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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
June, 2014, Vol. 14, Issue 06
Traditional Thai Massage Improves Bone Formation in Postmenopausal Women
By Massage Therapy Foundation Contributor
Contributed by April V Neufeld, BS, LMP, Jolie Haun, PhD, LMT, Derek Austin, MS, CMT, CSCS
When you were young, your parents may have told you drinking milk would give you healthy bones. As adults, we learn that activities such as exercise are also necessary in helping our body maintain bone density and decrease the risk of osteoporosis. This month, we will discuss a recent study showing how promoting healthy bones can be as easy as receiving Thai massage while lying relaxed on a floor mat.
A study performed at the Endocrine and Metabolism Unit of Ramathibodi Hospital in Bangkok, Thailand, and subsequently published in BMC: Complementary and Alternative Medicine (2013), examined the effects of traditional Thai massage on bone formation in postmenopausal women. The researchers speculated that the pressure exerted by the massage therapist on the patient may, "induce strain in the skeleton and affect bone, similar to other means of applying mechanical load."
Forty-eight postmenopausal women participated; subjects diagnosed with any disorders affecting bone metabolism such as diabetes, cancer or rheumatoid arthritis, among others, were excluded. A randomized crossover design was used, meaning each participant was in the control and the treatment group. In describing the design, the authors wrote, "Subjects in the treatment group underwent a two-hour session of Thai traditional massage twice a week for four weeks, while no intervention was given to subjects in the control group. After a two-week washout period, subjects were switched to the other arm of intervention for four weeks." Additionally, the subjects were asked to avoid exercise for 24 hours and to fast for a minimum of 10 hours prior to the morning blood test. In order to track changes in biochemical markers of bone turnover, each subject had measurements taken of their body and bone composition, as well as the bone mineral density of their first four lumbar vertebrae, neck of the femur and hip as a whole.
The methods of the study described the traditional Thai massage in moderate detail. A single massage practitioner performed Thai massage for two-hour sessions that involved direct pressure by the heel of outstretched hands on the subject's body for about a one to two second duration. The researchers outlined the subject's position (lying on back, lying on side, lying on chest) and various positions of the practitioner with photos. However, inadequate detail was given describing the amount of pressure being applied by the massage therapist. And, while the researchers indicated that the massage therapists applied pressure using the heel of the hand, the photos clearly indicated that fingers and broad hand positions were also used.
In a previous study, the researchers measured that a single two-hour treatment of traditional Thai massage increased the markers for bone formation by 4.8%. This current study indicated that two treatments per week resulted in higher markers, with the biggest improvement noted in the older women with smaller body frames (14.8% ± 3.3%). This is exciting news for older women who are concerned about osteoporosis and are not actively involved in a strength training routine, as well as for massage therapists who frequently use compressive techniques during treatments. The researchers discussed several other studies related to this project. Previous research has indicated that massage will decrease bone pain, improve bone growth and promote lean mass and bone growth in the early postnatal period. Additionally, people who participate in physical activity in addition to massage during the peri-neonatal period have improved bone formation. However, there is little research on the effects of massage on bone metabolism in adults.
As many people already know, performing mechanical load exercises (i.e. weightlifting and load bearing exercises such as walking and running) put strain on our skeletal muscles that then induces bone growth. Active and passive exercises will improve bone mass and decrease bone loss. What research has not yet shown is whether a light load must be accompanied by a high frequency in order to be as effective as a heavy weight with low frequency. It may be possible that low-impact activities such as walking or receiving massage must be repeated more often to receive the same benefits in terms of bone formation of someone lifting heavy weights less often. When speaking with our patients, we should note that this study indicates that Thai massage should be performed two times per week to have an impact on bone markers.
Though these findings are intriguing, the researchers discussed several limitations to the study. Most notably, this study does not specifically indicate that increased bone markers will result in increased bone mass and reduced fractures. Additionally, this study had a fairly small subject pool (n=48). It is also unclear if the effects of this study could be generalized to all massage therapists since only a single massage therapist was used to provide the Thai massage. The researchers also failed to mention the qualifications or education training of the massage practitioner. Future studies with this team should provide more details about the massage itself, such as qualification standards and a massage protocol for consistency and replication. One additional limitation was noted, in that the researchers indicated that while they excluded subjects taking medications for osteoporosis, they did include seven subjects who had osteoporosis at the spine, femoral neck or hip. Including women with an existing history of osteoporosis would certainly impact the results.
Despite the limitations of this research, the findings still have important implications for research and practice. First, we often think of outcomes associated with massage related to stress and pain reduction, however this study demonstrated healing effects of Thai massage that might not have otherwise been considered by most. This research extends the body of knowledge in massage research outcomes and can be used to help practitioners explain the impact of their work in promoting healthy bones. As practitioners and researchers work together to explore the impacts of Thai massage and other touch modalities on diverse outcomes, we continue to expand the knowledge of this work and its application to the larger field of health and wellness.
If you would like to read more details about this study, you can find the link to the full article at Biomed Central or visit the Massage Therapy Foundation's archive of research review articles.
Click here for more information about Massage Therapy Foundation Contributor.
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