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Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Generating Knowledge by Exploring Practice
Contributed by Beth Barberree BA, RMT; April Neufeld, BS, LMT; Jolie Haun, PhD EdS LMT
Many complex medical conditions such as traumatic brain injuries, have little or weak empirical evidence to describe what constitutes an appropriate approach to care. This month, the Massage Therapy Foundation explores a clinical case report titled, "Concussion Treatment using Massage Techniques: A Case Study." The case study was conducted by Sylvia Burns, MEd, LMP and was published in the International Journal of Therapeutic Massage and Bodywork in 2015.
There is growing concern about concussion-related symptoms, so much so that a plea for new interventions on how to treat post concussion symptoms was issued by the American Academy of Neurology. This article described the author's experience of successfully treating a patient's ongoing post concussion symptoms, particular to imbalance in the upper cervical spine, using advanced massage techniques.
Methods & Case Presentation
The patient was a male graduate student in his early 20's who sustained a head injury when he fell and hit his head on the back of a bench. Witnesses reported that he lost consciousness for 20 to 30 seconds. The impact on his right occipital area was treated with cold compresses at the time, and upon medical examination found there was no fracture or bleeding.
The patient reported headaches upon waking on the first day post injury. He reported to his primary care provider that his headache pain was in the 8 to 9 level range on a 10-point scale in which 10 is most severe. Bilateral soreness and stiffness suggested he had suffered cervical strain. He also stated that he was suffering motion sickness with car or boat travel, and nausea and difficulty concentrating accompanied his headaches. These symptoms interfered with his normal functioning and daily tasks. The primary care provider prescribed several medications for symptom resolution, as well as rest.
Three weeks later he was experiencing ongoing symptoms including headache, nausea with movement (such as leaning over to tie shoes), and difficulty concentrating on computer tasks. He had "fuzzy" thinking and poor concentration, and reported being unable to operate perform other usual daily tasks. The patient received no neuro-cognitive testing. At this point, the physician referred the patient for massage therapy treatment. There were no other modalities applied to the patient other than the prescribed massage therapy.
The massage therapist reviewed the patient's medical chart, general health, history of the event, treatment since the trauma event. Self-reported pain levels were noted using the Visual Analogue Scale (VAS). Physical assessment involved postural observation to assess for any imbalances in the pelvic and shoulder girdles, and cervical region. Then standing balance was evaluated using the Balance Error Scoring System (BESS), which has moderate to good reliability to assess static balance. This test involves having the patient stand on two feet and then one foot with eyes closed using both a hard and soft standing surface. These actions include feedback functioning from visual, somatosensory and vestibular systems. Scoring is based on the number of times the person commits errors (such as opening of eyes, removing hands from hips, lifting heels or forefoot from surface, moving hips more than 30° of flexion or abduction, stepping, stumbling, or falling, or staying out of the testing position more than 5 seconds). A lower score indicates fewer errors were committed.
With the patient on the table, palpation of the pelvic, cervical, and shoulder region was performed to assess muscle hypertonicity and strength of muscles in these areas.
The massage therapy care was provided by the author, who has 20 years of clinical experience and is familiar with concussion and trauma work. The goal of the treatments was to facilitate musculoskeletal balance, based on the concept that imbalance in the body or body part results in contraction of antagonist muscles in an effort to pull the body back to an anatomically preferred position. If the imbalance is removed, the muscles should revert to normal tonicity.
One month following the injury, the patient received two massage therapy sessions that occurred two days apart, each 45 minutes in length. The patient was observed and evaluated for postural balance, specific cervical symmetry, pain level, and symptoms at each session prior to applying treatment. One week after the second treatment, the patient returned for a follow-up appointment to only collect information, but no massage was applied. The patient was then discharged from care.
The therapeutic massage interventions began with patient laying clothed, in a prone position on a massage table. Treatments began with the pelvic girdle and moved up the body to address the shoulder girdle and cervical areas. The practitioner focused on release of myofascial tissues, reduction of hypertonicities in muscle groups with origins in the cervical area and insertions in the shoulder girdle (e.g. levator scapula, sternocleidomastoid, and scalenes).
Much of the treatment focus was on the cervical and cranial region while the patient laid supine. Specifically, the sub-occipital muscles and ligamental attachments were treated, and gentle caudal traction to the spine was applied. Details of the how the therapist approached the atlanto-occipital imbalance guided by experienced palpation, and atlanto-axial joint dysfunction are provided in the full article.
Before treatment, the patient reported consistent headaches at 8 out of 10 on VAS and was taking medication daily for pain and nausea. Following treatment, his headache pain was zero and he was no longer taking any medication. His ability to concentrate had increased from about 15 minutes to at least 2 hours, and he was able to increase his activity level each day. His BESS scores dropped by almost half, and his muscle tonicity and strength, along with cervical range of motion were normalized.
This case report demonstrates how massage therapy could be an effective intervention for treatment of post concussion symptoms. In particular, cases that involve atlanto-occipital joint dysfunction and associated muscular imbalance may be especially improved. The author clearly articulated that the specific massage approach used in this case was very specific, and requires advanced training in physical manipulation techniques and sensitive palpation skills. With such encouraging results, a larger scale study could be undertaken, perhaps specific to cases with obvious atlanto-occipital involvement.
This publication supports the field of massage therapy in both research and practice. Case reports provide an in-depth review of a single case to provide the breadth and depth of information to fully explore complex cases where the literature may lack in definitive evidence. Case reports are often used to generate knowledge of new and best practices, such as the use of massage therapy for post-concussive symptoms. Case reports are a valuable way for massage therapists to share their professional practice to support advancement in the field of massage.
Did you know the Massage Therapy Foundation is a big supporter of both practitioner and student case reports? The deadline to submit to the Practitioner Case Report Contest is October 3, 2016. Find out more information and who has won past case report competitions by visiting www.massagetherapyfoundation.org/student-practitioner-case-report-contests/.