resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.