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Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
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.
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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