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.
July, 2014, Vol. 14, Issue 07
TDR Massage Protocol for Pain Relief
By Linda LePelley, RN, NMT
Tissue Density Restoration (TDR) massage was developed in response to my clinical observations over a number of years that musculoskeletal tissues experiencing pain are associated with an elevation in tissue density (TD) and once the elevated TD is reduced, the pain is alleviated.Wanting to focus on these phenomenons and better understand their nature, I decided to stop doing relaxation massage and limited my practice to clients in pain.
My original focus was directed at determining the components of treatment that are most effective and discarding actions that, at best, do not appear to contribute to improvement or, at worst, are counterproductive. I asked my clients to participate; rather than just laying back and quietly enjoying the massage, they keep me informed about what they are experiencing throughout the treatment. Patterns of duplicable efficacy emerged, resulting in an extremely beneficial protocol.
Once I determined I had a replicable method of alleviating pain by treating the elevated TD, the questions that remained were:
The answers I've found are much like the treatment itself; simplistic, easily dismissed by some because they seem too elemental and easy. However, they are consistently reliable. In my experience of actively looking for elevated TD, I've found it happens to everyone in pain. All musculoskeletal pain can be located and felt (in the tactile sense) by a second person, as palpable areas of indurations at the locus of pain. From the toes to the top of the head, elevated TD can be found at any physical location that hurts. The older a person is, the thicker and more compressed the density can be. I suspect the reason has more to do with a buildup over time, rather than degenerative changes of aging. Rather than deterioration, it seems more accurate to describe it as a disorder of accumulation. (Perhaps previous injuries lay a foundation upon which TD builds? Maybe a residue is deposited during the inflammation process which, if not cleared out through normal circulation, attracts mineral deposits over time.) Through close observation and repetition I've found that the more malleable the affected tissue becomes, the longer the relief will last. People can be fully relieved of chronic pain and that relief retained with maintenance massages.
How it Works
I have ideas of how and why TDR massage works, but they are just that, ideas. I am not a pathologist, biochemist or neurologist, nor do I have the time or inclination to acquire the additional education it would require to be able to investigate the physiology involved in the formation of elevated TD. But I don't need to. I trust what I can see, experience and duplicate. I don't have to fully understand the mechanism of the combustion engine to drive a car, but that doesn't impair or hinder my ability to do so. I can leave scientific research to those who have dedicated their education and interest and are qualified to do such work. I suspect that in much the same way that I am impelled to discover how to affect changes in tissue density, a motivated researcher will investigate that explanation one day. I am a nurse massage therapist – my duty, talent and intention is to provide my clients the best possible pain treatment outcomes.
In order to share the method of TDR massage, I use the term, "Protocols". While I do not anticipate changes to these protocols, I think that it's a mistake to declare rules and dogmatically follow them. Doing so fosters resistance to any future perspective or observation that may suggest they need to be adjusted. It also stifles exploration, hinders growth and suppresses conversation and communication. With that said, I've found that by following these directions, the results are reliable and effective.
TDR Massage Protocol
The massage movements I use are abbreviated Swedish – friction effleurage in small, circular areas; using slight petrissage movements, which helps monitor the boundaries and density of the target area as they change throughout the treatment; and vibration, which can be used as the tissues become malleable and are able to be grasped and gently shaken. The smaller the focus area, the sooner it is likely to be resolved.
You will want to measure and document the state of the target area before providing treatment and then again afterwards, using the Tissue Density Grading Scale (TDGS). (See "The Tissue Density Grading Scale: A Communication Tool," Massage Today, March, 2014.) By doing so, you will have an accurate picture of the condition the tissues were in before treatment and proof of the effectiveness of your treatment afterwards.
First, focus on the location of the pain and target the worst spots first. (As tissues soften and the pain begins to resolve, the target area may shift.) Causing pain promotes the localized excretion of inflammatory chemicals which I suspect may play a part in the development of elevated TD. Regardless, there is no reason to exacerbate an already painful condition. The amount of pressure to use at any time will depend on the clients ability to tolerate it without going over a 3 on the 0/10 pain scale. Using the Walton Pressure Scale along with the TDGS will help you determine treatment progress and provide more precise documentation.
Keep the tissues you are working on moving continually. This will usually require working on areas no larger than the span of your two hands at a time. Doing so not only contributes to tissue heating through friction, but I believe that in addition, the movement combined with appropriate pressure, creates a fatigue state that helps soften TD.
I have found that it takes about 45 minutes of consistent, firm, circular massage to begin to affect change at which time you can feel a smoothing of ridges and softening change in the density of the target area. At this time, the client will also state that it feels better. Continue treatment(s) until the indurations are no longer palpable, and tissues are with a Grade 1 on the TDGS.
If the condition requires more than one treatment to resolve, it is best to schedule following treatments as closely as possible. The tissues seem to remain more malleable for a few days following treatment, thereby not requiring as long to respond and soften.
This protocol applies to pain of any size, at any location. When a new client comes seeking relief, I tell them that if I can feel elevated TD at their pain site, I will be able to help them. As one develops their sensitivity to the palpable varieties of tissue densities and becomes adept at restoring it, they will find themselves able to truthfully state, "I feel your pain," and then relieve 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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