resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
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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