resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Assessing and Treating Tennis Elbow
The most common elbow injury is a strain to the common extensor tendon which controls the wrist, but begins at the elbow. This injury is commonly known as "tennis elbow." Tennis elbow earned its name because many tennis players suffered from this injury.
This is an injury which is not exclusive to those who play racket sports. It is very common in people who use their hands and wrists a great deal in their occupations. The involved muscles are used frequently to grip and lift objects.
You use them when you open doors, paint a wall, screw and unscrew jar lids and turn a screwdriver. Most people with this injury experience pain with activities such as shaking hands, washing dishes, wringing a cloth or lifting a teapot.
Tennis Elbow Anatomy
Tennis elbow means that there is a slight tear or inflammation of one particular muscle tendon unit, frequently near where it connects to the bone at a place medically known as the teno-periosteal junction.
Among the muscles at the outside of the elbow joint, there are two very closely associated muscles: the extensor carpi radialis brevis (See Figure 1) and extensor carpi radialis longus (See Figure 2). Both of these muscles share the common tendon which attaches to the bone at the outside of the elbow (the humerus), the tendon fibers of the longus extend a little further up the attachment to the bone than do the brevis.
Of the various sites of injury the most common is in the common tendon close to its attachment to the bone. The pain is felt at the lateral aspect of the elbow with activities involving the wrist joint and may extend from the outside of the elbow into the forearm as far as the wrist.
To locate the exact area of attachment, lean sideways against a wall and bend your arm as though you were going to shake hands with someone. Push your elbow against the wall. The knobby bone you feel pressing into the wall is called the lateral epicondyle of the humerus and is the area where the common tendon attaches to the elbow. This is often the site of the injury.
A little probing with your finger will confirm that this is the spot or you may find it a little lower down the arm in the tendon itself. The muscle bellies of the brevis and longus and their tendons pass down the forearm. The brevis attaches at the back of the hand just beyond the wrist joint while the longus continues on into the fingers.
In addition to the teno-periosteal junction the injury may also occur in the main part of the tendon, called the body of the tendon, or at what's called the musculo-tendinous junction, which is where the tendon and the muscle join each other. The final place of injury with a tennis elbow may be in one or both of the muscle bellies of these two muscles.
How and Why?
This bothersome and frequently long-term injury is extremely common. It regularly afflicts people who lift heavy objects, scrub floors, wait tables, and, of course, play racquet-sports. When racquet enthusiasts get tennis elbow, it's usually because the muscle-tendon unit is fatigued due to repetitive stress or a sudden excessive strain applied to the muscle tendon unit.
It can also occur by falling onto the elbow or bumping the elbow against a wall or another surface with some force. This causes a sudden muscle contraction which tears a few of the fibers of any part of the muscle tendon unit. An inflammatory response occurs. Then adhesive scar tissue develops, often becoming chronic.
Tennis elbow may occur suddenly. The pain may be so severe that you may be forced to stop what you are doing. Tennis elbow may also come on slowly in a milder form initially and then become severe. In this case, the tendon has suffered many minor micro-tears over a period of time by particular repetitive activities, eventually resulting in a severe, painful tennis elbow if you continue to use it.
Where the common tendon attaches at the outside of the elbow it is in close proximity to several other muscles and tendons which control the wrist and fingers. The close proximity of these structures makes it likely that extraneous scar tissue formation which accompanies this injury will bind several structures together.
This binding together with scar tissue inhibits the individual function of the different structures making healing more difficult.
Ask the client to straighten the elbow and bend their wrist upwards as if they were a policeman saying, "Stop." Now, place the other hand at the back of their upturned hand and attempt to push the upturned hand forward while they resist. Use slight force, at first; as it is usually all that is needed to reproduce the pain. Pain at the outer side of the elbow during this test with associated weakness indicates a tennis elbow is present. The pain causes the weakness.
This method for treating any soft tissue injury must always be combined with the appropriate rehabilitative exercises. Friction therapy is designed to break up the unwanted and unnecessary scar tissue which accompanies most soft tissue injuries causing them to become chronic. The rehabilitative exercises are necessary to prevent the reformation of adhesive scar tissue and to rehabilitate the injured muscles and tendons.
This friction technique is best done in a sitting position. Bend the client's arm at a 90-degree angle and supinate the forearm. While holding the forearm with one hand, place the thumb tip or index finger of your other hand at the lateral edge of the lateral epicondyle of the injured elbow. To check that your hand placement is correct, move your thumb medially onto the tendon and ask the client to raise and lower the hand, as in the test. If you are in the right place, the tendon will tighten under your thumb or index finger. Press down on the tendon attachment at the elbow and apply friction in a medial direction only. Repeat this for 5 to 10 minutes with interruptions as needed for the client's comfort. After frictioning, massage the entire arm extensively, especially the extensor surface of the forearm.
These two exercises which are done throughout the day will limit the formation of extraneous scar tissue and help it to change from a matted network of fibrous tissue into a useful, pliable scar.