resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
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.
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.
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.
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?'
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.
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.
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).
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.
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.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
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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
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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.
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.
Let's Talk About Biceps Injuries at the Elbow
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Lessons from Functional Neurology
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Adventures with the Pericardium
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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.
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.
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.
March, 2016, Vol. 16, Issue 03
Make a Difference in Clients who Suffer from Traumatic Brain Injury
By Don McCann, MA, LMT, LMHC, CSETT
There are manual cranial therapies for massage therapists that can make a significant difference for clients who have had brain injuries. Unfortunately, many massage therapists are unaware of the positive effect they can have with their brain injured clients.
Recent medical research has actually verified systems in the brain that were previously unrecognized. There are three that are of significant importance for manual therapy. The first is that they now recognize that the cranial motion exists with a subtle movement of the cranial bones. For years, medical schools have been teaching that the cranial bones do not move. The second was a breakthrough study at the University of Rochester Medical Center that discovered the glymphatic system. This discovery was only possible because of advances in technology that allowed them to study living brains.
The glymphatic system is a pressurized system that shadows the blood vessels of the brain and is now recognized as the principle waste removal process for the most sensitive of organs, the human brain. The third was a "stunning" discovery at the University of Virginia that overturns decades of textbook teaching that shows the brain is directly connected to the immune system by lymph vessels previously thought not to exist. While it has always been recognized that there were some lymph vessels in the brain, they were thought to be minimal and not of great significance. The new findings show that the brain has a complex and sophisticated immune system based on this newly discovered and extensive lymph system. Again, this only makes sense as the most sensitive organ of the body would need this.
In the past, when some of the treatable brain injuries occurred, massage therapists were seldom included in the treatment process. If we look at the systems mentioned above, we can see this was a major oversight by the medical community because, once the danger of further hemorrhage or damage to the brain was no longer an issue, massage therapists trained in specialized cranial techniques could have provided one of the primary forms of treatment. This is a bold statement which I now am going to back up.
First, we will look at what happens to the above mentioned systems when a traumatic brain injury takes place. When the cranial motion is examined after traumatic brain injury, it is dramatically diminished. The injury itself can jam sutures even to the point of causing them to become calcified. In addition, there is soft tissue damage. This can be from the surface layers of fascia just under the skin through the reciprocal tension membrane where it passes through the sutures, and inside the lining of the cranium into the tentorium that supports and holds the brain. This can dramatically disrupt the cranial motion and block neurological function as this tissue thickens into scar tissue.
In the acute stages of brain injury, a restriction of the cranial motion can cause a backup of fluids in almost any part of the brain. This backup of fluid causes pressure and swelling on the brain and inhibits brain function. Restoring cranial motion allows the systems of the brain to work normally and release the swelling. In addition, restoring the cranial motion can often result in a balancing of the temporal lobes which often dramatically reduces vertigo, and the inability to concentrate.
Case study #1
Robin, a 30-year-old real estate agent, had a brain injury from an auto accident. For three months she was unable to drive, had significant headaches, could not concentrate, could not stand bright lights, and was on medication for vertigo. She came for treatment because she also had a cervical flexion/extension soft tissue injury. Using kinesiology to evaluate her cranium, it was revealed that she had minimal cranial motion and almost no cranial motion of the left temporal bone. In addition, the relationship of the occiput/atlas/axis was jammed with no motion. The cranial/structural core distortion release, a complete unwinding of the restrictions of the cranial motion, was applied which restored full motion to the cranium. Additional synchronizing of the temporal bones and a mobilization of C1 were applied. By the time Robin got off the table, she felt her concentration was nearly 100%, her headache that had been present since the injury was gone, the lights in the room were no longer affecting her, and her vertigo had disappeared. Additional sessions further normalized and expanded her cranial motion and also treated the soft tissue injuries in her neck. Within three sessions, Robin felt that her brain injury was healed and that she could return to her real estate practice. This was a very good example of how the restrictions of the cranial motion which also jammed C1, had prevented her brain injury from healing. The timely application of cranial/structural techniques produced rapid and long lasting improvement.
Cranial motion is involved in both the glymphatic and lymphatic systems of the brain. However, each deserves special attention beyond just the restoring of the cranial motion. The glymphatic system is the principle waste removal system for cleansing the brain, and a brain injury damages the glymphatic vessels often collapsing or even breaking them. This is especially obvious when there have been broken blood vessels and hemorrhaging as the glymphatic system shadows the circulatory system. The first symptom of damage to the glymphatic system is swelling. Cerebral spinal fluid and blood will back up or leak out in an area that is damaged. The second is additional inflammation because waste products of the brain accumulate and cause constant irritation which also results in swelling. The third, and this takes place over time when the glymphatic system has not been restored back to full function, is brain degeneration due to lack of waste removal and a buildup of protein and amyloid beta. This may not be evident for a number of years after the injury, and is a major contributing factor to the early onset of dementia or Alzheimer's for those who have had multiple concussions.
In an acute brain injury, once danger of hemorrhage and additional damage has passed, treatment of the glymphatic system can dramatically speed up recovery. The glymphatic system pumps along with the cranial motion, but to engage it fully it is necessary to compress it. A specialized cranial/structural technique, the frontal/occipital decompression, will compress this system and then work it in a pumping motion. This will push fluid through collapsed glymphatic vessels and pump accumulations of fluid out of the brain. In addition, this pressurized pumping of the glymphatic system will dramatically increase the removal of waste products and inflamation. This will help to restore the glymphatic system back to full function. Many clients report immediate relief from concussion symptoms.
Case Study #2
Cindy, a college basketball player, had three major concussions in three years and, six months after the third one, hadn't shown any improvement in her ability to concentrate and attend school. She was also lethargic and had constant headaches. The physicians had said it was just going to take time and there could be some permanent damage.
At Cindy's first session, the cranial/structural core distortion release was applied to release the restrictions in her cranial motion. After the cranial motion had been restored the frontal/occipital decompression was applied to pump out the excess fluid and waste products and reduce inflammation in her brain. By the time the session was over, Cindy was not as lethargic and was starting to show more interest in her environment. This technique was applied four more times on a weekly basis with steady progress in her ability to concentrate, memory retention, and energy levels. Her headaches had also disappeared. By her fourth session, Cindy was back in school and able to handle her full load. This was after six months of not being able to read or concentrate enough to go to class. A CAT scan also showed a clearing in the areas that had previously been inflamed and swollen.
The lymphatic system also responds well to compression and decompression and is also treated with the frontal/occipital decompression. Consequently, there are two systems at work when treating inflammation and swelling with the frontal/occipital decompression. Both dramatically help in the recovery from treatable brain injuries.
Another effect of brain injuries, is leaving the client's brain susceptible to further neurological diseases and degeneration because of the damage to the lymphatic system which is the major component of the brain's immune system. Restoring the lymphatic system and lymph drainage can prevent the development of other neurological diseases such as MS, ALS and Alzheimer's.
As you can see, massage therapists can make a significant and long lasting therapeutic difference when treating clients who have had treatable traumatic brain injuries. Hopefully, this has expanded your awareness of the exciting possibilities that are available for successfully treating clients who have sustained treatable brain injuries. These techniques are not available through the medical community.
Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.
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