resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
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.
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.
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.
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.
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.
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.
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.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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