resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
December, 2015, Vol. 15, Issue 12
Pain Chasers vs. Pain Solvers
By Debbie Roberts, LMT
In 1995, I took a course taught by a physical therapist on post rehabilitation. It was a four-day course on how important a personal trainer could be after the client was finished with physical therapy.It went over the proper and safe exercises for hip replacements, knee replacements, shoulder surgeries, and more. The entire time I was in the class thinking that thank goodness I am both a massage therapist and personal trainer. The other thing going through my mind was I have to find a way to bridge the gap between massage therapy and exercise.
Functional movement at that time was not being taught in massage school. There was and still is a great need to incorporate the understanding of how the human body moves. It was and still is my goal to elevate the field of massage therapy beyond the Swedish massage taught in schools. I had applied to the state of Florida to teach massage therapist exercise and at the time was turned down. Exercise was not under the scope of our practice, but understanding movement was. So it was born, the course and thought process to teach the world of massage therapists Functional Integrated Massage and Movement Therapy. But this concept is far from new. In 1940, Dr. Ida Rolf developed her system of Structural Integration. Her approach was using manual therapy and sensorimotor education to improve human biomechanical functioning as a whole rather than to treat particular symptoms. The important thing is not to chase the symptoms or the pain, always go after the cause.
Are you a pain chaser? In order to truly know you have to ask yourself a few honest questions. How well do I know how to evaluate a set of symptoms? Am I always looking for new evaluation tools? Am I willing to admit I don't know and seek out education to help me excel in this topic? In this article we are going to apply the concept of Functional Integrated Massage and Movement Therapy to a very stubborn case of Posterior Tibial Tendon dysfunction (PPT). I want to help you become an even better therapist by not falling into the trap of chasing the pain. As massage therapists, we are very sympathetic to someone complaining they are in pain. Our antenna go up and we are on high alert that someone needs our help. With the absolute best intensions, we invite them to lie down on our table and we will repair the problem or at least help dull their current pain level. Let's examine together the importance of understanding how valuable evaluation in gravity before the table time is. Looking before treating is critical to obtain the results both you and the client are expecting to achieve. Having a reliable means of evaluation is vital to therapeutic massage.
With her permission, I am going to tell you about Crazy Mary who originally presented with the diagnosis of Posterior Tibialis dysfunction. She is an above avid group exercise leader with an appetite for moving. She is the best in shape 52-year-old I know. Everyone loves her classes and her enthusiasm is infectious. She has suffered with various structural issues throughout her life stemming from a L1 fracture at age 16. I know you know the client that just won't listen until their pain and wallet start to match. They are spending, spending, and spending. While spinning, spinning, spinning in the same cycle. Well that was Mary. However, not everything was her fault. In physical therapy, they focused on band exercises for her Posterior Tibialis Dysfunction, the massage therapist that had treated her focused on her Posterior Tibialis pain, and her chiropractor focused on adjusting her sacrum that never seemed to stabilize. But no one was addressing her functioning as a whole. I convinced her to let me do a full evaluation before lying down on the table and that is where everything began to change. Matthew 7:7 says, "Ask and it will be given to you; seek and ye shall find; knock and it shall be opened unto you."
Here are the results of my full evaluation:
So what do you think, treat from the top down or the bottom up? Treat the front fascial line or the back facial line? What throws up the red flag for you? The good news in one respect there is no right and there is no wrong way to approach this client as long as all of it gets addressed to eliminate more than the symptoms and return her to a fully functioning human being without pain. The following is how I approached the issue over several visits. As you can see from the evaluation, there were multiple things going on and each with its unique situation and effect on the central nervous system. Your recipe is to develop an effective treatment plan based on your evaluation. So your treatment plan not to chase pain is only as effective as your evaluation.
Function and Treatment
I started at the bottom along the back facial line where the transverse tarsal joint had become very rigid. This joint is composed of the talo-navicular and calcaneal cuboid joint. The transverse tarsal joint relies on normal function of the subtalar joint, in order to move normally. Because the transverse tarsal joint is made of two joints, the transverse tarsal joint can be either loose and floppy (early flatfoot stage) or rigid (late flatfoot and heel rise) at certain points in the walking cycle. As the name suggest, the heel rise phase begins when the heel begins to leave the ground. During this phase, the foot functions as a rigid lever to move the body forward. During this phase of walking, the forces that go through the foot are 2-3x a person's body weight. This is because the foot creates a lever arm (centered on the ankle) which serves to magnify body weight forces. Given these high forces and considering that Mary took much more than the most active person of 10,000 steps per day, it is not surprising that the chronic repetitive stress produced Posterior Tibial tendon dysfunction. I treated each part of the joint separately using isometrics combined with mobilization.
Another contributing factor was Mary loved to use an outdoor elliptical as her mode of transportation, so she was always on the ball of her foot shortening the gastroc-complex and pulling on the calcaneus. The elliptical put her in a forward bent position using her T-12-L1 as a fulcrum point tugging and pulling on the entire back fascial line. This set of problems I treated with client education of how important watching her posture during this activity was and how the body did not load and unload naturally with an elliptical. I suggested limiting the use as a constant mode of transportation.
My overall suggestion to you, the therapist, is to follow the Superficial Back Line in its entirety which I had to do for Mary. The next part that became important to treat was the scar tissue and calcium that had developed around her L1 fracture. This needed to be released to help allow her body to come back into extension and not remain in that C-curve. Treating the QL and releasing the hypertonicity would be part of the solution for her SI joint on the right side to start to close properly. She happily reported that she had been able to taper the amount of chiropractic adjustments.
By releasing the QL's line of pull this allows the hip to come into better joint alignment. The right hip dysfunction and weakness have an opportunity to start to regain strength and communicate with the CNS. By removing the hypertonicity (she was so point tender I had to use a cup) in the gluts her body began to trust the right side again. The foot gets help from hip rotators to pull her out of the pronation during gait thus helping the Posterior Tibialis dysfunction.
The psoas imbalance had to be addressed, a better breathe pattern had to be taught, her overdeveloped quads needed tissue release, finishing this treatment all the way up to her SCM and the cranium. Not every detail of the treatment could be listed here. I suggest looking at the front fascial line.
For an injured muscle to regain strength with ease and balance, the scar tissue needs to become aligned and integrated with the muscle fibers. Even a small muscular injury or in Mary's case a L1 fracture, can lead to developing a chronic pain pattern which persists for months or even years. After 36 years of misalignment, trying to fix just one of the pieces will not work. That would be called chasing the pain. Mary's fascial system and joint centration as a whole needed to be address in all of the planes of motion. Lasting change not temporary change comes with understanding how to perform rehabilitation incorporating the Central Nervous System and the body as a whole. In the words of Ida P. Rolf, "Strength that has effort in it is not what you need; you need the strength that is the result of ease."
Click here for more information about Debbie Roberts, LMT.
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