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My View From Here

By Ralph Stephens, BS, LMT, NCTMB

About the Columnist
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How Often Should You Treat?

Every now and then I get the urge to come down off my political soapbox and share some clinical and health related information with you. This is one of those times. I hope you enjoy another side of my "view." Fear not, the editorials will continue.

How Often to Treat?

One question I am often asked by clinical massage therapists is, "How often to treat?" In traditional medicine that was practiced for many centuries, therapies like acupuncture and massage were done in 15 to 20 minute segments, five days a week for about one to four weeks depending on the severity of the case. That gave the body a gentle nudge repeatedly to help it achieve health. That was proven from experience to be the best way.

More recently, Russian massage protocols, based on research considered invalid here because our research community didn't make any money from it and because it goes against the "Central Dogma," often utilize 15 to 20 minute sessions, several times a week. Years ago in physical therapy, it was not uncommon for a patient to have prescriptions to be seen two or three times a week for 12 appointments and then have a repeat 12 appointments before evaluating whether or not to continue. Such protocols have become totally impractical in our current modern world. Time and resource limitations of the patient, insurance limitations, and other factors have people receiving less care than they ideally need for physical conditions. Our profession has settled in on the 60-minute time slot as the standard, although shorter and longer sessions are often available.

"Sometimes the hardest part of our job is to motivate people to stay with the program long enough to get the healing they desire." Lawrence Woods – Developer of Neural Reset Therapy® (NRT)

So, how often to see a patient these days? Bottom line – I want to see the patient just as symptoms return or begin to worsen again after the previous appointment. I book a new patient 2 appointments one week apart. After the first appointment they are instructed to keep track of how they feel every 12 hours until the next appointment. They feel better when leaving my office. (If they do not, there is no charge and the next appointment is cancelled – feel better, I guarantee it!). Often they experience some post treatment soreness, but that is different from the original pain complaint(s). That goes away in a day or so and they usually feel better. Yet, then they usually start to experience their symptoms again at some point during the week. At the second appointment, I ask when symptoms returned or worsened. Let's say it was in four days. Then they need to see me every four days. By the way, that is how I phrase it, "You need to see me every four days." Never say, "I need to see you." The patient does not care at all what you need; they only care about what they need. They also expect you to be the professional and tell them what they need. Always frame your recommendations from the patient's perspective. When they can go from treatment to treatment without symptoms, start spreading the appointments further apart. Once they can go a month without return of symptoms, it becomes, "Call me when you need me.

If the condition is chronic, or is re-facilitated by work, home, or athletic activity, then we figure out at what interval intervention is needed to prevent the return of symptoms or to support their desired quality of life. That might be once a week to once every couple months. Every two or three weeks is a very common interval. This protocol has worked very well for me and for hundreds of my students.  I hope it helps those of you struggling with this issue.

How Often Does Something New Appear?

I have been reading some blogs and forums lately. These days it seems a hot topic in medical research is that the nervous system is involved in pain and soft-tissue dysfunction. Stop laughing! This is big news to the "researchers" who are "discovering" this. Its making peer reviewed journals and all. Now who would imagine that what we are doing is not really affecting the individual tissues directly but instead is nothing more than stimulus–response. What a concept, but actually I (and a few others) have been teaching for a couple decades now, that our window to the body is the nervous system and that what we are really affecting is the nervous system which then in response to our stimuli gives us a positive (desired) response. This is often why massage does not elicit the desired response, because the therapists provided the wrong stimuli to elicit it. Sadly, too many patients equate the endorphin release from pain and pressure to be "relaxation" because endorphin is pleasant to experience. The tissue probably didn't change much, especially for very long. In the process, therapists are destroying their bodies doing "Deep Tissue Massage."

This comes at an interesting time, as there is a recently developed, unique new massage technology that deliberately and directly stimulates the nervous system to predictably and consistently reset (eliminate) trigger points, hypertonic and ischemic muscles rapidly and easily for the therapist and painlessly for the patient. (Really painlessly – not just "Hurt so good" or to "tolerance".) It is called Neural Reset Therapy® (NRT). It is the first significant advancement in soft tissue therapy I have seen since the 1980's when neuromuscular and myofascial techniques came on the scene. I have alluded to it several times in this column but I promise I will explain it in detail in my next article.

Thank you all for reading my articles. I'll be back this summer or before with some great new, non-political information before I get back onto politics!

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