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Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
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.
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.
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.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
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.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
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.
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."
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.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
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.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
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."
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
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.
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.
May, 2014, Vol. 14, Issue 05
Deep Tissue Massage Helps Plantar Fasciitis
By Massage Therapy Foundation Contributor
Contributed by Derek R. Austin, MS, CMT, Beth Barberree, BA, RMT, MK Brennan, MS, RN, LMBT
Can ten minutes of deep tissue massage combined with stretching alleviate plantar fasciitis? Plantar fasciitis, also known as plantar heel pain syndrome (PHPS), is a common pathology characterized by pain on the sole of the foot.Often, the pain is worse in the morning and when coming up on the toes of the affected foot. Both the plantar fascia and plantar flexor muscles are often tender to palpation and may contain myofascial trigger points. Unfortunately, there is limited evidence for what clinical treatment is effective for PHPS. More and more, massage therapy and stretching are seen as first-line interventions, in contrast to steroid injections or possible surgery.
Since shortening of the plantar flexor muscles could increase stress on the plantar fascia, it seems reasonable that massage to these muscles would relieve foot pain in patients with PHPS. However, until recently, there was no scientific evidence that deep tissue massage of the calf muscles reduces PHPS symptoms. The Massage Therapy Foundation's research column is summarizing a recent single-blind randomized clinical trial on the effects of deep massage combined with neural mobilization exercises. The article is titled "Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: A pilot randomized clinical trial" and was published online in the journal Manual Therapy in September 2013.
The authors, based at an outpatient physical therapy clinic in Israel, recruited consecutive patients with PHPS who were referred by an orthopedic surgeon. PHPS was defined as plantar heel pain that was worse with initial weight bearing after a period of rest but improved with activity. Patients were excluded if they had systemic disease, tumor, fracture, a history of corticosteroid use, severe vascular disease, prior lower leg surgery, referred pain to the heel from a source other than the posterior calf muscles, or an inability to attend scheduled treatments. The study was single-blind in that one author, who did not provide treatment and did not randomize patients, conducted the physical examinations at admission and discharge.
Sixty-nine patients were randomized into either the massage group (n = 36) or the ultrasound group (n = 33). There were no significant differences between the two groups of patients at baseline. All patients received eight treatments over a 6-week period with a frequency of 1 to 2 sessions per week. Treatment was performed by one of fifteen staff physical therapists. It was noted that only 51 participants completed the treatments and discharge assessment. Additionally, there were no significant differences between those who dropped out of the massage group and those who dropped out of the ultrasound group.
The massage therapy intervention was performed with the patients lying prone with their feet off the end of the table. Ten minutes of deep massage therapy was performed using "forceful soft tissue massage mobilization techniques, described by Cyriax (1984), directed to the incompliant and painful areas of the posterior calf muscle group." The therapists massaged the medial and lateral aspects of the posterior calf from both a medial and lateral approach. The pressure was deep enough to generate a pain response and was performed with thumbs or another body part, such as an elbow.
The massage intervention was compared to a treatment of ultrasound. The authors report that although ultrasound has not been shown to be effective for PHPS, it is still commonly used in some physical therapy clinics. Ultrasound was delivered to the painful area on the heel using slow circular movements for three minutes at a frequency of 1 MHz and intensity of 1.0 W/cm. The ultrasound group did not receive the neural mobilization exercise.
Calf muscle stretching has been shown at both short- and long-term follow-up to be effective in managing PHPS. Thus, all patients in the study were instructed in self-stretching directed at the posterior calf muscles. A standing calf stretch was taught, with the affected foot furthest from the wall and both feet positioned in a line. The patient leaned forward while keeping the heels on the floor until a stretch was felt in the posterior calf or achilles. In order to stretch the gastrocnemius, the back knee was kept extended, and, in order to stretch the soleus, the back knee was bent. Each of these stretches was performed three times daily, 5 repetitions of 20s stretching with 10s rest.
In addition to the calf stretches, the group of patients randomized to receive deep massage also performed a neural mobilization exercise. Patients performed a passive straight leg raise with dorsiflexion using a long belt. The idea was that doing so would increase tension on neural structures such as the plantar nerve and further alleviate pain. The authors do not state the duration or frequency of this neural mobilization exercise, though it may have been performed like the stretches.
In order to assess response, the authors used the Foot & Ankle Computerized Adaptive Test (CAT), which is a patient-rated functional outcome measure based on the Lower Extremity Functional Scale (LEFS). The Foot & Ankle CAT is rated from 0 (low functioning) to 100 (high functioning). Pain on taking first steps in the morning was rated on a 10-cm visual analogue scale (VAS).
The authors performed a mixed-model ANOVA, which showed a significant group-by-time effect (p = 0.034) for change in the Foot & Ankle CAT in both groups. This change was still significant (p = 0.025) after the authors controlled for age, gender, body mass index (BMI), and chronicity. The massage group improved on the Foot and Ankle CAT from an average of 47% at baseline to an average of 62% after treatment. The 95% confidence interval for improvement in the massage group was 9% to 21%. The ultrasound group improved on the Foot and Ankle CAT from an average of 50% at baseline to an average of 56% after treatment. The 95% confidence interval for improvement in the ultrasound group was 1% to 11%. The group-by-time interaction from the ANOVA indicated a significant (p = 0.034) difference in improvement between the two groups.
The pain level with first morning steps of patients in both groups also decreased significantly for all participants. However, there was not a significant difference in pain levels between the groups. The massage group reported a reduction in morning pain levels from an average of 6.8 out of 10 at baseline to an average of 4.2 out of 10 after treatment. The 95% confidence interval for pain improvement in the massage group was -1.4 to -3.4. The ultrasound group reported a reduction in morning pain levels from an average of 6.9 out of 10 at baseline to an average of 4.4 out of 10 after treatment. The 95% confidence interval for pain improvement in the ultrasound group was -1.4 to -3.8.
The authors concluded that the change in functional status of the patients in the massage group was both statistically and clinically significant. They stated that the change in functional status of the patients in the ultrasound group was not clinically significant despite being statistically significant. Both groups experienced a clinically relevant improvement in pain with first steps in the morning.
The study has limitations that affect its applicability to everyday massage practice. The study included a small sample size with many patients who dropped out. There was no true control group, as patients in the ultrasound group received a treatment of ultrasound as well as the calf stretches. Finally, since only the massage group received the neural mobilization exercise, the use of this exercise confounds the effect of deep massage.
In conclusion, deep massage of the posterior calf combined with stretching may improve the function of patients with plantar fasciitis more than a combination of ultrasound and stretching. Ten minutes of deep pressure massage to the posterior calf easily fits into most therapeutic massage sessions and may be worth a try with your clients. Regular self-stretching of the gastrocnemius and soleus muscles appears to be an important part of managing plantar fascia pain in patients with PHPS. Future research could explore the use of other massage techniques including possibly massage of the plantar fascia itself.
If you follow this column, then you know that exciting research about massage therapy is being done right now. Your massage therapy practice can be improved by relying on evidence-based interventions. In order to help massage therapists learn the ins-and-outs of research, the Massage Therapy Foundation has created a course on the Basics of Research Literacy. This online, 8-hour, NCBTMB-approved workshop, teaches massage therapists and educators how to incorporate principles of research literacy into your practice and teaching.
Not sure what to make of a confidence interval, p-value, t-test, or ANOVA? In this easy-to-use online course, you will learn basic research vocabulary and concepts, how to use various databases to look up research, evaluate published research articles for their validity, and apply research findings to massage practice to improve outcomes.
To learn more about touch and caregiving, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search Pub Med for CAM/CIM cost analysis studies.
Click here for more information about Massage Therapy Foundation Contributor.
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