resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
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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