Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
May, 2014, Vol. 14, Issue 05
Deep Tissue Massage Helps Plantar Fasciitis
By Massage Therapy Foundation Contributor
Contributed by Derek R. Austin, MS, CMT, Beth Barberree, BA, RMT, MK Brennan, MS, RN, LMBT
Can ten minutes of deep tissue massage combined with stretching alleviate plantar fasciitis? Plantar fasciitis, also known as plantar heel pain syndrome (PHPS), is a common pathology characterized by pain on the sole of the foot.Often, the pain is worse in the morning and when coming up on the toes of the affected foot. Both the plantar fascia and plantar flexor muscles are often tender to palpation and may contain myofascial trigger points. Unfortunately, there is limited evidence for what clinical treatment is effective for PHPS. More and more, massage therapy and stretching are seen as first-line interventions, in contrast to steroid injections or possible surgery.
Since shortening of the plantar flexor muscles could increase stress on the plantar fascia, it seems reasonable that massage to these muscles would relieve foot pain in patients with PHPS. However, until recently, there was no scientific evidence that deep tissue massage of the calf muscles reduces PHPS symptoms. The Massage Therapy Foundation's research column is summarizing a recent single-blind randomized clinical trial on the effects of deep massage combined with neural mobilization exercises. The article is titled "Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: A pilot randomized clinical trial" and was published online in the journal Manual Therapy in September 2013.
The authors, based at an outpatient physical therapy clinic in Israel, recruited consecutive patients with PHPS who were referred by an orthopedic surgeon. PHPS was defined as plantar heel pain that was worse with initial weight bearing after a period of rest but improved with activity. Patients were excluded if they had systemic disease, tumor, fracture, a history of corticosteroid use, severe vascular disease, prior lower leg surgery, referred pain to the heel from a source other than the posterior calf muscles, or an inability to attend scheduled treatments. The study was single-blind in that one author, who did not provide treatment and did not randomize patients, conducted the physical examinations at admission and discharge.
Sixty-nine patients were randomized into either the massage group (n = 36) or the ultrasound group (n = 33). There were no significant differences between the two groups of patients at baseline. All patients received eight treatments over a 6-week period with a frequency of 1 to 2 sessions per week. Treatment was performed by one of fifteen staff physical therapists. It was noted that only 51 participants completed the treatments and discharge assessment. Additionally, there were no significant differences between those who dropped out of the massage group and those who dropped out of the ultrasound group.
The massage therapy intervention was performed with the patients lying prone with their feet off the end of the table. Ten minutes of deep massage therapy was performed using "forceful soft tissue massage mobilization techniques, described by Cyriax (1984), directed to the incompliant and painful areas of the posterior calf muscle group." The therapists massaged the medial and lateral aspects of the posterior calf from both a medial and lateral approach. The pressure was deep enough to generate a pain response and was performed with thumbs or another body part, such as an elbow.
The massage intervention was compared to a treatment of ultrasound. The authors report that although ultrasound has not been shown to be effective for PHPS, it is still commonly used in some physical therapy clinics. Ultrasound was delivered to the painful area on the heel using slow circular movements for three minutes at a frequency of 1 MHz and intensity of 1.0 W/cm. The ultrasound group did not receive the neural mobilization exercise.
Calf muscle stretching has been shown at both short- and long-term follow-up to be effective in managing PHPS. Thus, all patients in the study were instructed in self-stretching directed at the posterior calf muscles. A standing calf stretch was taught, with the affected foot furthest from the wall and both feet positioned in a line. The patient leaned forward while keeping the heels on the floor until a stretch was felt in the posterior calf or achilles. In order to stretch the gastrocnemius, the back knee was kept extended, and, in order to stretch the soleus, the back knee was bent. Each of these stretches was performed three times daily, 5 repetitions of 20s stretching with 10s rest.
In addition to the calf stretches, the group of patients randomized to receive deep massage also performed a neural mobilization exercise. Patients performed a passive straight leg raise with dorsiflexion using a long belt. The idea was that doing so would increase tension on neural structures such as the plantar nerve and further alleviate pain. The authors do not state the duration or frequency of this neural mobilization exercise, though it may have been performed like the stretches.
In order to assess response, the authors used the Foot & Ankle Computerized Adaptive Test (CAT), which is a patient-rated functional outcome measure based on the Lower Extremity Functional Scale (LEFS). The Foot & Ankle CAT is rated from 0 (low functioning) to 100 (high functioning). Pain on taking first steps in the morning was rated on a 10-cm visual analogue scale (VAS).
The authors performed a mixed-model ANOVA, which showed a significant group-by-time effect (p = 0.034) for change in the Foot & Ankle CAT in both groups. This change was still significant (p = 0.025) after the authors controlled for age, gender, body mass index (BMI), and chronicity. The massage group improved on the Foot and Ankle CAT from an average of 47% at baseline to an average of 62% after treatment. The 95% confidence interval for improvement in the massage group was 9% to 21%. The ultrasound group improved on the Foot and Ankle CAT from an average of 50% at baseline to an average of 56% after treatment. The 95% confidence interval for improvement in the ultrasound group was 1% to 11%. The group-by-time interaction from the ANOVA indicated a significant (p = 0.034) difference in improvement between the two groups.
The pain level with first morning steps of patients in both groups also decreased significantly for all participants. However, there was not a significant difference in pain levels between the groups. The massage group reported a reduction in morning pain levels from an average of 6.8 out of 10 at baseline to an average of 4.2 out of 10 after treatment. The 95% confidence interval for pain improvement in the massage group was -1.4 to -3.4. The ultrasound group reported a reduction in morning pain levels from an average of 6.9 out of 10 at baseline to an average of 4.4 out of 10 after treatment. The 95% confidence interval for pain improvement in the ultrasound group was -1.4 to -3.8.
The authors concluded that the change in functional status of the patients in the massage group was both statistically and clinically significant. They stated that the change in functional status of the patients in the ultrasound group was not clinically significant despite being statistically significant. Both groups experienced a clinically relevant improvement in pain with first steps in the morning.
The study has limitations that affect its applicability to everyday massage practice. The study included a small sample size with many patients who dropped out. There was no true control group, as patients in the ultrasound group received a treatment of ultrasound as well as the calf stretches. Finally, since only the massage group received the neural mobilization exercise, the use of this exercise confounds the effect of deep massage.
In conclusion, deep massage of the posterior calf combined with stretching may improve the function of patients with plantar fasciitis more than a combination of ultrasound and stretching. Ten minutes of deep pressure massage to the posterior calf easily fits into most therapeutic massage sessions and may be worth a try with your clients. Regular self-stretching of the gastrocnemius and soleus muscles appears to be an important part of managing plantar fascia pain in patients with PHPS. Future research could explore the use of other massage techniques including possibly massage of the plantar fascia itself.
If you follow this column, then you know that exciting research about massage therapy is being done right now. Your massage therapy practice can be improved by relying on evidence-based interventions. In order to help massage therapists learn the ins-and-outs of research, the Massage Therapy Foundation has created a course on the Basics of Research Literacy. This online, 8-hour, NCBTMB-approved workshop, teaches massage therapists and educators how to incorporate principles of research literacy into your practice and teaching.
Not sure what to make of a confidence interval, p-value, t-test, or ANOVA? In this easy-to-use online course, you will learn basic research vocabulary and concepts, how to use various databases to look up research, evaluate published research articles for their validity, and apply research findings to massage practice to improve outcomes.
To learn more about touch and caregiving, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search Pub Med for CAM/CIM cost analysis studies.
Click here for more information about Massage Therapy Foundation Contributor.
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