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Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
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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