A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
July, 2014, Vol. 14, Issue 07
Prone Position Syndrome
By David Lauterstein, RMT
How many times have you been receiving a massage and noticed after 40 minutes that you are still lying face down? Your sinuses have filled up. Your face and jaw are being deformed by the face cradle, leading to a related symptom, "cradle face." Your pelvis has been stuck in one awkward position for the much of the session.If you're a knowledgeable receiver, you may already be wondering what will be left out of the massage, because, after 40 minutes prone, receiving mostly back and shoulder work, there is no way the lower body, front torso, arms, hands, head and neck can be adequately addressed. How many times has a therapist apologized for leaving something out because they "didn't have enough time" or they simply ignored it? How many times have you gotten off the massage table and found some symptoms worse from being prone too long or sore from certain areas overworked or underworked?
Much of this can be traced to what I have named, "Prone Position Syndrome" or PPS for short. I'm being both funny and serious in bringing this up. This syndrome is obvious, but I've not often heard it identified as one of the major problems with massages these days. Why do therapists cause PPS so often? What are the causes and problems of PPS and what is the cure?
The first poblem is the lack of education regarding the importance of timing in a massage. What's the cure? Take a better history and determine a game plan for what body segments you will emphasize and approximately how much time you will spend on them. Get client agreement regarding your plan. Then monitor your timing as you go.
The belief that more is better – especially when it comes to working tense areas. The assumption that more force or that more repetitions will improve the session especially affects therapists' work with the back and posterior shoulder girdle. What's the cure? Realize less is often more! The thing that relaxes muscles' tensing is the nervous system. So honestly in massage we are not so much doing soft tissue manipulation (in spite of what most state laws say), instead we use manual suggestions to talk the nervous system into initiating the relaxation response. More repetitions do not do a better job of convincing the nervous system to relax – anymore than verbally telling the person to relax again and again and again.
Therapists are sometimes taught or get into the habit of always working at the same tempo, often doing all their strokes somewhat slowly. Frankly, if the massage is all slow, the client is often just put to sleep. When the client sleeps, there is no body-mind learning. The cure? Work that truly honors the nervous system, the mind and the body's needs – will vary in tempo. It is important to slow down in places of tension. It is equally important to speed up where things are relatively fine. I often think of Muhammed Ali's famous exhortation to "Float like a butterfly. Sting like a bee."
To repeat a stroke more than three or four times generally dishonors the client's nervous system. The nervous system GETS the message pretty quick! It doesn't need to be forced to relinquish its tension through brute force or excess repetitions. We need to remember that the client's awareness accompanies our touch and that a really good massage often will nonverbally impart important information to the client about their body and mind and emotions. I recently received a student session and I pointed out that the nervous system gets the message pretty quick and, if it's all slow, it's like assuming talking slow will improve communication.
Excess preoocupation with addressing the back, shoulders and neck and especially in the prone position. This often is a habit reinforced by frequent client requests to "just work on my back and shoulders." Clients do not realize that where their pain ends up is not necessarily where it's coming from. The most common example of this is back pain due to chronic forward flexion of the torso. As long as the front isn't lengthened, the back cannot let go. The cure?
Ida Rolf had an important saying, "Go where they're not." Explain to your clients, if they are willing listen, that you are happy to emphasize their backs and shoulders, but that often their back tension is related to posture and to stress elsewhere in the body. Therefore, in order to give them even more thorough and longer-lasting relief, in addition to giving the back, shoulders and neck lots of attention, your work will help them even more by addressing tension in the legs and feet which give critical support to the back; and addressing tension in abdomen and upper chest to help with the hunched over posture so many of us adopt at our desks and driving.
Boredom - the therapist just won't be bothered to individually plan the timing in the session. The cure? If you are bored in your work, you need to re-examine your attitudes and the environment you work in. Often in school, students say the subject they find most boring is business. But in graduate surveys, they often say if there was one subject they needed to pay more attention to it was business. If you are bored in your work, it is time re-examine your business plan; or, if you don't have one, it is high time create it. This can be fun and it certainly is necessary – look at Business Mastery by Cherie Sohnen-Moe or some other good business text written for massage therapists/health professionals.
Even more serious - lack of care. Sometimes one may be the sixth or seventh client of the day or the twenty-fifth of the week! The therapist, sadly enough, may just not care a whole lot at that point. The cure? Similar to boredom, lack of care may result from your attitudes or from being in an environment that is discouraging. Re-visit your business plan! Every business owner and/or employee needs to make sure that they keep on finding ways to activate their care for themselves and others in their work.
Not having the anatomical knowledge or technical skills to address the client's problems. The cure? Re-visit your anatomy and the most effective techniques you learned in school. Take continuing education that gives you efficient ways to address tension. Learn particularly how to pleasurably and effectively address the myofasical structures which keep the torso in chronic flexion – among them, especially rectus abdominis and pectoralis major.
Together we can overcome this pervasive problem. Let us free ourselves and our clients from the dreaded effects of Prone Position Syndrome!
David Lauterstein is Co-Director of Lauterstein-Conway Massage School in Austin, Texas. He is author of "The Deep Massage Book" and "Putting the Soul Back in the Body." David has been inducted into the Massage Therapy Hall of Fame, received AMTA's Jerome Perlinski Teacher of the Year Award, and in 2013, was recognized as "Educator of the Year" by the Alliance for Massage Therapy Education. For more info, visit www.TLCschool.com.
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