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News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
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.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
August, 2014, Vol. 14, Issue 08
How To Effectively Work with Wheelchair-Bound Clients
By Sharon Puszko, PhD, LMT
There are more than 1.7 million people in the U.S. who depend on wheelchairs and scooters to get around. Most of these people are currently over the age of 65, which means massaging them requires specific knowledge about how to work with geriatric clients, as well as clients with mobility issues.With the growing number of elderly in our country, as well as veterans of war, practitioners would benefit from learning how to properly work with wheelchair-bound clients.
Injuries to the elbow, wrist and hand are common among wheelchair users, but shoulder injuries are the most prevalent. Torn rotator cuffs and tendinitis are often the causes of shoulder pain. Muscle imbalance caused by overuse can lead to abnormal biomechanics and thus, injury. The most common disparity in strength associated with rotator cuff tear or tendinitis is an imbalance between the internal and the external rotators of the shoulder. Also, the prevalence of carpal tunnel syndrome among manual wheelchair users is between 49% and 73%.
Proper positioning in the wheelchair is probably most important for the prevention of repetitive strain for manual wheelchair users. A combination of manual mobility and powered mobility may be a workable compromise for some wheelchair users. Modern manual wheelchairs are easier to transport and easier to carry than powered wheelchairs. However they may not offer the same degree of independence for users with chronic arm or shoulder pain.
Many people who use wheelchairs suffer from foot pain as well. Walking and standing allows people to stretch the achilles tendon that runs up the back of the leg. Constantly sitting can cause the achilles tendon to shorten, placing the foot in a constant state of extension. Many people using wheelchairs develop plantar flexion, a condition in which the achilles tendon shortens as a result of sitting for most of the time. When the foot is being pulled into an extended position by the ever shortening Achilles tendon, it becomes very painful as it progresses. Plantar flexion also makes relearning to walk after a stroke even more difficult because it disrupts the normal heel to toe gait. An extended foot massage can help relieve some of this pain. Passively flexing the foot and stretching the calf muscles can also help with pain management of this condition.
"Massage therapy is seen as a positive method of pain management, but just treating the pain is not an end in itself," said James Laskin, MS, PT, adjunct professor for the division of rehabilitation services at the University of Oklahoma and the Health Services Center of Oklahoma City. He emphasizes the importance of treating the problem, not just the symptom.
Many people who spend their time in a wheelchair will develop pressure sores. These lesions are caused by unrelieved pressure over a period of time sufficient to cause the destruction of soft tissue cells. The pressure between bone and searing surface compresses the soft tissues of the buttocks and forces the blood out of the tissues. The longer one sits without movement to change the pressure areas, the greater the cellular damage. The same process occurs for those of us who can walk when we sit on a hard surface for too long. However, our subconscious nervous system causes us to move periodically, shifting the pressure points and allowing blood to re-enter the compressed tissues. Spinal cord injury causes a loss of the sensation that is vital to this process.
Most paraplegics and quadriplegics have no feeling in their soft tissues. They feel no distress, fail to move periodically and consequently develop pressure sores. Chair-bound individuals are advised by their physicians and therapists to change their position every 10 minutes or so by doing "pressure lifts" or other pressure point changing routines designed to stimulate the flow of blood to soft tissue. This allows the blood to re-nourish the tissues that have been under high pressure. The sad fact is that people forget to move, or may be unable to move themselves. The use of massage therapy on the coccyx, ischium (pelvic bone) and lower back can help prevent pressure sores on wheelchair users.
Even with the best passive cushion technology available, pressure sores are one of the greatest health risks a chair-bound person can have. They can cause a drastic decline in quality of life. Curing a sore may require weeks or months lying face down on the stomach or even skin grafts. Deep sores may very well develop into life-threatening bone infections, and can change a productive, self-sustaining individual into a bed-ridden patient dependent upon others for a long period of time.
Ultimately, the benefits of massage therapy for wheelchair-bound clients include improved range of motion, circulation and alleviated decubitus ulcers. This specific modality is also important for the massage therapists who are led to the rewarding practice of working in nursing homes and with assisted-living residents.
Sharon Puszko is the owner/director/educator for Day-Break Geriatric Massage Institute. She may be contacted at
or through her Web site: www.daybreak-massage.com.
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