resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Defending With Vitamin D: Helps Prevent Progression to Diabetes
A 2014 clinical trial published in the American Journal of Clinical Nutrition provides additional evidence that optimal vitamin D nutritional status may be important in preventing the progression of prediabetes to diabetes in prediabetic adults.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Is the EHR Ship Setting Sail Without Us?
The numbers are in: As of July 2014, 10,253 doctors of chiropractic have received $123,059,868 in EHR stimulus funds – and yet that represents less than 15 percent of our profession.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
We Get Letters & E-Mail
Not All Evidence Is Equal; An Abundance of Misinformation; A Well-Researched Decision; Far Too Dangerous.
Are Your Work Orders in Order?
There are times when a patient's occupational duties will delay or prevent them from recovering. These circumstances create the need for the doctor to recommend modified duty or remove the patient from work.
Women's Health: Herbal Formulas to Help Patients With Dysmenorrhea
Chiropractors have long treated women for menstrual pain (dysmenorrhea). Since roughly 60 percent of all chiropractic patients are women and 30-50 percent of women have a history of menstrual cramps, the vast majority of doctors of chiropractic will inevitably see patients with dysmenorrhea.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Image Is Everything: The Power of Branding
Successful businesses use color and design to attract people to their service. They understand how important image is and hire experts to create an attractive package. Starbucks works hard to create an atmosphere that is warm and inviting.
A Dream Come True for Chiropractic: Funding Prevention and Public Health
Back in 2005, Sen. Tom Harkin (D-Iowa) said: "Let's face it, in America today we don't have a health care system, we have a sick care system.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Love a Nurse – and They'll Love You Back
According to various sources, there are about 3 million registered nurses in the U.S., and according to the American Nurses Association, they are under serious pressure in today's health care reality.
News in Brief
Major Organizations Announce Joint Conference; Fighting for Section 2706; New Vice President of Chiro. Program at Parker; Two Families, One Chiropractic Dynasty.
State by State: Comparing Chiropractic Scope of Practice
"The issue of 'scope of practice' has been a bugaboo ever since our early quests for legal recognition for chiropractic," according to Dr. Claire Johnson, editor in chief of JMPT and National's other two chiropractic journals.
Billing for Same-Visit Extraspinal and Spinal Manipulation
Q: I have always been under the premise that when billing 98943, extraspinal chiropractic manipulation, on the same visit as spinal manipulation, 98940-98942, that the extraspinal manipulation requires modifier 51.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
The Art of Day-to-Day Assessment and Treatment: Clinical Pearls
Let's focus on the day-to-day process of assessing and treating the patient. I am proposing a particular attitude; a way of looking at the patient. This often evolves over a few treatments and then changes as you figure out what is significant.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Overcoming Barriers to Exercise Compliance
One of the most common questions other practitioners ask me is, "How do I get patients to do their exercises?" I am not frustrated by my patient compliance, as many doctors are; in fact, I am actually happy with my patients' involvement and commitment.
May, 2014, Vol. 14, Issue 05
A Practical Application of the Tissue Density Grading Scale
By Linda LePelley, RN, NMT
The Tissue Density Grading Scale (TDGS) was developed to reliably represent the condition of musculoskeletal tissues at all stages of treatment or progression. By comparing pre-treatment assessments that include the TDGS with a post-treatment follow-up assessment, the effectiveness of any massage therapy treatment can be objectively depicted and documented.
While the following example makes reference to the use of Tissue Density Restoration (TDR) massage, it is important to understand that the TDGS is representative of the state of musculoskeletal tissues regardless of any type of treatment, or what treatment that may be. TDR massage is just the modality I happen to use, but any other type of massage may be evaluated in the same manner, whether it is Trigger Point Therapy, Myofascial Release, CST, Bowen, etc.
The basic TDGS follows. A more complete explanation of the scale may be found in the March 2014 issue of Massage Today.
Tissue Density Grading Scale
A Case Study
A 54-year-old male client presented complaining of moderate to severe pain in his left shoulder stating, "It hurts all around, it's stiff, I have trouble lifting my arm and turning my head to look back is difficult." He attributed it to a 20-year-old auto collision, combined with age and a recent drop in the temperature seemed to have made it worse. He was not able to raise his left arm to shoulder height. He stated that he didn't want to go to a doctor because he didn't want pain medication or muscle relaxers, which were all he'd been offered on previous visits to complain about the same symptoms.
Having the client right side-lying, I gently grasped the glenohumoral joint and attempted to mobilize it. I found the entire region was resistant to movement, resulting in rocking the client's entire upper left quadrant and head. The scapula's medial border seemed to be firmly engulfed within the tissues above and below it; they felt rubbery and solidified. The client's right side, by comparison, was found to be very mobile, with normal range of motion.
I explained to my client that, because I could feel and demonstrate to him the elevated density in the affected tissues, I believed I could help relieve his pain and improve his range of motion. I suggested several treatments, with the first ones given as closely together as possible.
The basic guidelines for Tissue Density Restoration (TDR) massage are:
I started the assessment/treatment with the client on a warm table, using a heat transferring device, similar to a hot stone. I began to feel areas that were notably firmer than their surroundings. As the tissues became a little more malleable, I asked my client to identify the areas that hurt the worst. He directed me to spots just above the superior border and superior angle of the left scapula; the top lateral edge of his humerus; and near the base of the deltoids. We also found a large, hardened area between the upper medial aspect of the scapula and the spine. Its location and density prevented the scapula from being able to adduct. I explained to my client that while it didn't belong there, it probably consisted of multiple layers of tissues that do belong – they have simply adhered to each other and conglomerated. The good news, however, is that no matter how uncomfortable and disruptive the structure may be, it can be restored to normal density and proper functioning.
The first hour of my client's initial two hour visit was spent determining the areas that were causing the greatest amount of pain and dysfunction. These target areas were determined to be:
The remainder of the session was spent using TDR massage techniques. By the end of the massage, the borders of the identified areas were more pronounced and easier to locate, due to softening of the surrounding tissues, as well as some improvement in the target areas. The results of the post-treatment assessment were:
This client received four treatments in the first week, followed by six more weekly treatments. The client states he is very happy with the results, he feels as if he is 75% to 80% improved. He claims he is able to turn his head easily when backing up in his car; and he has a full range of motion in his arm and shoulder. At this point the TDGS is:
I hope this example of how I use the TDGS portrays the value and usefulness of this tool. You may have noted that a color is associated with each grade. By color coordinating the numerical grade, one may provide a more comprehensive illustration of the size, location and condition of affected tissues on any anatomical diagram. The TDGS is easily adapted into whatever documentation form you prefer, whether it be written, drawn or both.
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.
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