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Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
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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