Supplement Safety: Is It Time to Give Big Pharma a Chance?
Why in the world would I, a chiropractor, consider Big Pharma when I make a vitamin / supplement recommendation to a patient? There are several supplement manufacturers at every chiropractic conference, even at some of our schools.
A Little More Chiropractic, A Lot Less Pain
Why should I visit a doctor of chiropractic when I'm not experiencing pain or other symptoms? That's the question many patients still ask themselves, despite the growing body of research supporting the value of chiropractic maintenance care.
The Carcinogen Most Patients Consume
A known carcinogen is being naively consumed by many, if not most of your patients, who have little to no understanding of how dangerous it really is. Depending on the age of the patient, this carcinogen is a leading, if not the leading, risk factor for death and disability.
Renying-Cunkuo Pulse: The Essential Pulse Method of the Ling Shu
The Ling Shu is a Han Dynasty classic book on the practice of Chinese medicine. It presents five main channel systems: Muscle Channels, Chapter 13; Luo Collaterals, Chapter 10 and others; The Main Channels, Chapter 10 and many more; Separate Channels (Divergent Channels) Chapter 11; and the Eight Extraordinary Channels, referenced in chapters throughout the book (there is very little theory).
A Moment of Silence for Dr. Leon Chaitow (1937-2018)
After months of declining health, Dr. Leon Chaitow – clinician, author and teacher – passed away on Sept. 20, 2018 at the age of 80.
How to Address the Question, "Do You Accept Insurance?"
Do you ever dread getting asked the question, do you accept insurance—when you only accept cash, or when you are out-of-network? As part of my daily practice, mentoring acupuncturists to grow their practices faster and more effectively, I talk to a lot of practitioners.
Pregnancy Health: Looking at the Lower Extremities
When patients tell us they are pregnant, many times we focus on the obvious pregnancy signs and symptoms related to their current trimester of pregnancy, and the biomechanical impact on the spine and pelvis.
Procuring a Place for the Future
As the acceptance of acupuncture continues to grow in the U.S. it is important that the profession be licensed in every state, and nationally board certified.
A New NCCIH Director ... One That Backs Acupuncture
The third time is a charm—the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), announced it's newest director, Dr. Helene Langevin.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 1)
In the absence of acute trauma, a usual strength-building session includes concentric, eccentric and isometric exercises. Popular exercise programs typically include concentric movements as the major muscle contraction and should constitute approximately 70-75 percent of the workout time.
Paradise Lost: AWB Relief in Hawaii
In November, 2014, Acupuncturists Without Borders (AWB) was hosting a training seminar on Oahu. A couple of us from the big island (aka "Hawaii" County) contacted AWB because the big island was in the middle of a crisis.
Manual Muscle Testing for Cervical Radiculopathy (Pt. 2)
Dr. John Bandy developed a protocol that associated specific muscles with myotomal nerve root levels. The deltoid is associated with the C6 nerve root; the triceps with the C7 nerve root; and the finger abductors with the C8 nerve root.
World Acupuncture Day: A Meeting in Paris
World Acupuncture Day is an event organized by the World Acupuncture Day Organization (WADO) in response to the eighth anniversary that UNESCO has included acupuncture and moxibustion on it's Representative List of the Intangible Cultural Heritage of Humanity.
Creatine: Muscle Fuel No Longer Just for Athletes!
Erase that image of the 20-year-old, muscle-bound bodybuilder using creatine. Replace it with the image of a lean, strong, fit 80-year-old hiking up a mountain. Creatine, a staple of athletes for more than 50 years, is now being used by athletes and non-athletes alike to help slow normal age-related muscle loss, improve exercise recovery, increase strength, and live a more active lifestyle.
Travel-to-Treat Coverage Finally Becoming a Reality?
Long-awaited legislation poised to hit the president's desk extends liability insurance coverage from one state to another for DCs and other state-licensed health care professionals who care for athletes / athletic teams that cross state lines.
NBCE Exams: Better, Shorter, More Opportunities
The NBCE's Written Exams department, led by Bruce Shotts, DC, developed a solution to computer-based testing on college campuses. Their work has resulted in 11 exam opportunities per year. CBT exams are on schedule to begin January 2019 as follows:
The Husband/Wife Imbalance
The Husband/Wife Imbalance, like Aggressive Energy, is an energetic block that will result in death, unless cleared, as its presence indicates that nature has given up the fight against the internal or external pathogenic factors that have assaulted the body/mind/spirit of the patient.
Case Study: Osteoporosis and the Role of Orthotic Support
The following is the second of three case studies by Dr. Wong on conservative management of lower-extremity complaints. Article #1 (September issue) explored chiropractic management of patellofemoral arthralgia.
Bait & Switch: Are You Guilty?
One of my three sons recently shared a story with me regarding an experience with a chiropractor, which stimulated me to write this ethics article. According to my son, he called a chiropractor's office and asked if his insurance was accepted at the office.
Cyberthreat Checklist: 10 Key Steps to Defend Your Practice
Living in an Internet-connected society brings many conveniences and benefits. The power of the Internet to connect us with customers, store data and find information has opened the door for many small-business owners to grow and flourish.
Vertebral Subluxation: Give Credit Where Credit Is Due
Vertebral subluxation: have any other words caused as much turmoil and controversy in the chiropractic profession? As a chiropractic term, vertebral subluxation did not make its debut until six or seven years after the profession's founding.
Chiropractic Integration a Big Success, Suggests Research
Whether chiropractors should integrate with other health care professionals in medical / multidisciplinary settings remains a contentious issue, depending on whom you ask, but there's no denying two realities.
An Effective Herb for Stress
We all know stress has become a significant factor in the increasing number of reported mental health disabilities and a contributor to various physical health conditions, such as ulcers, high blood pressure, heart disease, and so on.
On Point: Acupuncture Theory & Discussion
Welcome to my new column for Acupuncture Today, which will focus exclusively on the theoretical discussion and clinical application of acupuncture theory and acupuncture points. One of the most common questions I encounter from novice to experienced practitioners is "how do I choose the correct acupuncture point?". I hope this column can help answer some of these questions.
The NCCIH Seeks Participants for Acupuncture RCT
The National Center for Complementary and Integrative Health (NCCIH) is seeking participants for a new Funding Opportunity Announcement (FOA)—a Randomized Control Trial (RCT), which will evaluate the impact of, and strategies to best implement acupuncture treatment of older adults (65 years and older) with chronic low back pain (CLBP).
Checking Your Posture: A Wholistic View From Head to Toe
As you begin reading this article, what position is your body in? Are you sitting down, standing up, lying down, or walking down the street perhaps? Whatever position you are in, stop and observe your posture.
Avoid These New-Patient Turnoffs (Before It's Too Late)
I can't believe this doctor is making me watch this video in a room by myself, your new patient thinks to herself as she texts her best friend.
The Road to TCM, A Talk With Bob Doane
Bob Doane, a veteran acupuncturist, talks about his journey to TCM, the evolution of this medicine, and what he foresees in the future.
Cynicism, Burnout and the Search for the Ideal Patient (Pt. 1)
There is a video on the Internet that has gathered 6 million views as I write this article (so likely millions more by the time you read it). The video is of a doctor in an ER mocking a patient who is extremely weak and distressed.
Placebos, Presence and the Zero Point
We spend a huge amount of time learning the techniques and methods of acupuncture and Chi-nese medicine, and are given professional licenses based on our ability to remember and accu-rately apply them.
A Moment of Silence for Dr. Leon Chaitow (1937 – 2018)
After months of declining health, Dr. Leon Chaitow – clinician, prolific author and teacher – passed away on Sept. 20, 2018 at the age of 80.
News in Brief
The Next Generation of Chiropractic Researchers: Historic NIH Grant; Cleveland University – Kansas City VP Joins CCE Site Accreditation Team; NUHS Opens Second Veterans Clinic; R.I. Chiro. Society Celebrates 100 years.
December, 2007, Vol. 07, Issue 12
Researching the Effects of Massage Therapy in Treating Rheumatoid Arthritis
By Robin B. Anderson , CMT, NCTMB
The following abstract, "Positive Systemic Effects Using Therapeutic Massage as a Conjunctive Treatment for Rheumatoid Arthritis," received bronze recognition from the Massage Therapy Foundation at the 2007 American Massage Therapy Association National Convention in Cincinnati. The abstract was submitted by Robin Anderson, CMT, NCTMB, who operates a private practice in the Northern Baltimore suburban region of Maryland. She is a guest massage instructor at her alma mater, the Community College of Baltimore County, and also has experience as an American Council on Exercise (ACE) certified personal trainer with special training in cancer recovery exercise programming, senior fitness and post-rehabilitative exercise. The abstract is reprinted here in its entirety. If you have a research abstract you would like to submit for possible publication in a future issue of Massage Today, please send an e-mail to , with massage research abstract in the subject line.
Objective: This study considered the efficacy of causing positive systemic effects translating into sustained periods of symptomatic remission in the management of rheumatoid arthritis (RA) for a recently diagnosed patient.
Methods: The study subject reported RA complications with pain-related symptoms in the right shoulder, forearm and index finger. Over a 10-week period, the subject received 8 therapeutic massage sessions; 7 were weekly and one was at a 3 week interval. Each session lasted for 1 to 1½ hours and was mainly comprised of Swedish and myofascial techniques to the musculature surrounding the right glenohumeral joint with an additional specific hand massage protocol and light friction strokes in the right antecubital region to encourage lymph flow.
Results: At the third weekly session, the client reported experiencing no pain or discomfort. This period of non-flare up and absence of pain continued through the remainder of the study period, even with a longer 3 week duration between sessions at the end of the 10 weeks. The client also noted that no pain medication other than her weekly Methotrexate dosage was taken throughout the duration of the study and that she obtained a better quality of sleep and daily activity.
Conclusion: Therapeutic massage treatments, while able to achieve qualitative muscle release in an affected joint region, can also positively affect the physiological systems of a patient with RA and help to alleviate and prolong the deteriorating effects of the disease.
Autoimmune diseases are noted for their deteriorative properties of physiological systems as a faulty immune response (Werner, 2005). The functionality of the circulatory system and the presence of persistent stress levels can have a negative impact on circulation, triggering pathogen invasion and producing symptomatic pain, discomfort and inevitable decline consistent with the progressive nature of this disease classification. Massage therapy has the ability to significantly affect systemic disorders because of its applicable methodology: the promotion of detoxification through vasodilation to assist in the removal of toxins, which can cause pain responses; the improvement of overall circulation by encouraging blood and lymph flow; the activation of the parasympathetic nervous system division by lowering blood pressure, heart rate and respiration rate inducing relaxation and stress reduction (Prekumar, 2004; O'Brien, n.d.). Massage therapy, when used in conjunction with other prescribed treatments, can have a positive systemic effect in the management of the symptoms and progression of an autoimmune disorder.
Rheumatoid arthritis (RA) affects the structural integrity and function of musculoskeletal joints and eventually the entire body (Osborn, 2005). The immune system mistakenly attacks the membranes and joint structures via the accumulation and stagnation of synovial fluids, initiating inflammation, pain and loss of function, called articular degeneration (Lowe, 2006). RA in its progressive stages will damage other structures and organs such as blood vessels, lungs and the pericardium. Once diagnosed, patients generally spend their lifetime using traditional and alternative therapies attempting to manage and decelerate the debilitation process (Werner, 2005).
Signs and symptoms are prominent morning stiffness and joint swelling, tenderness and pain. The distinctions associated with RA are the tendency to first affect the interphalangeal and metacarpophalangeal joints of the fingers/hands and toes/feet, as well as cause entrapment syndromes of nerves near affected joints such as the median nerve at the carpal tunnel. The development of subcutaneous nodules on protuberances of bones, bursae and tendon sheaths are also notable (Papadakis and McPhee, 2006).
The current approach to treatment is to attempt to stall or interrupt the inflammatory symptoms (known as flare-ups) associated with the advancement of joint deterioration, minimize the occurrences of intense pain episodes and decreased joint mobility, and subside the condition into a remission phase. A pyramid approach has been developed to determine the level of therapeutic intervention. At the base of the pyramid, the "first line" of drugs and therapies are suggested such as rest, exercise and non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (i.e., Prednisone). When the first line loses its efficacy, a "second line" is employed, which depending on the drug, increases risk of toxicity based on dosage and prolonged usage. These cytotoxic drugs are called slow-acting anti-rheumatic drugs (SAARDs) (i.e., Methotrexate), and are sometimes used in conjunction with a first line drug upon early diagnosis of RA. This sometimes is very effective but also is known to cause some notable side effects from the usage duration. Physical therapy, therapeutic devices and joint replacement surgeries are mechanical measures used in conjunction with the drug pyramid. Ultimately, present methods are devised to provide pain relief, decrease joint inflammation and to maintain and restore joint functionality preventing further bone and cartilage deterioration (Schumacher, Klippel and Koopman, 1993). It is logical to deduce that using massage therapy treatment can positively affect RA with similarly noted therapeutic goals.
A recent study at the Touch Research Institute in Miami on the effects of hand massage in arthritis patients demonstrates this premise. Through the use of wringing, skin rolling, circular, and friction type strokes, Dr. Field substantiates by measuring grip strength pre and post treatment that the treatment group realized a significant improvement in mobility and function in comparison to the control group which did not receive massage therapy (Field, et al., 2006). Moreover, to increase formation and flow of synovial fluid in affected joints, treating the surrounding joint tissues with light friction and vibration and establishing a methodical treatment interval is suggested (Wine, 1995). Since RA is a systemic disease, it can also create blockage in lymph nodes proximal to affected joints and thereby contributing to discomfort and pain experienced by the patient. The aforementioned gentle circular friction techniques have been used to help increase the delivery of oxygen and nutrients and assist in the removal of waste products surrounding the affected joints (Osborn, 2005). When the joint is in an acute inflammatory stage, massage is contraindicated. However, when in remission, massage can effectively manage symptoms, prevent inflammation, and reduce joint damage (Lowe, 2006).
Client Profile: A 39-year-old female dental hygienist, married and the mother of three children, presented with pain and discomfort in her right shoulder and second (index) finger joints. She recently was diagnosed with RA after enduring nearly eight months of a constant "flare-up" condition, describing symptoms of dull, achy pain throughout her entire body causing difficulty in mobility, particularly in the morning hours, and reduction in the ability to perform daily tasks at work and home; the client also stated that she experienced visible swelling in the noted joints, additionally, in the knees and feet, with the right side seemingly more affected. Medical examination by her primary care physician and a rheumatologist, and medical testing of X-rays and blood work, indicating high levels of rheumatoid factor, resulted in her definitive diagnosis in May 2006. The client was prescribed two medications, a "first line" corticosteroid in conjunction with a "second-line" SAARD, to manage her condition - Prednisone, 5 mg each dosage, two doses per day, to address the long-term constant pain condition she had been enduring, and a 7.5 mg dosage of Methotrexate, was taken weekly. After the initial flare-up alleviated, she was instructed to take Prednisone only when a flare-up recurred.
The client reported that since her diagnosis and starting the prescribed medication, her flare-ups were unpredictable and sporadic, lasting approximately 1-2 days in occurrence. Activities that triggered flare-ups included excessive periods of walking, standing or performing household chores and activities which caused overexertion or fatigue. Other secondary factors that may have exacerbated her RA condition were repetitive occupational activities, family environment and overall daily stress levels. As an addendum of historical interest, she was a baton twirler for 10 years as a child and may have sustained some structural injury in her fingers, hands, wrists and arms. She also noted a previously unpleasant massage experience.
Overview: The 10-week study consisted of the following elements: initial baseline assessment and client interview, 7 weekly treatment sessions at exact 7 day intervals, and one final treatment session (for a total of 8 treatments) after a 3-week period with a reassessment and concluding client interview. Each treatment session was 1 - 1½ hours in length. A postural assessment with photographs and range of motion testing using a goniometer were performed to document any asymmetries corresponding to the RA affected joints and to obtain comparative data on the functionality between left and right shoulder joints (Andrade and Clifford, 2001). Measurements were taken in the following planes of motions: shoulder flexion, extension, abduction and lateral and medial rotation, in both standing and supine position. The client filled out a weekly log sheet with personal descriptive comments prior to treatment and reported any flare-ups from the previous week, immediately following treatment, hours after treatment and daily progress during the week until the next session. Elements of statistical significance included a pain rating scale with 1 as the lowest and 10 as the highest, description of daily activities, indication of flare-up and subjective comments. Number of hours of sleep was also noted. At the conclusion of the 10 weeks, data from pre and post treatment assessments and subjective commentary were analyzed.
Plan and Techniques: The primary objectives were to affect the systemic conditions associated with RA. If it is conclusively determined that the massage treatments were positively affecting and managing her condition, then the client could potentially explore the adjustment of medication dosages to lower levels with the advisement of her rheumatologist, and utilize massage at a regular treatment interval to help regain some mobility and thereby, enhancing her overall quality of life (i.e., desire to exercise again, maintaining more active lifestyle, ability to manage stress more effectively, and have fewer physical limitations) and delay the deterioratory elements associated with RA.
Given the data obtained in the client interview, the treatment plan was structured based on a series of factors. Since the client had a previously unpleasant experience with massage, it was important to establish a gauging presence of touch to dispel any previous apprehension. Secondly, palpation of surrounding joint tissues and structures and their responses to certain techniques dictated treatment planning. The client's ability to achieve a relaxed state during treatment also influenced the plan. Finally, once trust in the student therapist was established, specific treatment protocols used with RA and related muscle tension were utilized. The following illustrates an overview of treatments:
Session 1: Acclimation of touch sensitivity, palpation of structures and experimentation of Swedish, deep-tissue tools and myofascial release techniques. Achievement of relaxation state.
Clinical Visits: The first session established the baseline treatment, palpation of structures and experimentation with massage techniques. Swedish techniques were used in an effort to cause relaxation and establish trust and intention with the client. The palpation of the muscular structures in the glenohumeral joint of the right shoulder and the metacarpophalangeal joints of the right index finger indicated that the cervical and forearm areas held significant tension and discomfort, specifically, the short head of the biceps brachii, deltoid, pectoralis minor, scalene and levator scapulae. The lower right leg in the posterior compartment had ischemic knots in the gastrocnemius and soleus muscles proximal to the Achilles tendon attachments, which suggested that joint discomfort may have caused some additional compensatory patterns in her posture and gait. Observation of the client's relaxation during treatment was also noted for future treatments. Deep-tissue tools and myofascial- release techniques were employed to test effectiveness and client tolerance; her muscular structures responded minimally to myofascial release and therefore, the use of deep tissue techniques (to the client's tolerance level) were used to address muscle tension.
The second treatment session began the first phase of actual treatment that addressed her RA condition. Since the right shoulder area seemed to be a source of great tension and imbalance, it was initially targeted as a starting point. An effective shoulder release would theoretically cause the other affected joints to eventually subside their corresponding tension. Techniques used were myofascial gross and focused stretches on the deltoid (separated into anterior, middle, and posterior segments), biceps brachii (separating the long and short heads), triceps brachii (separating each muscle head), and upper trapezius; myofascial cranial base, levator scapulae, and scalene (anterior, middle, and posterior) stretches; and effleurage and petrissage strokes for warming up and moving tissues. These applications opened up the upper thoracic and cervical areas as the muscles seemed much more receptive to myofascial release and deep tissue techniques this time. Subsequent sessions allowed for continuation of myofascial work. The massage techniques used in the study performed at the Touch Research Institute were incorporated into the remaining sessions to directly treat the metacarpophalangeal joints of the right index finger. This technique begins with effleurage-like strokes starting at the wrist then moving superiorly to the elbow and then inferiorly along the sides of the affected forearm; a wringing motion is then applied to the same forearm area; a circular back and forth motion using the thumb and forefinger is used to cover the entire forearm, hand and the specific affected joints; then skin rolling is performed using the thumb and forefinger across the hand laterally to medially, then moving superiorly up both sides of the forearm to the elbow/antecubital area; a final effleurage was used as a closing/transition stroke (Field, et al., 2006). To stimulate fluid production within the bursa of the right shoulder, circular friction strokes were utilized around the affected area and compressive pressure and minimal rotation movement from the olecranon process superiorly to the head of humerus were used to gently massage the inside of the glenohumeral bursa. Circular friction strokes were used on the lateral and medial sides of the antecubital space to target the lymph nodes in an effort to get lymph flowing more freely.
A reasonable degree of relaxation and trust in touch was progressively reached by the client at each session. This was indicated by her ticklish sensations in the triceps that presented in later sessions that were not initially evident. Commentary review from the client's daily logs and SOAP notes showed an overall positive satisfaction. Additionally, subjective visual observation of her posture and gait when she arrived for her appointments displayed noticeable improvement with each passing week. The elevation change in her arm/hand positions at the mid thigh were exhibited, the arm/hands appeared more level, equating to relieved tension in the shoulder joints. While increased mobility was realized in left shoulder flexion and abduction (21 to 25 degrees increase) in the erect positions, the right RA affected shoulder showed notable corresponding gains in the same motion planes; this indicates that the client may have been restricting motion patterns on the opposing left joint in compensation for experienced pain or discomfort from the right RA affected side. Supine measurements in both shoulders showed statistically similar changes in mobility. Supportive data was also found in the client's log sheets. At the beginning of the study period, the client reported experiencing joint pain as high as a 7 on the rating scale. Further review showed that the client reported no pain (0) for a period of 38 days towards the latter end of the study. This notable drop in the pain rating and non-occurrence of flare-ups bears significance proving the positive systemic and overall life quality effects of massage as a conjunctive therapy to her medications. While number of hours of sleep was recorded, since the client regularly obtained an average of 7-8 hours each night, it was not a contributing factor to outcome.
The study data strongly support using massage as a conjunctive therapeutic treatment in RA cases. In just a 10-week period, this client was able to realize a state of nullified pain in her RA-affected joints and achieve a virtual remission status. It is apparent that the weekly treatment interval was effective in order to cause systemic changes and physiological response. Once a positive response was elicited, the client was able to achieve longer pain-free periods toward the end of study, indicating a readiness to transition into a maintenance level for massage treatment. It is not specifically clear what elements were most effective during the treatment process (i.e., strokes used, achievement of musculature releases in surrounding joint areas, or direct massage on the affected joint[s]); however, the overall improvement of joint functionality shows that incorporating massage treatment directly to affected joints using applicable portions of documented protocols (Field, et al., 2006; Andrade and Clifford, 2001; Wine, 1995) further demonstrates the success of these techniques. Generally, the use of massage therapy achieved a favorable systemic outcome. These results also suggest that regular massage therapy treatments bear further scrutiny in relation to prescription medication usage. With regards to this client's prescriptions, she had not taken one Prednisone dosage since the commencement of this study. Given the potentially damaging side effects of Methotrexate usage in the long term, if her rheumatologist is satisfied with these documented outcomes, then consideration to mildly reduce the dosage and/or types of medications used when regular massage sessions are maintained conjunctively as part of her overall disease management regimen is warranted. Further research in measuring blood levels to determine other systemic effects would be ideal.
The author would like to acknowledge Beverly Hamilton, CMT, and Jamiel Hafiz, CMT, for their supervision, guidance and instruction throughout the course of this case study. She would also like to recognize Dr. Tiffany Field and her colleagues from the Touch Research Institute at the University of Miami for granting access to their hand arthritis research prior to publication. A special acknowledgement to Theodora Welsh, CMT/MLD, for the tremendous educational opportunity to allow this research study to be conducted and selected to represent the Massage Therapy Program at the Community College of Baltimore County.
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