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Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
March, 2014, Vol. 14, Issue 03
Educate Yourself: Massaging a Client with ALS
By Sharon Puszko, PhD, LMT
In 1941, baseball legend Lou Gehrig died of a neurological disorder known as Amyotrophic Lateral Sclerosis. For the first time, people in cities across the country were discussing this rare and mysterious disease in their newspapers and on their radio stations.During the 70 years that have passed since then, advances in scientific research have provided us with a better understanding of the causes, symptoms, types and treatment of ALS. However, there is still no proven cure for the disease. Over the past 10 years, physicians have increasingly turned to massage therapy to help their patients manage the symptoms of the disease.
While this is fantastic news for practitioners of massage therapy, it also means we must educate ourselves about ALS. Do you know what the symptoms of ALS are? Are you aware of how the disease affects people emotionally? Would you treat an ALS client the same way you would treat an athlete? In order for massage therapy to be truly beneficial to PALS (People with ALS), massage therapists must do their best to learn appropriate techniques for ALS clients and do their best to understand what life is like for PALS.
What is ALS?
ALS is an incurable, degenerative, neurological disorder affecting the nerve cells of the brain and spinal chord that control voluntary muscle movement. These nerve cells deliver messages from the brain to the skeletal muscles of the body involved with voluntary movements such as walking, writing or playing an instrument. As these cells gradually deteriorate, the brain can no longer tell the body what to do. For instance, the brain of an ALS patient will tell its hand to pick up a pen and start to write, but the message will no longer be able to reach the hand. Muscles eventually waste away from disuse and this can lead to paralysis in the late stages of the disease.
The ALS Association says there are about 30,000 Americans living with ALS and about 5,600 people are diagnosed with the disease every year in the United States. ALS is more common among men than women and the majority of cases appear in people between the ages of 40 and 70. ALS has no economic, racial or ethnic boundaries and occurs in two out of every 100,000 people worldwide.
What Causes ALS?
There is no one definitive cause of ALS. There are several theories surrounding the causes of the two types of ALS occurring in the United States: sporadic and familial. Sporadic ALS is the most common type of the disease, accounting for 90% to 95% of all cases. Disturbances in the immune system, excess levels of the neurotransmitter glutamate and exposure to fertilizers, heavy metals or animal hides are all possible factors that may influence the likely hood of acquiring sporadic ALS. Familial ALS (FALS) accounts for the remaining 5% to 10% of ALS cases in the United States. About 40% of familial ALS cases are linked to a defective gene on chromosome 21 that does not produce a normal amount of the enzyme superoxide dismutase. It is unknown at this time what genetic defect is the cause for the remaining 60% of people with FALS.
Symptoms of ALS
Initially, patients with ALS usually experience a weakening of skeletal muscles in the arms and legs. They might also have frequent muscle spasms in these areas. People with ALS find it difficult to pick things up, walk, swallow and communicate effectively. As the disease progresses, the muscles of the arm and legs will begin to atrophy. During the final stages of the disease, the respiratory muscles that control breathing deteriorate and the patient must depend on a respirator for the rest of his/her life.
Some of the most common physical problems people with ALS encounter are: dysphagia and the need to meet nutritional requirements; the maintenance of blood gases within normal range; impaired verbal communication; weakness, impaired mobility and activity intolerance; constipation; and pain and discomfort due to muscle cramps. Depression is common among ALS patients and many experience an alteration in self-concept and body image.
Rilutex (riluzole) is one of the only drugs that has proven to prolong a patient's life and delay the progression of ALS. Most of the other medications (Baclofen, Zanaflex, Tramadol) prescribed by doctors are to help ease the patient's pain, not to treat the disease. Because many of the symptoms people with ALS suffer from are related to skeletal muscles, physical therapy and massage therapy are now being recommended as another form of pain management.
How Can Massage Help?
Massage therapy increases blood circulation, relaxes muscles, improves range of motion, reduces pain and swelling and promotes improved respiration: all of which can help treat symptoms ALS patients suffer from. People with advanced ALS are often threatened by decubitus ulcers from lack of activity. Massage therapy can help a patient maintain good circulation in order to avoid decubitus ulcers; at the same time, it can also help the patient overcome depressive feelings he/she might be having as a result of a recent loss of speech or the disease in general.
Dr. Robert Pascuzzi, a Professor of Neurology at the Indiana University School of Medicine, is of the opinion that massage therapy, "can be very beneficial to patients with ALS. Those who have been fortunate enough to receive such therapy all seem enthusiastic about the effects: relaxation... rest... feeling good. If their muscles are stiff and spastic it helps relax them and makes their skin feel better. Remember, these patients have intact sensation; they just have weak muscles. I have probably had 10 or 20 ALS patients receive massage therapy over the years. I think doctors should suggest ALS patients try massage therapy, as it would be well worth a try for everyone. I think it improves the quality of their day. They feel better."
Below are some techniques designed specifically for the needs of an ALS patient.
Passive and Assistive Range of Motion Exercises
Range of motion exercises will prevent or at least slow down the freezing of joints as the disease progresses and the body moves less often. As always, check with the doctor before doing any of these movements.
While people in advanced stages of ALS might not be able to give verbal feedback to a massage, often they can let you know what they are feeling by the movement of facial muscles or the blinking of eyes. By asking "yes" and "no" questions, it is possible to work successfully with an ALS patient.
Sharon Puszko is the owner/director/educator for Day-Break Geriatric Massage Institute. She may be contacted at
or through her Web site: www.daybreak-massage.com.
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