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Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
February, 2012, Vol. 12, Issue 02
Dealing with Fibromyalgia
By Stuart Taws
It is estimated that between two to four percent of the population are now suffering from fibromyalgia, including Irritable Bowel Syndrome and TMJ. Perhaps our massage school education did not include how to successfully deal with fibromyalgia.Massage therapists often express a lack of confidence, some fear and anxiety along with the lack of a clear program for how to go forward and help their clients diagnosed with fibromyalgia.
In 1990, the American College of Rheumatology (ACR) established the definition of chronic widespread pain and the 11 of 18 tender point test to diagnose this "mystery illness." Interestingly, for most people, these points are naturally a little tender. This protocol has proved to be somewhat of a tragedy. A male MD "prodding" a female in pain looking for tender points then announcing that she has fibromyalgia has a negative downside. Once a medical practitioner determines that you have a certain condition and names it, then you get to keep it. You become like Alice in Wonderland going down the "Rabbit Hole" of a series of elaborate and sophisticated medical tests. The results confirm your symptoms and perhaps your worst fears, but along with the diagnosis there is no forward looking answer to your pain free recovery. Please note: the ACR 11-18 tender point protocol was for study criteria only and was never meant to be used as a diagnostic tool.
After decades of research, there is still no satisfactory answer by the medical profession for chronic pain syndromes. You receive prescriptions for painkillers, sleeping medication and anti-depressants. These deal with symptoms, not the cause of the condition.
When you're in pain for many years, you change physiologically. In one study by the University of California, they found that persistent stress shortened the length of the telomeres in the DNA. If stress can affect your very DNA, imagine what it can do to your sensitive molecules. Stress changes you at a molecular level. When you are in pain, life changes and you change. All the happiness of life has been put into the mortar and pestle of life, crushed like chaff and blown into the wind of despair. Sleep is continually disturbed so the REM phase, where all emotional stresses of the day are processed keeping mental health and stability, is rarely achieved.
In 1997, F. Wolf (University of Minnesota) published an article looking at some of the data collected in population-based studies. He found "that the number of tender points an individual has is highly correlated with the number of measures of distress. High threshold tender points are a sedimentation rate for distress."
In the mechanism of pain, it is observed that after injury the nervous system can delay it's response to that injury by a day, week or a month. When a person is diagnosed with cancer, the oncologist often asks what happened in their lives two years previously. When you ask a similar question of your fibromyagia clients, surprisingly I have found there was a serious illness or a vehicle accident, death in the family or a bitter divorce and custody battle over the children, all within the last two years. As the manifestation of pain is delayed, the connection is not made and falls into the mystery illness category.
"Information regarding pain is immediately transmitted from the injured tissue to the cerebral cortex," according to Dr. Linda Sorkin. Notice that pain quickly becomes a matter of the higher centers. She continues, "The peptides and injury products activate the pain fibers, sensitize and excite the nociceptors. There 'silent nociceptors' that signal well after tissue damage and that inhibition of this activity diminishes the perception of pain. There are spinal cord sensory cells, that when activated by injury refers pain to portions of the body that share these neurons, or cell cross talk. These fibers release glutamate and peptides from their central terminals and this biochemical cascade magnifies and enhances the response, becomes triggered into a long lasting spinal sensitization and the resulting hyper sensitization to pain even spills over into un-injured tissue."
This biomechanical cascade throughout the body over a period of developing hyper-sensitivity means you can have sites of pain all over where there is no injury. This understanding is vital. Similar to many MD's, some massage therapists fall into the trap of being judgmental, supposing their clients are somewhat neurotic and using an imaginary pain as a secondary benefit in life. You must always believe everything they tell you. "When they tell you the pain is real, it is real," said Dr. Daniel Clauw, Professor of Rheumatology and the director of the University of Michigan Chronic Pain and Fatigue Research Center, is the country's leading expert on Fibromyalgia and the author of many studies. "In people without pain, these structures encode pain sensations normally. In people with fibromyalgia, the neural activity is increased."
"It is time for us to move past the rhetoric about whether these conditions are real, and take these patients seriously as we endeavor to learn more about the causes and most effective treatments for these disorders," said Richard Harris, a Research Investigator.
These studies indicate that fibromyalgia patients have abnormalities within their central brain structures. Clauw states, "this is a diffuse, central problem with pain processing, a problem with the way people are processing pain or sensory information." Pain, he says, "is a miscommunication between the brain and the spine. It's as though someone has increased their volume control center, turning the volume up."
How do we use this information? The brain, spinal cord and the CNS are described as listening systems. The new neuro-sciences when referring to the brain and CNS use the expression plasticity. They are not fixed but are plastic; the input from the extremities can be changed. We do this by giving the listening systems new information and changing the direction of the input back into the higher centers. This remodels how the brain and CNS modify how they process pain.
The handmaidens of chronic pain syndromes are fear, anxiety and underlying anger. Pain in itself is harmless.
It is how the brain and CNS process and respond to perceived injury insult that cause the alarm. There is not the software to do an MRI, CAT scan, PET scan and X-Ray of the sensitive nervous system. The sensitive nervous system has gone off like a fire alarm, every fire department in the region has been mobilized, lights flashing, loud sirens piercing the night, and guess what, there is no fire! I tell the client that rightly or wrongly their "silent alarm has been tripped" and their brain and CNS believes they are under attack. They only response the body has to protect them is the inflammation response with the end result of pain.
Now here comes the tricky part, especially for a male therapist talking to women in pain. I compliment them on being so sensitive, as the truly caring and compassionate souls of this world often end up in pain. I try to change the context of the pain from not being some sort of divine punishment, but rather an unfortunate random reaction to a very stressful world. If your intention is good and kind, that shines through. When you carefully and gently suggest there is nothing physically wrong with them, rather they have a lovely kind friend deep inside trying so hard to help them, maybe too hard, they seem to accept that. Not only are you the only one that has patiently listened to them, but you also are the only one that is actually going to gently touch them for an hour, a rarity in the medical profession.
Listen to your client; but you must have a specific program in mind. If this is done seamlessly, moving back to the original site of pain briefly, there is not the time for the client to work out what you are doing, so there is a certain amount of distraction. I really like a side lying position with the client at the very end of the table. This is not working on soft tissue only; my intention is to dramatically change the input into the CNS. If you get the nervous system on your side first, then any therapy you use will be infinitely more successful.
Remember, during all this time you are talking to the sensitive nervous systems, re-assuring these delicate systems they are safe and secure and to desist in their protective mode. That is what getting the nervous system on your side first means. This is the most important part of any treatment.
Stuart Taws is a Sports Rehabilitation Therapist originally from England, now living in California. Stuart is the developer of Soft Tissue Release - the Taws Technique. For 20 years he has been teaching through Massage Schools and Weekend Workshops. For more information, visit www.softtissuerelease.com or
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