resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
February, 2016, Vol. 16, Issue 02
Earning Respect Through Research
By Debbie Roberts, LMT
I was very fortunate and grateful for a recent case that earned the respect and referral of an orthopedic surgeon. This was done by doing the appropriate assessments, documentation, research and a written report.He truly was thankful for my comprehensive written report and the picture I had included, which was a faulty alignment posterior view from the book Muscles Testing and Function, Third Edition by Florence Peterson Kendall, PT and Elizabeth Kendal McCreary. This picture showed how the quadratus on the left had shortened, creating a misalignment of the pelvis and the weakness of the same hip. He told the client, "You are in good hands." In fact, that same day, he had another case in his office which had a similar history and they actually passed each other in the waiting room. He immediately picked up the phone and called my office with the referral. Needless to say, I was very excited he had enough confidence in my research and documentation to give me the referral. I am sharing this particular case with you because learning how to follow through makes a widespread impact to our industry of massage therapy. Your participation doing this sort of follow through can gain two great things: an increase to your referral base and it helps to professionally expand our place in the health care industry.
The reason this report was significant is the combined fact that this orthopedic surgeon did not believe the pain pattern matched the MRI report of a torn labrum and he didn't feel that surgery at this time was necessary. He felt there was another reason for the pain pattern she was experiencing. So he referred her to a physical therapist to try strengthening exercises which shortly ended with her having increased lumbar pain. The physical therapist concluded she was a surgical candidate and referred her to another orthopedic surgeon who concurred she needed to have immediate surgery to repair the labrum. This left her confused, what was the right approach for her? She wanted another opinion so she came to see me for an evaluation and assessment of her structure.
Always ask yourself the most important question: "why is this happening to the client." The question "why" should lead you down the path of using assessments, needing to research all the possibilities and then taking the time to write a complete, detailed report in case the client needs it to take to another health care professional.
It is very important to our industry as a whole to gain a positive reception from other health care providers. We are a critical part of a clients overall well-being and health. Just because you may not file insurance, doesn't mean you shouldn't take the time to assess and do documentation. I haven't filed an insurance claim in more than 10 years, but I still conduct my business like at any given moment this client may need records as to the type of therapy I am providing for them. What if their physical therapist wants to know? What if their chiropractor wants to know? As a massage therapist, you are a health care provider. Built into that title is the responsibility to the client just like any other provider within their care to keep notes and records. You never know the far-reaching effects one report might gain.
The following is the actual case and the report that was presented to the physician. The name is left out for privacy issues. The report was done on letterhead. Save this as a reference to use as a guide for your documentations. After the report, I will talk a little further on leg-length inequalities and hip dysplasia.
This client presented to my office with the diagnosis of a torn left labrum, left hip dysplasia, left hip pain that on occasion, radiates down the left leg. She was seen by a physical therapist that evaluated her and didn't think physical therapy would help and concluded it was a surgical issue. She has been seeing a chiropractor for more than a year that performed the Graston Technique to her left hip muscles because of a previous diagnosis of hip bursitis and combined giving her adjustments to help with her rotated sacrum.
Enclosed is a picture of the myofascial dysfunction that the client presents with. She is showing a lower limb-length inequality both on the massage table and in gravity. In a supine position on the massage table, her left leg appears to be longer by assessing both the medial malleolus and the heels. On a bilateral assessment of the ASIS's, the left was lower and more anteriorly rotated than the right side. In gravity, a lift under the right foot makes her feel more balanced. She states she has always had a funny walk and wouldn't wear a bathing suit because of the ribs sticking out further on the left side. On the table, the anterior rotation of the left ribs was quite noticeable. In a prone position, her sacrum is deeper anteriorly on the right side. Her left glut lacks the same tone as the right and there was weakness on a MM test of the left glut in a prone position. She stated that in a prone position her ASIS do not touch the table equally.
When I performed manual therapy, she had a great deal of hypertonicity in the left QL. When I relieved the tension in both the left QL and the right piriformis, the medial malleolus appeared equal on the supine retest. In gravity, she stated she felt more balanced. However, the treatment did not hold as confirmed by her chiropractor the next day. He stated she had 8mm's difference and after his treatment the difference remained at 4mm's.
According to Janet G. Travell, MD and David G. Simons, MD from Volume 2 Chapter 4, page 61, there is a need to take a standing radiograph to evaluate lower body asymmetries. Manual therapy is very successful in treating muscular asymmetries, but not if there is an underlying structural issue. If the x-ray is conclusive, the patient may benefit from having a professional orthotic made. I think the quadratus muscle is trying to help stabilize her pelvic position similar to what happens in the trendelenburg sign. We have scheduled her to have manual therapy three times this week to see if her body will hold the muscular length.
Thank you for your time and if you have any questions please do not hesitate to call me at my office 772-288-0073. Deborah A. Roberts, LMT, NASM CPT, TPI Medical Level 3
Writing the Report
Now, ask me how many times I re-wrote the report. At least five times because after reading it, I wasn't being specific or to the point enough. Make your documentation short and to the point, one page is plenty. End with a title of conclusion just in case that is all the health care provider has time to read. Be sure to read it out load to yourself like you are talking to the doctor. That helps hearing if the report is making your point clear. Now, ask me how much time I spent researching before I decided to write the report. At the least six to eight hours. Yes, I knew quadratus was involved and was hypertonic to the point that when she stood her left hip was noticeably higher and on palpation there was absolutely no doubt what my hands told me. But I needed to be clinically specific which meant re-reading from the Myofascial Pain and Dysfunction Manual the entire chapter again to see what I felt related to this case. That research then lead me back to Volume 1, Upper Half of the Body, Second Edition, starting on page 179 to discuss lower limb-length inequality (LLLI). Quoted from this chapter is how correcting LLLI is often essential for lasting inactivation of TrPs in muscles that are overloaded by the length discrepancy.
Her condition was complicated with the diagnosis of hip dysplasia. Hip dysplasia is a medical term for a hip socket that doesn't fully cover the ball portion of the femur. This allows the hip joint to become partially or completely dislocated. Most people with hips dysplasia are born with the condition. This client will present with hip pain and spasms due to the fact the muscles are trying very hard to stabilize the joint. This type of client will not benefit by passive stretching and you could add to the instability. This fact is why she was told to stop doing Yoga.
He ordered the radiography and it did, in fact, show the lower limb-length inequality. For now, his approach is to treat the LLLI with a lift, continue manual therapy and see if that will manage her hip discomfort. However, there may be a need further down the road to repair the labrum, smooth out the ball of the femur, and hollow out the socket for better articulation. The real bottom line is if they had done the labral repair only, this client could have been like many who have had surgery and the pain remained the same because the underlying structural condition wasn't addressed as well.
Every client you see that is in pain always ask the simple question, "why." It may lead you down many roads.
Click here for more information about Debbie Roberts, LMT.
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