Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Acupuncture in the U.K. Today: A Personal View
When asked to write a short piece on the current state of the U.K. acupuncture profession, my first response was to say it has all been relatively quiet.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients, in May 2014, researchers showed that drinking the equivalent of 2 to 4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Calculating Billable Units
I recently learned of an office that was audited based on the number of acupuncture sessions performed in one day. Is there a maximum number of sessions that can be performed in one day?
Use Technology to Gain New Patients and Improve Efficiency
From the smartphone in your pocket to your microwave oven, advancements in technology have made almost every aspect of our lives easier.
The Nectar of Plants: Essential Oils and Chinese Medicine
Essential oils are a very hot topic these days, especially with the likes of the Ebola virus and the resurgence of measles lurking in our awareness, but when I first became interested in Chinese medicine, essential oils weren't on the radar screen for acupuncturists.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
What Does Success Mean to You?
Recently, I was asked to speak to young, budding businesswomen about running a successful business — and at first I thought, "Me? You want me to speak to others about success?!"
Acupuncture and the Pulse
In 1991, I attended a martial arts workshop hosted coincidentally by Sung Baek, a martial artist and the head of his lineage as a Korean trained acupuncturist. I was enamored by the details Sung could attain from the pulse, as told to me by some of his apprentices.
The Source-Luo Point Combination
The luo collaterals are part of the acupuncture channel system presented in the Su Wen and the Ling Shu (The Nei Jing). The function and clinical application of the luo mai are primarily presented in chapter 10 of the Ling Shu, however, they are also found in others chapters in the Su Wen and the Ling Shu.
The Modern Acupuncturist
You studied ancient Chinese medicine, but I'll bet you don't practice it! Contrary to popular belief, our medicine has evolved A LOT over the years. Let's take a brief walk through history and discover the differences between ancient and modern acupuncturists.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
TMF 2015 Scholarships
The Trudy McAlister Foundation (TMF), a nonprofit organization established to support students who are on track to make contributions either to clinical practice and/or to the understanding of the role of Traditional Oriental Medicine, has announced the 2015 scholarship recipients.
How One Little Symbol (#) Gets You More Patients
Are you struggling to get more fans or followers for your acupuncture practice? Or are looking for ways to simply connect with your patients? Or do you just want to know how to keep them engaged (comments, retweeting, liking and sharing)?
The Year to Make Things Happen
It is hard to believe that the Year of the Ram – 2015 is half over. Time seems to be moving especially fast. This is the year for things to happen for the acupuncture profession.
March, 2014, Vol. 14, Issue 03
The Tissue Density Grading Scale: A Communication Tool
By Linda LePelley, RN, NMT
Most of my years of clinical work as a nurse massage therapist have been focused on exploring the density of tissues. I've consistently observed that the client's areas of subjective pain are closely associated with an objective increase in tissue density (TD) and, when that elevated TD is reduced or restored, the pain is resolved.Several therapists have contacted me since I began writing about elevated TD, to let me know that they have experienced the same phenomenon, and appreciate that I have introduced and described it. More of the relationship between elevated TD and pain is discussed in "Tissue Density's Relationship to Pain and Dysfunction" (Massage Today, April, 2012).
In the course of treating musculoskeletal pain, a therapist needs to document the care that has been given for the purpose of assessing the efficacy of the treatment provided, and for sharing that information with the client and others, such as the referring physician/therapist; other members of the health care team; or for insurance reimbursement purposes. While it is not definitive, I've developed the Tissue Density Grading Scale to be that practical communication tool. Regardless of the treatment modality utilized, TD grading is a useful way to compare treatments and assess their effectiveness.
Tissue Density Grading Scale
Grade 0 (Yellow) = Tissue is flaccid, hangs from attachments and has little to no resistance to gravity.
Grade 0 (Yellow) – depicts advanced wrinkling; the hanging tissues found on some chins and underarms and the sagging, drooping tissues often noted on persons who have quickly lost a great deal of weight. It is important to note that grade 0 tissues are often found superficially over an area of elevated TD in the 2 to 3 range. It may feel as if the loose tissues have separated from deeper tissues, which in turn are becoming condensed. The deeper tissues are usually tender with moderate palpation, with easily definable borders.
Grade 1 (Green) – TD represents normal, healthy tissue that is pain-free, well hydrated and well perfused. It is easy to palpate, identify and differentiate muscles, bones, ligaments and other connective tissue. Usually warm to the touch with no pitting when palpated.
Grade 2 (Blue) – TD indicates elevated tissue density. Upon palpation you will find the tissues tight, sometimes hardened and resistant to mobilization. They do not relax easily and are reported to be uncomfortable, even painful. Clients often describe Grade TD 2 tissue as being tight, sore, achy, heavy, stiff and/or painful. However, grade 2 TD can be latent, without complaint of pain or dysfunction until activated by injury, use or palpation. The borders of the affected areas are easy to determine.
Grade 3 (Red) – TD can be found in small strands and bands interspersed with other grades of TD, causing much pain and dysfunction, such as that of Carpal Tunnel Syndrome and Tendonitis. Larger areas are often found in a wide variety of conditions, such as Restless Leg Syndrome, MS, Parkinson's, and Fibromyalgia. Grade 3 TD feels firm and rubbery, and is resistant to mobilization.
Grade 4 (Brown) – TD is associated with profound dysfunction, for example, curvatures and contractures such as those experienced by persons who are bedridden or extremely sedentary for long periods of time. Painful knots and lumps, and the “bony overgrowth” found in arthritic conditions are composed of grade 4 TD. It is hardened and often believed to be composed of bone.
It is important to note that although an area of tissue may be palpably denser than that of its surroundings, it may not be tender or painful. However, an area or spot that hurts will exhibit elevated TD. By softening hardened tissues and restoring those to a more malleable, mobile, smooth condition, nerves and nerve endings are no longer being painfully trapped and tugged. Normal tissues do not hurt when squeezed or pressed into. When you focus on the clients' directions to pain locations and the firmness of the involved tissues, you can locate, successfully treat and document most musculoskeletal pain complaints.
Along with the graduated number scale to differentiate tissue densities, each level is also color coded to provide for the creation of a more graphic representation, if desired. Because a TD Grade is objective, you (the therapist) should make your own determination of TD. You should have the client direct you to the area that is most uncomfortable or painful, and document their description of the pain quality and level, but grade TD based only on what you actually feel. If you can feel a lump, ridge or textural change, so can anyone else who is looking for it.
Linda LePelley, RN, NMT is a registered nurse and licensed massage therapist with 19 years of clinical massage experience. She developed Tissue Density Restoration (TDR) Massage, an effective treatment for the pain found in hyper-dense tissues. For more information, visit www.MyHealingHands.com.
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