resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Earning Respect Through Research
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.