resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
May, 2014, Vol. 14, Issue 05
A Practical Application of the Tissue Density Grading Scale
By Linda LePelley, RN, NMT
The Tissue Density Grading Scale (TDGS) was developed to reliably represent the condition of musculoskeletal tissues at all stages of treatment or progression. By comparing pre-treatment assessments that include the TDGS with a post-treatment follow-up assessment, the effectiveness of any massage therapy treatment can be objectively depicted and documented.
While the following example makes reference to the use of Tissue Density Restoration (TDR) massage, it is important to understand that the TDGS is representative of the state of musculoskeletal tissues regardless of any type of treatment, or what treatment that may be. TDR massage is just the modality I happen to use, but any other type of massage may be evaluated in the same manner, whether it is Trigger Point Therapy, Myofascial Release, CST, Bowen, etc.
The basic TDGS follows. A more complete explanation of the scale may be found in the March 2014 issue of Massage Today.
Tissue Density Grading Scale
A Case Study
A 54-year-old male client presented complaining of moderate to severe pain in his left shoulder stating, "It hurts all around, it's stiff, I have trouble lifting my arm and turning my head to look back is difficult." He attributed it to a 20-year-old auto collision, combined with age and a recent drop in the temperature seemed to have made it worse. He was not able to raise his left arm to shoulder height. He stated that he didn't want to go to a doctor because he didn't want pain medication or muscle relaxers, which were all he'd been offered on previous visits to complain about the same symptoms.
Having the client right side-lying, I gently grasped the glenohumoral joint and attempted to mobilize it. I found the entire region was resistant to movement, resulting in rocking the client's entire upper left quadrant and head. The scapula's medial border seemed to be firmly engulfed within the tissues above and below it; they felt rubbery and solidified. The client's right side, by comparison, was found to be very mobile, with normal range of motion.
I explained to my client that, because I could feel and demonstrate to him the elevated density in the affected tissues, I believed I could help relieve his pain and improve his range of motion. I suggested several treatments, with the first ones given as closely together as possible.
The basic guidelines for Tissue Density Restoration (TDR) massage are:
I started the assessment/treatment with the client on a warm table, using a heat transferring device, similar to a hot stone. I began to feel areas that were notably firmer than their surroundings. As the tissues became a little more malleable, I asked my client to identify the areas that hurt the worst. He directed me to spots just above the superior border and superior angle of the left scapula; the top lateral edge of his humerus; and near the base of the deltoids. We also found a large, hardened area between the upper medial aspect of the scapula and the spine. Its location and density prevented the scapula from being able to adduct. I explained to my client that while it didn't belong there, it probably consisted of multiple layers of tissues that do belong – they have simply adhered to each other and conglomerated. The good news, however, is that no matter how uncomfortable and disruptive the structure may be, it can be restored to normal density and proper functioning.
The first hour of my client's initial two hour visit was spent determining the areas that were causing the greatest amount of pain and dysfunction. These target areas were determined to be:
The remainder of the session was spent using TDR massage techniques. By the end of the massage, the borders of the identified areas were more pronounced and easier to locate, due to softening of the surrounding tissues, as well as some improvement in the target areas. The results of the post-treatment assessment were:
This client received four treatments in the first week, followed by six more weekly treatments. The client states he is very happy with the results, he feels as if he is 75% to 80% improved. He claims he is able to turn his head easily when backing up in his car; and he has a full range of motion in his arm and shoulder. At this point the TDGS is:
I hope this example of how I use the TDGS portrays the value and usefulness of this tool. You may have noted that a color is associated with each grade. By color coordinating the numerical grade, one may provide a more comprehensive illustration of the size, location and condition of affected tissues on any anatomical diagram. The TDGS is easily adapted into whatever documentation form you prefer, whether it be written, drawn or both.
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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