resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
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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