resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.