resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
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.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.