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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
December, 2015, Vol. 15, Issue 12
Massage and the Stress Response
Making Sense of the Existing Literature
By Massage Therapy Foundation Contributor
Contributed by Beth Barberree, BA, RMT; April Neufeld, BS, LMT; and S. Pualani Gillespie LMT, MSN, RN, BCMTB
Massage has long been seen as a way for people to decrease their stress levels. With the growing number of people seeking massage therapy care in recent years, it becomes increasingly important to understand if it is effective in managing the negative health consequences of stress. In this month's article review, we explore work from a team of experienced researchers who provided a review of the existing literature in this area.
Albert Moraska, Robin Pollini, Karen Boulanger, Marissa Brooks, and Lesley Teitlebaum in their 2008 article, "Physiological Adjustments to Stress Following Massage Therapy: A Review of the Literature," provided a critical evaluation of peer-reviewed research that had investigated the relationship between massage therapy and physiological measures of stress. The authors emphasized that reviews like this one are important to understanding the effectiveness of massage therapy in the management of the health impacts of stress.
In this literature review, massage therapy was defined as "the manipulation of soft tissues for the purpose of producing physiological effects on the vascular, muscular or nervous systems of the body." Only studies where massage therapy was applied within the context of this definition were included, so any studies involving light touch modalities were excluded. The research group only included studies where the massage was provided by trained therapists, and those with adults as the participants. This process of deciding what studies will be included and excluded is called setting the inclusion criteria.
With these criteria in mind, the research team conducted a broad and extensive search of several electronic research databases, along with the researchers' own libraries, for articles that pertained to "stress" in combination with "massage," "bodywork," "physiotherapy," and "manual therapy." Articles were included when "presenting dependent variables of stress that included the hormones cortisol, epinephrine, norepinephrine, or physical measures of blood pressure (BP) and heart rate." Of the initial 1032 citations reviewed that met the search parameters, only "25 articles were found to meet all inclusion criteria."
The research team found that the 25 studies employed a diversity of experimental methods. There was large variability in session duration, "from 5 to 90 minutes, with over half (52%) of the studies having a session duration between 20 and 30 minutes." Commonly, 6 to 10 treatments were delivered, but data was most often collected following the first session. The researchers chose not to report on specific massage techniques used as the specific techniques used were reported in varying degrees of detail and those studies had varied results.
"Study populations were varied and included sexually abused women, patients with eating disorders, pain conditions, hypertension, HIV positive diagnosis, cancer, post-operative patients, critical care patients, healthy adult populations, and some specific disease states." Hormones that are markers for stress response were also noted by the researchers in this review.
Salivary cortisol is easy to collect from the mouth and non-invasive, so massage therapy studies frequently use this method for assessing cortisol levels. Of those studies that measured reductions in salivary cortisol it appears that the decrease, although significant, may be short term. There does not appear to be a cumulative reduction in salivary cortisol levels with multiple massage treatments. The subject populations in these studies were highly varied, "which suggests that many groups may experience an immediate benefit from massage therapy for this variable. . . However, most study participants were either healthy adults or experiencing chronic life stress."
Urinary cortisol has been used to assess changes following multiple massage treatments. The studies that assessed urinary cortisol did so at baseline and after 5 weeks of twice-weekly massage and found evidence of a cumulative reduction in urinary cortisol.
"Epinephrine (adrenaline) is produced mainly from the adrenal medulla and reflects the subject's sympathomedullar activity" [activity from this gland]. "Epinephrine output is mainly influenced by mental stress."
"Norepinephrine (noradrenaline) is considered an indicator of sympathoneuronal [sympathetic nervous system] activity as most of the circulating norepinephrine is released from sympathetic nerve endings. This hormonal defense reaction is aimed at routing energy from organs to muscles for the muscles" and "is more responsive to physical activity" than to mental stress. However, the authors state a decrease in either of these hormones "may indicate a physiological reduction in stress" routing circulation from organs to muscles.
Cardiovascular responses reported in 16 of the studies were blood pressure and heart rate. "Increases in blood pressure, respiration and heart rate are all physiological manifestations of the sympathetic nervous system's response to stressful events." There were mixed results in the studies reporting these responses, with the differences including what body parts were massaged, the massage techniques applied, overall health of the study participants, duration of the massage session, and single session versus multiple sessions. No studies reported an increase in blood pressure. Also the effect of massage on heart rate, although not sustainable, seemed to be repeatable as decreases following massage occurred one visit after the next.
It was noted by the research team that their review was based on the outlined inclusion criteria. The authors contrasted their review with a meta-analysis completed by Moyer et al. (2004). Results of the two reviews were not consistent. The two reports differed with respect to levels of salivary cortisol and blood pressure; the Moyer et al. (2004) report found no massage sessions that affected salivary cortisol and did find a change for blood pressure. The authors of the current review conclude that the difference in findings reveals more about the current state of massage therapy research than about the clinical effects of massage therapy on stress measures. Overall, "the studies reviewed showed a variety of methodological shortcomings."
Of significant interest to readers is the authors' conclusion that, "to date, the research on massage therapy and stress has not progressed to demonstrate efficacy in a trial of sufficient size or methodological rigor to make definitive statements about its efficacy in reducing stress as measured by physiological variables in any particular patient population." It is unfortunate that the evidence does not support making strong conclusions about the impact of massage therapy on physiological stress indicators. It is also unclear why there is no mention of heart rate and blood pressure in the key words listed as search criteria in the current review, even though these non-hormonal markers of stress were included in the review. This may lead to difficulty in having this review come up in other literature searches.
The authors identify opportunities for future studies to examine the effectiveness of massage therapy. Based on the diversity among the studies in the current review, the authors emphasized the need for research that employs methodological rigor including large sample sizes, detailed and reproducible treatment protocols, and reporting of clinical and statistical significance.
The Massage Therapy Foundation continues to support and promote research as seen in this month's review. The Foundation is currently accepting scientific submissions for our 2016 International Massage Therapy Research Conference (IMTRC) that will be held in Seattle, Washington, May 12-15. More information about the conference as well as the submission guidelines are now available on our website at www.massagetherapyfoundation.org.
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