resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
Should They Stay or Should They Go?
No, I'm not talking about that song from The Clash. Let me begin by telling you that the client we will discuss had too many correlating tests and symptoms to stay. Based on this client, we will be taking a look at vertebral artery stenosis or insufficiency and the risk factors of treatment. We will discuss some of the signs and symptoms that just might make you want to play this tune in your head when a medical massage type of client comes walking in your door. More clients and more doctors are recognizing the words medical massage. Although that is great, it certainly comes with an entire set of specialized expertise that doesn't necessarily mean a strong sense of palpatory skills.
Should you treat or should you delay treatment or should you not treat at all is the biggest question for a therapist that states they do medical massage or any specialty massage that has the goal of relieving pain. It is truly imperative that the client get a full medical clearance in order for you to safely perform medical massage that would include stretching, soft tissue manipulation, isometrics, or traction, if necessary.
In talking with another colleague of mine, we both agreed that the longer we have been in the massage therapy profession the less anxious we are to jump right in performing manual therapy without first knowing the complete history of the client and making sure the doctor knows the type of therapy the client is about to receive. There are a ton of unusual circumstances that seem to seek out our help these days. And the client situation we are going to talk about in this article was no different.
She had been referred to me by a friend. Over the phone, she stated she was having left neck pain and occasional headaches that weren't getting any better with either physical therapy or chiropractic care. She had hopes that a medical massage might help. Sounds simple, doesn't it? Maybe soft tissue issues with the scalenes, trapezius muscles, or the SCM? When she presented with her reports and history, and I performed a cervical assessment, it became alarmingly complicated. So much so, I didn't treat, I wrote a report for her general physician, neurologist, and chiropractor asking them to make sure she could receive medical massage therapy with light traction.
Here is what set this all in motion. Her reports raised significant concern for manual therapy without medical clearance and this is only the impression of the report, not the whole report.
First, there were spinal biomechanical alterations noted in the C spine. Second, intercalary bone formation at C3,4,5,6 disc levels. Third, posterior osteophytes formation is suspected at the C6 disc level. Fourth, spondylosis, unconvertebral arthrosis and facet arthrosis in the cervical spine more prominent at the C6 level. Fifth, osteopenia advanced for her age. And sixth, the neural arch of C1 seemed incomplete.
Her lumbar report stated that they saw atherosclerotic calcific plaguing present within the abdominal aorta. It also stated she had baastrups kissing stenosis of the lumbar spine. Spondolosis and arthrosis at the lower thoracic and lumbar spine most prominent at L3. Also, spinal biomechanical alterations noted. Red Flags: The calcific plaguing can be happening in any artery and the aortic artery has a branch to the left vertebral artery.
Definitions you need to know
Intercalary bones are common discal ossifications that are usually triangular in morphology, found in the anterior annular fibers of an intervertebral disc, and are thought to be degenerative in aetiology.
Osteophytes, commonly referred to as bone spurs or parrot beak, are bony projections that form along joint margins. They should not be confused with enthesophytes, which are bony projections that form at the attachment of a tendon or ligament.
Unconvertebral arthrosis is a term used to describe a specific form of osteoarthritis affecting the unconvertebral joints, more commonly known as the Luschka's joints, located along the cervical vertebra.
Facet arthrosis is a term used to describe how the joint cartilage deteriorates – and joints depend on this cartilage to stay lithe and mobile.
Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.
Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis. Bone density is a measurement of how dense and strong the bones are.
Baastrups syndrome (also referred to as kissing spines) results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in hypertrophy and sclerosis with focal midline pain and tenderness relieved by flexion and aggravated by extension.
According to an article written by the American Heart Association, abdominal aortic calcification deposits, detected by lateral lumbar radiograms, are a marker of subclinical atherosclerotic disease and an independent predictor of subsequent vascular morbidity and mortality.
Why I Said No
First, I asked the question why physical therapy hadn't helped. Physical therapy was able to relieve her headaches but not the left sided neck pain. Red Flag: Left neck pain since July and it is now January. Why?
Second, she relayed she had been having vertigo for the past two months that had not been discussed with any of her three medical professionals, only the physical therapist. She had an incident during physical therapy and the physical therapist performed a maneuver that helped. However, she experienced nausea and vomiting for about four hours that evening. She also stated that the vertigo could happen at rest and/or always seemed to happen when she turned her head to the right.
Red Flags: Only one out of four of her medical team knows she is experiencing vertigo and this needs medical clearance. The vertigo could be brought on at rest. The vertigo also happens when her neck is turned to the right. Is she impinging a nerve, artery or vertebrae? And why nausea and vomiting after the physical therapist relieved the vertigo?
Third, she says she feels like her head is fuzzy all the time and she can't think. Red Flag: Just ask the question why? Why is there less blood supply going to the brain? Maybe she has a subluxation. These are questions for her neurologist or chiropractor.
Fourth, she is describing auras without headaches. Like she can see or experience a big circle sometimes. Red Flag: Experiencing auras without headache is typically a vascular migraine symptom followed by a headache. This is another question for her neurologist.
She is standing with her whole body rotating to the left. From the frontal view, her head is tilted more to the left. Her left eye looked more strained than her right eye. When I asked her to cover her left eye, her vision was more blurred on the right. When I asked her to cover her right eye, her vision remained clear. Flexion of the cervical spine was without pain or discomfort. However, extension of the cervical spine made her dizzy and gave her a sensation of an attack of vertigo. There was discomfort on the left side of the neck when side bending to the right. She had more cervical ROM looking to the right than she did looking to the left and there was pain on rotation to the left. Slight palpation of the right occiput and suboccipital muscles made her feel like she could experience vertigo and it was exquisitely painful. Red Flag: Left eye strain and the difference in vision when covered. Extension of the cervical spine just slightly made her dizzy, to close to a positive vertebral artery test.
Here is the question of the day: Does she have the potential of vertebral artery insufficiency or stenosis? And how many red flags should you ignore? Answer, none. She needs medical clearance.
Let's look at the signs and symptoms of vertebral artery stenosis or vertebrobasilar insufficiency. First, what is vertebrobasilar insufficiency? The vertebrobasilar arterial system is located at the back of your brain and includes the vertebral and basilar arteries. These arteries supply blood, oxygen, and nutrients to vital brain structures, such as your brain stem, occipital lobes, and cerebellum. A condition called atherosclerosis (which she has) can reduce or stop blood flow through the vertebrobasilar system. Arthrosclerosis is a hardening and blockage of the arteries. It happens when plaque that's made up of cholesterol and calcium builds up in your arteries. The buildup of plaque narrows your arteries and reduces blood flow. Plaque can completely block your artery over time, preventing blood from reaching your vital organs. This can occur in any artery in your body. When it occurs in the arteries of your vertebrobasilar system, it reduces blood flow to structure in the back of your brain.
The symptoms of vertebrobasilar insufficiency vary depending on the severity of the condition. Some symptoms may last for a few minutes, and some may become permanent.Sypmtoms might include:
She took the report to her chiropractor and he performed a more extensive test for vertebral artery insufficiency. At this time, he didn't believe she had this, but during the exam he did say to her, "no wonder you are having all these symptoms as you are incredibly subluxated at C2 and C3." I got the call after her adjustment and she said it is amazing how clear she felt, with less pain and thanking me for taking the time to do the report. She is also taking the report to her neurologist. There may be more medical tests necessary to clear her for medical massage. Moral of the story: Trust your insight before applying your hands.
Insight is the capacity to gain an accurate and deep intuitive understanding of a person or thing.