grade 0 tissues are often found superficially over an area of elevated TD in the 2 to 3 range. It may feel as if the loose tissues have separated from deeper tissues, which in turn are becoming condensed. The deeper tissues are usually tender with moderate palpation, with easily definable borders.
Grade 1 (Green) – TD represents normal, healthy tissue that is pain-free, well hydrated and well perfused. It is easy to palpate, identify and differentiate muscles, bones, ligaments and other connective tissue. Usually warm to the touch with no pitting when palpated.
Grade 2 (Blue) – TD indicates elevated tissue density. Upon palpation you will find the tissues tight, sometimes hardened and resistant to mobilization. They do not relax easily and are reported to be uncomfortable, even painful. Clients often describe Grade TD 2 tissue as being tight, sore, achy, heavy, stiff and/or painful. However, grade 2 TD can be latent, without complaint of pain or dysfunction until activated by injury, use or palpation. The borders of the affected areas are easy to determine.
Grade 3 (Red) – TD can be found in small strands and bands interspersed with other grades of TD, causing much pain and dysfunction, such as that of Carpal Tunnel Syndrome and Tendonitis. Larger areas are often found in a wide variety of conditions, such as Restless Leg Syndrome, MS, Parkinson's, and Fibromyalgia. Grade 3 TD feels firm and rubbery, and is resistant to mobilization.
Grade 4 (Brown) – TD is associated with profound dysfunction, for example, curvatures and contractures such as those experienced by persons who are bedridden or extremely sedentary for long periods of time. Painful knots and lumps, and the “bony overgrowth” found in arthritic conditions are composed of grade 4 TD. It is hardened and often believed to be composed of bone.
It is important to note that although an area of tissue may be palpably denser than that of its surroundings, it may not be tender or painful. However, an area or spot that hurts will exhibit elevated TD. By softening hardened tissues and restoring those to a more malleable, mobile, smooth condition, nerves and nerve endings are no longer being painfully trapped and tugged. Normal tissues do not hurt when squeezed or pressed into. When you focus on the clients' directions to pain locations and the firmness of the involved tissues, you can locate, successfully treat and document most musculoskeletal pain complaints.
Along with the graduated number scale to differentiate tissue densities, each level is also color coded to provide for the creation of a more graphic representation, if desired. Because a TD Grade is objective, you (the therapist) should make your own determination of TD. You should have the client direct you to the area that is most uncomfortable or painful, and document their description of the pain quality and level, but grade TD based only on what you actually feel. If you can feel a lump, ridge or textural change, so can anyone else who is looking for it.
Click here for previous articles by Linda LePelley, RN, NMT.
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