Updates to ICD10, Specifically for Myalgia (Muscle Pain)
Are there updates to ICD10? I attempted to enter M79.1 for myalgia (muscle pain) and it was rejected by my clearing house as being invalid. What is the new code for myalgia?
Using Tuina in the Acupuncture Clinic
The beneficial effects of touch are apparent to anyone who has stubbed their toe on an errant piece of living room furniture – after the initial angrily shouted expletive, we grab the offending digit in our hands because we know that it will help the pain.
The Back Squat: More Than a Training Exercise
The squat movement pattern is not only essential for ADLs; it is considered a foundational exercise for strength, resiliency and sport performance.
Digital Dilemma: Issues With Post-Processing Collimation
With digital radiography, we are now able to electronically collimate images after acquisition. This may seem convenient, but there are also downsides to this technique.
Extraordinary Chinese Medicine
The very fact that we exist as complex, multidimensional beings at this manifest level, and get to experience—through our senses—others, the world around us, as well as our own selves, is a miracle.
Turn Back the Clock With Nutrition
The anti-aging market is booming because, well, who doesn't want to look young, healthy and vibrant for as long as possible? And while there are many anti-aging products and systems marketed to the public, few people realize the most effective way to slow down the visible passage of time is to give the body the nutrients it needs to be truly healthy.
Acupuncture: More Effective in an Integrated Health Care System?
Acupuncture has traditionally been used in the primary care setting as a supplemental stream of care for patients. Patients can seek out or be referred to outside acupuncture providers based on their patients need.
The #1 Essential Element of Every Patient's Care Plan
The #1 Essential Element of Every Patient's Care Plan
Exercise Therapy Following Motor Vehicle Trauma (Pt. 3)
Keep the neck in retraction by pulling the chin back toward the spine. Some rehab instructors used to refer to this as "packing the neck." I really emphasize decompressing the head away.
Quick SI Assessment: 8 Tests
The lower back is a generator for a number of types of pain. As you know, it involves several different articulations: the lumbar spine with vertebral bodies, discs and facets; the sacroiliac joints; and the lumbosacral junction.
West Hartford Group Charts a Possible Course for Chiropractic's Future
The West Hartford Group, incorporated in 2006, is "a think tank dedicated to the acquisition of social, cultural and professional authority for the chiropractic profession, where the doctor of chiropractic (i.e., chiropractic physician in some jurisdictions) serves within the mainstream health care delivery system as a patient-centered, evidence-based, non-surgical, primary spine care health care professional." The WHG Board of Directors recently approved the following resolution it suggests as "one possible future for the chiropractic profession."
Make Room for New Kids on the Bus
Kids who were never "fortunate" enough to ride the bus to school actually may have missed out on many lessons related to the social challenges they would face later in life. One of the most classic might be called "The New Kid on the Crowded Bus."
Learn to Speak the Language of Personal Injury
For many providers, personal-injury cases and working within the med-legal arena can often be a confusing and frustrating endeavor. After all, for the majority, personal injury is a niche.
Time to End the Medicare Madness
Medicare's coverage of only a single chiropractic service (manual manipulation of the spine to correct a subluxation) may change soon if H.R. 7157, the Chiropractic Patients' Freedom of Choice Act of 2018, is approved:
Quantum Physics Research and the Ancient Roots of Acupuncture
Acupuncturists and quantum physicists have a lot in common. They are both working in fields that are rooted in an inter-connected universe. According to traditional Taoist cosmology everything in the universe is connected to everything else – nothing is separate.
2019 Practice Trends: How Does Your Practice Compare?
In order to better understand trends within the chiropractic profession, we periodically survey DCs throughout the U.S. and share the findings of our Expanding Chiropractic Practice Survey for your review and reflection.
How H.R. 302 (Travel to Treat) Became Law: Behind the Scenes
Sports chiropractic has created opportunities to put our profession on a pedestal. However, as chiropractors have stood on the pedestal with the success of their athletes, they have risked everything and put their licenses on the line when knowingly or unwittingly crossing state lines where travel to treat is not allowed. H.R. 302, signed into law in October 2018, mitigates some of that risk.
The NCCIH is Seeking Acupuncture Researchers for a Chronic Pain RCT
The National Center for Complementary and Integrative Health (NCCIH) in partnership with the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare & Medicaid Services (CMS) is seeking acupuncturists for a new Funding Opportunity Announcement (FOA)—a Randomized Control Trial (RCT).
The Four Needle Technique: A Follow-Up to the Husband/Wife Imbalance
In my previous article on the Husband/Wife Imbalance (Nov 2018), I made mention that successful clearing of this lethal block may require treatment stronger than the first two protocols explained.
News in Brief
Dr. James Badge, former president of the National Board of Chiropractic Examiners who, among other accomplishments, played a key role in the development of the board's Practice Analysis of Chiropractic (a report issued every five years and based on a survey of the profession), passed away on Nov. 7, 2018.
Diverting the Crisis Stages of Life: Yang Wei Mai and the Necessity of Change
One of the biggest struggles in which we help our patients is the process of change. I often hear two common questions, "I'm unhappy. How can I change?" and "My life is changing, how do I deal with it?"
The Truth About Malpractice Claims Against DCs (Pt. 2)
I save (print and scan in file) all emails and texts to and from patients regarding any recommendations of care, follow through of therapies, and especially urgent or emergency care recommendations.
DCs Step Up as Radiation Emergency Screeners
Throughout the United States, acts of terror are occurring more frequently and the substances used are increasing in variety. Many communities have experienced some terroristic threat or activity in the past few years.
Calming the Disturbed Meridians: A Way to Treat "Phantom" Pain
Margot J. was advised by her oncologist to talk to a psychiatrist about her post-mastectomy phantom pain. Instead, her friends sent her to me. Interesting situation—she'd recently experienced a double mastectomy and still felt intense pain in the spaces once occupied by her breasts.
BCBS of Tennessee Takes a Stance for Acupuncture
BlueCross BlueShield (BCBS) of Tennessee, the state's largest insurance provider, is starting the year off with some significant changes—they have dropped Oxycontin from their list of covered prescriptions and added acupuncture coverage.
How to Handle the "F" Word
Have you ever been fired? It's terrible, nasty business, especially if you're on the receiving end. Most people are doing their best, and when they're terminated, they can become furious. If it's handled incorrectly, some people may even try to sue you for doing what's best for your practice.
Differentiating Qi Under the Needle
In the marketplace, we hear of dry needling being talked about more and more. As professional practitioners of Chinese medicine and acupuncture, it is important that we do not lose sight of our passion, purpose and belief in what we are doing, both for the sake of preserving the full practice of acupuncture and Chinese medicine, and for the sake of our patients.
Repave the Road to Financial Ease With Cash Profit Centers
Remember the adage, "Don't put all your eggs in one basket?" Well, that's what you do when you count 100 percent on insurance reimbursement to sustain your practice.
Give the Overtraining Injury Epidemic Your Full Attention
Athletes are known for their competitiveness, their drive. That's why it's no surprise to learn that research published in the Journal of Sports Medicine has found a large majority – as many as 60 percent – of athletes regularly "overreach" or "overtrain" by working their bodies either too often or too hard.
June, 2008, Vol. 08, Issue 06
Contemplating Thai Massage Regulation
By Nephyr Jacobsen, LMT
I've done deep-tissue Swedish massage for 17 years. I mean really deep; no fluff-and-buff stuff here. But it doesn't come close to Thai massage, and nothing I've seen does. It's yoga and Rolfing and acupressure and tapotment and chiropractic and reiki and deep compression work and myofacial release and hydrotherapy with herbs and the power of spirit, all rolled into one.At the same time, it's none of those things because those aren't Thai and the truth is, Thai massage really is Thai. It's not a new brand of ayurvedic medicine or a twist on Chinese meridians, it's seriously Thai and it's serious medicine.
And here in the U.S., you can practice it after watching a do-it-yourself video, taking a two-day workshop or reading a book. And you can teach it after going to Thailand and taking a five-week course, a two-week course or a one-week course, never having actually had a working practice of it in your life. And people do. So long as you meet the regulatory professional massage laws of your state (which are all written with Swedish massage in mind), you can practice and teach Thai massage without a day of training if you so choose. And in some states, you don't even have to be a licensed massage therapist because you can claim this extremely physically intensive bodywork modality is technically energy work.
There is no regulation of Thai massage outside of the Swedish massage laws in the U.S., and I'm not even sure if there should be. Regulation is a sticky subject and with Thai massage, it gets complicated very quickly. At this time, the majority of states have some sort of regulatory agency that establishes the specific requirements to practice bodywork professionally and governs all massage modalities. A few states have no massage oversight at all and little to no requirements concerning practice. In those states with explicit oversight, all massage modalities are grouped together and have the same requirements. There are no specific laws for specific modalities. At this time, no organization in the U.S. has the authority to specifically regulate, certify, register or accredit Thai massage practitioners, therapists, bodyworkers, instructors or schools.
A Case for Thai Massage Regulation
Thai massage has the potential to cause injury if not done correctly. This applies both to the therapist and the receiver. Thai massage is a far more dangerous modality than Swedish massage could ever be. With proper training, it's amazingly therapeutic. And knowing effleurage, petrissage, cross-fiber friction and the diaper drape doesn't prepare anyone for practicing Thai massage. That's like saying if you're a highly trained golfer, it follows that you are qualified to play professional basketball. It's apples and oranges.
What this means is that states requiring that Thai massage practitioners be licensed massage therapists have really not done anything to protect the public safety in regard to Thai techniques. Because none of the required massage training (I'm not talking about the sciences of anatomy/physiology here) has anything to do with what you must know to practice Thai massage. It is left up to the practitioner to voluntarily seek out quality instruction.
This is why the regulation of Thai massage by a body of professional practitioners can be seen as necessary. In this case, oversight must come from within the community of Thai massage practitioners, because these are the individuals who truly understand the techniques and the proper methods of training. Of course, these individuals also would have to be professional licensed massage therapists, in order to comply with state laws.
A Case Against Regulation
And here is where I start to sound a bit inconsistent, because a part of me believes the way one trains should be voluntary. I have always felt that massage, as with herbalism and midwifery, belongs in the layperson's hands, where some of the best teachers are quietly hidden and carry no state-governed credentials. I am deeply suspicious of massage regulation, with its pandering to large corporate schools and its focus on written exams for a field that involves the unmeasurable ability to touch and feel with intuition and competence.
In the world of Thai massage, regulation is nearly impossible. While schools and practitioners have begun to be regulated by the Ministries of Education and Public Health in Thailand, it remains a fact that some of the most proficient therapists in Thailand are unlicensed, unrecognized and unofficial. Some of these practitioners are masters of hereditary methods; some live in the far-out villages where licensure is not possible.
Maintaining the Status Quo
There are some who suggest Thai massage practitioners should not have to be licensed massage therapists at all, meaning they should not have to meet any existing state requirements in order to practice their profession. This position holds that Thai massage is not the same as other bodywork modalities and should have either no requirements or only those of our own regulatory agencies. They propose that we should not even call it Thai massage, suggesting instead names such as Thai Yoga Therapy or Thai Intensive Stretching. It's as if a change in semantics will change the fact we are "manipulating soft tissue," the common definition of massage in most states. While I agree Swedish massage licensure does not qualify one to practice Thai massage, I do not think it hurts.
Another factor in this issue of creating regulatory agencies specifically for Thai massage is the need to be wary of self-absorption - to the point of forgetting the public we serve. So, how do we regulate Thai massage? We set the standards not by creating more regulatory agencies and attempting to separate ourselves from the rest of the massage world, but by creating classes and schools with a high bar and by being practitioners who don't balk at training. What if, instead of using our energies to fight the existing system and create new regulating agencies, we were to work together within the system? This could be the best of both worlds. Thai massage does not become regulated unto itself (hopefully avoiding homogenization), and by following state requirements of licensure, at least in states that have requirements, the people who can practice will by default be those who are willing to put in a little extra work.
I have looked through both lenses and agreed with what I saw. In the end, I have come to a place at which I accept things the way they are. It's not perfect, but I know the things that bother me most about the present and likely future of Thai massage are not actually going to be fixed by less or more regulation. They are not being fixed by the states that don't require Thai massage therapists be licensed in massage and they are not being fixed in Thailand, where there is very specific government regulation of Thai massage. What bothers me are things like gaps in integrity and the need for better understanding. Things like the tendency to call Thai medicine ayurvedic or Chinese because we don't understand it enough or respect it enough to grant it its own standing. Things like infighting among practitioners and teachers. More importantly, I am bothered by the actual danger of an ancient art becoming watered down and distorted until it no longer exists in its true form.
Luckily, these are things we can change without having to restructure the system. These are things we change through personal commitment. As we teach our students and teach each other, we set the bar higher and encourage quality in the Thai massage community. I believe it's up to us as individuals, not laws, to keep Thai massage safe and authentic. Those who do will shine brightly.
Nephyr Jacobsen is the founder and director of The Naga Center School of Traditional Thai Medicine in Portland Ore. She has been a massage therapist for 17 years and has spent extensive time studying Thai massage, both domestically and in Thailand.
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