resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Spaghetti Elbow: Ulnar Collateral Ligament Reconstruction
Where did the term spaghetti elbow come from? Well, one of the most famous surgeons for pitchers is Dr. James Andrews, the renowned Birmingham, Ala., orthopedic surgeon and founder of the American Sports Medicine Institute. After he performed the surgery on my client / baseball pitcher, the first thing he said to him was, "Your ulnar collateral ligament looked like a piece of spaghetti." There was no integrity left; he was surprised the pitcher had lasted as long as he had before deciding to have surgery.
I was very privileged to be involved for 11 years with this baseball professional, who was a mid-reliever for 16 years. Over the course of those 11 years, I had to grow as a massage therapist to keep up with the task of understanding the multitude of injuries with which he could present.
I decided to write about "spaghetti elbow" for three reasons. The first comes from a recent presentation at a convention, where the question was asked, "What is a Tommy John surgery?" So I thought there just might be more massage therapists out there who could benefit from a deeper understanding of one of the most common elbow surgeries in baseball.
The second reason is being able to share with you how I treated this player after his surgery and helped him get back in the game. And the third reason is I recently had an 11-year-old baseball player in my office with medial elbow pain. So, I am also hopeful that collectively our profession will be able to help not only in the recovery from this surgery, but also in the prevention as well. Understanding the cause and the treatment is important education to the moms, dads, youth athletes and coaches you meet and treat.
What is Tommy John Surgery?
Ulnar collateral ligament reconstruction, commonly known as Tommy John surgery, is a surgical procedure to reconstruct the UCL using a tendon from somewhere else in the body. The tendon is used to re-create the damaged ligament and improve the stability of the elbow joint. A tendon is sometimes removed from the patient's wrist and grafted into the elbow – woven in a figure-eight pattern through tunnels drilled in the humerus and ulna bones.
In my client / pitcher's case, the doctor used a tendon from gracilis. Doctors typically complete the operation in about an hour. The surgery requires a full year of rehabilitation and typically another year pitching before returning to pre-injury form. I saw this firsthand with my client / baseball player. Essentially, the body must convert a tendon into a ligament, get it carrying blood again and train it to start working as a ligament. It is very weak immediately after the surgery, and the rebuilding process must be gradual. No amount of therapy can rush this process, so I say this as a precaution to anyone that might think differently.
Dr. Andrews also called Tommy John surgery "the anterior cruciate (surgery) of the elbow" in a USA Today article by Rob Rogacki on May 29, 2014 titled, "Dr. James Andrews Blames Tommy John Epidemic on Pitcher Overuse."
What Contributes to Tommy John Surgery?
I attended a baseball conference in which Dr. Andrews was a speaker, and he made the statement that the valgus stress on the elbow joint is like having a 50 pound bulldog sit on it with each pitch. According to MLB.com, pitchers with the game's best P/IP (pitches to innings pitched) ratio typically average fewer than 15 pitches per inning. A starting pitcher with those numbers would be able to go seven innings on fewer than 105 pitches.
But take that times the number of appearances over one season, not including practice, and add in how long they have actually played the game – ouch! A mid-reliever's average appearance in a game is one to three innings. My client / pitcher was one of the biggest surprises for the Yankees in 2006, leading the American League with 83 appearances and topping all big-league relievers with 102.5 innings out of the bullpen. Remember, this doesn't include warm-up bullpens, practice, or the fact that they probably started playing at age 5 or 6. No wonder the doctor saw his UCL was spaghetti!
The ASMI states that overuse and muscle fatigue are the biggest risk factors for injury. Often, UCL injuries in pitchers are due to the cumulative damage of thousands upon thousands of pitches thrown, especially if a young pitcher is trying to squeeze every ounce of velocity out of their arm.
As a pitcher's arm fatigues, their mechanics can falter, placing more stress on the ligament in the elbow and shoulder with every pitch. As a massage therapist, you will see and feel a tight pectoralis minor, tight subscapularis, tight posterior cuff, and certainly a tight latissimus, along with biceps and forearm tightness, to name a few.
Tommy John surgery has become an epidemic because of the additional risk factors for adolescent pitchers, which include pitching on multiple teams, pitching year-round, playing catcher when not pitching, poor pitching mechanics, and poor physical conditioning. Another factor is the lack of conditioning education of the adolescent coaching staff, which is usually a mom or dad in their after-school program.
Another thing that bothers Dr. James Andrews is the scary misconception among youth players that "pitchers should get Tommy John surgery as soon as possible so they will be better for college and they will be able to throw harder after surgery." The ASMI found a surprising 25 percent to 50 percent of amateur players, parents, and coaches believe this to be true Dr. James Andrews says it is not true. Indeed, MLB pitchers often show some improvement in performance upon return from Tommy John surgery. However, such improvements for a professional or amateur pitcher are due to the surgeon fixing the problem; followed by the pitcher working intensely with the physical therapist, athletic trainer, strength coach, and pitching coach. The time without pitching after surgery also helps the athlete's body. Performance eventually decreases over time for MLB pitchers after Tommy John surgery (similar to the typical decrease over time for healthy MLB pitchers).
It is also important to realize that 10 percent to 20 percent of pitchers never make it back to their previous level after Tommy John surgery. My client / pitcher did make it back and was able to perform two more years, and left the game as the top closer for an overseas team.
What Should Treatment Look Like After Surgery?
#1: Remember the length of time it takes for this tendon to act as a ligament. You need to have the thought process that you are a part of a team effort to get this athlete back in the game. My client / baseball player had to take my CV to the team physical therapist, and then we had to have a meeting before I was allowed to treat him. The physical therapist clearly stated that a massage therapist he had trusted before had ruined a player's arm that he had been treating, so he would never consider referring out again. My client / ballplayer assured the physical therapist that I would listen and follow whatever he wanted me to do and not do.
#2: I never started stretching or isometrics before the physical therapist had indicated it was OK to do so. Timing is everything after any surgery and rehabilitation is performed in stages for a reason, just like following a recipe. One misstep and you have a failure on your hands.
#3: After he finally came out of the brace and they allowed me to do treatment, my client / pitcher's elbow was left with a problem of a biceps contraction, leaving him at a 30 degree flexion angle. The therapy goal is to achieve zero degrees of elbow extension. My treatment started very gently, utilizing a major amount of contrast therapy and very light cupping. The next visit he had showed improvement of about 10 degrees. This time, I spent up to two hours of hot packs, massage cupping, and PNF stretching with no passive movement on my part; all active movement on his part. I keep alternating the treatment on his arm by addressing all of the other muscles that had gotten tight over time, such as his pectoralis, subscapularis, trapezius, levator, SCM, etc., while the heat was on his arm.
Keep in mind he was still going to physical therapy and to achieve full recovery and zero elbow extension, his therapy was daily. The good news is within two weeks he had full extension. Each visit was approximately 1 ½ hours of using several modalities to override that biceps contraction, which is very common after a Tommy John surgery.
The takeaway from this story is recognizing the length of recovery that is necessary for an UCL to heal and educating your community on the prevention of UCL surgery. Encourage moms and dads to understand the need for time off, playing multiple sports, and the fact that and nothing good comes from playing through pain. A longer playing career and less possibility of burnout are other benefits. My client / pitcher made it to the majors by playing three sports in high school, taking the last year of high school off from baseball. He always took 4-6 weeks off after the season before training and throwing again to get ready for spring training.
He had great kinematic sequencing in his pitches, which was created by his dedication to functional training, chiropractic, acupuncture and massage therapy. I would like to invite you to read my July 2011 article ["Team With Pro Athletes: A Win for Everyone"], to read more on how he felt massage therapy had helped his recovery.
"The most certain way to realize our own dreams is to help others realize theirs." — Mary Anne Radmacher