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Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
July, 2014, Vol. 14, Issue 07
TDR Massage Protocol for Pain Relief
By Linda LePelley, RN, NMT
Tissue Density Restoration (TDR) massage was developed in response to my clinical observations over a number of years that musculoskeletal tissues experiencing pain are associated with an elevation in tissue density (TD) and once the elevated TD is reduced, the pain is alleviated.Wanting to focus on these phenomenons and better understand their nature, I decided to stop doing relaxation massage and limited my practice to clients in pain.
My original focus was directed at determining the components of treatment that are most effective and discarding actions that, at best, do not appear to contribute to improvement or, at worst, are counterproductive. I asked my clients to participate; rather than just laying back and quietly enjoying the massage, they keep me informed about what they are experiencing throughout the treatment. Patterns of duplicable efficacy emerged, resulting in an extremely beneficial protocol.
Once I determined I had a replicable method of alleviating pain by treating the elevated TD, the questions that remained were:
The answers I've found are much like the treatment itself; simplistic, easily dismissed by some because they seem too elemental and easy. However, they are consistently reliable. In my experience of actively looking for elevated TD, I've found it happens to everyone in pain. All musculoskeletal pain can be located and felt (in the tactile sense) by a second person, as palpable areas of indurations at the locus of pain. From the toes to the top of the head, elevated TD can be found at any physical location that hurts. The older a person is, the thicker and more compressed the density can be. I suspect the reason has more to do with a buildup over time, rather than degenerative changes of aging. Rather than deterioration, it seems more accurate to describe it as a disorder of accumulation. (Perhaps previous injuries lay a foundation upon which TD builds? Maybe a residue is deposited during the inflammation process which, if not cleared out through normal circulation, attracts mineral deposits over time.) Through close observation and repetition I've found that the more malleable the affected tissue becomes, the longer the relief will last. People can be fully relieved of chronic pain and that relief retained with maintenance massages.
How it Works
I have ideas of how and why TDR massage works, but they are just that, ideas. I am not a pathologist, biochemist or neurologist, nor do I have the time or inclination to acquire the additional education it would require to be able to investigate the physiology involved in the formation of elevated TD. But I don't need to. I trust what I can see, experience and duplicate. I don't have to fully understand the mechanism of the combustion engine to drive a car, but that doesn't impair or hinder my ability to do so. I can leave scientific research to those who have dedicated their education and interest and are qualified to do such work. I suspect that in much the same way that I am impelled to discover how to affect changes in tissue density, a motivated researcher will investigate that explanation one day. I am a nurse massage therapist – my duty, talent and intention is to provide my clients the best possible pain treatment outcomes.
In order to share the method of TDR massage, I use the term, "Protocols". While I do not anticipate changes to these protocols, I think that it's a mistake to declare rules and dogmatically follow them. Doing so fosters resistance to any future perspective or observation that may suggest they need to be adjusted. It also stifles exploration, hinders growth and suppresses conversation and communication. With that said, I've found that by following these directions, the results are reliable and effective.
TDR Massage Protocol
The massage movements I use are abbreviated Swedish – friction effleurage in small, circular areas; using slight petrissage movements, which helps monitor the boundaries and density of the target area as they change throughout the treatment; and vibration, which can be used as the tissues become malleable and are able to be grasped and gently shaken. The smaller the focus area, the sooner it is likely to be resolved.
You will want to measure and document the state of the target area before providing treatment and then again afterwards, using the Tissue Density Grading Scale (TDGS). (See "The Tissue Density Grading Scale: A Communication Tool," Massage Today, March, 2014.) By doing so, you will have an accurate picture of the condition the tissues were in before treatment and proof of the effectiveness of your treatment afterwards.
First, focus on the location of the pain and target the worst spots first. (As tissues soften and the pain begins to resolve, the target area may shift.) Causing pain promotes the localized excretion of inflammatory chemicals which I suspect may play a part in the development of elevated TD. Regardless, there is no reason to exacerbate an already painful condition. The amount of pressure to use at any time will depend on the clients ability to tolerate it without going over a 3 on the 0/10 pain scale. Using the Walton Pressure Scale along with the TDGS will help you determine treatment progress and provide more precise documentation.
Keep the tissues you are working on moving continually. This will usually require working on areas no larger than the span of your two hands at a time. Doing so not only contributes to tissue heating through friction, but I believe that in addition, the movement combined with appropriate pressure, creates a fatigue state that helps soften TD.
I have found that it takes about 45 minutes of consistent, firm, circular massage to begin to affect change at which time you can feel a smoothing of ridges and softening change in the density of the target area. At this time, the client will also state that it feels better. Continue treatment(s) until the indurations are no longer palpable, and tissues are with a Grade 1 on the TDGS.
If the condition requires more than one treatment to resolve, it is best to schedule following treatments as closely as possible. The tissues seem to remain more malleable for a few days following treatment, thereby not requiring as long to respond and soften.
This protocol applies to pain of any size, at any location. When a new client comes seeking relief, I tell them that if I can feel elevated TD at their pain site, I will be able to help them. As one develops their sensitivity to the palpable varieties of tissue densities and becomes adept at restoring it, they will find themselves able to truthfully state, "I feel your pain," and then relieve it.
Click here for previous articles by Linda LePelley, RN, NMT.
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