Housekeeping - nebula.wsimg.com

Slide 1 Massage in a Clinical Setting

Dr. Bryan Hawley

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Slide 2

Notes and recording will be sent out tomorrow

Certificates will be emailed

1 week out

Questions

All presented tonight is based off OUR OWN CLINIC system

Email ([email protected])

Lets begin

copy right 2010 Dr Bryan Hawley

Housekeeping

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Slide 3

Dating back to the ancient Olympians

Late 1980’s

American Massage Therapy

1992

National Certification Examination for Therapeutic Massage and Bodywork

Historical Perspective

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Slide 4 Many Types of massage

Therapeutic Massage is Desired for more Clinical work

Deep Tissue in some cases

ART/PNF

General light muscle work is usually not desired in our clinic for patient care.

Clinicians and Massage Therapist should consider if massage is warranted prior to pt coming in for ROF

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Slide 5

Massage Manipulates the body’s tissues to:

Reduce muscle spasm

Promote relaxation

Improve blood vascular flow

Increase venous drainage

Broad range of massage theories, techniques, and effects

Purpose

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Slide 6 So how does massage fit in a clinical

setting?

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Slide 7

Case Presentation

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Slide 8

45 yo female with R shoulder/neck pain and hand numbness

Exacerbated by external rotation and abduction of shoulder

Computer worker

MVA 8 days ago hit from behind

Prescribed mm relaxants and pain meds

VAS 8/10

Dx is a TOS patient/ post MVA

History

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Slide 9

Etiology

Hyperextension neck injury (whiplash)

Repetitive stress injuries (typing, assembly lines)

Falls on slippery floors/ice

Neurogenic TOS

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Slide 10

The three entrapment sites of thoracic outlet syndrome (TOS) are 1.between the anterior and middle scalenes 2. between the first rib and clavicle 3. between the pectoralis minor and rib cage.

1.

2.

3.

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Slide 11 Plexus entrapments

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Slide 12

Watch for seatbelt injury

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Slide 13 Forward head/Cervical Kyphosis

NOTE: Deflect head piece

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Slide 14 So what is the care plan

Heat Estim/Modalities Joint manipulation (CMT) Passive ROM stretching progress to AROM Soft tissue manipulation (massage) Needs to be in the Drs or attending’s SOAP (plan) portion to include myofascial release /massage. Also recommended number of visits with both short term and long term goals.

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Slide 15

Croft Grades of Severity of Injury for MVA

Grade I Minimal; No limitation of motion; No ligamentous injury; No neurological findings

Grade II Slight; Limitation of motion; No ligamentous injury; No neurological findings

Grade III Moderate; Limitation of motion; Some ligamenetous injury; Neurological findings may be present

Grade IV Moderate to Severe; Limitation of motion; Ligamentous instability; Neurological findings present; Fracture or disc derangement

Grade V Severe; Requires surgical management/stabilization

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Slide 16 Croft Guidelines for Frequency and Duration of Care in Cervical Acceleration/Deceleration Trauma 1

Daily 3x/wk 2x/wk 1x/wk 1x/mo Duration Visits

Grade I 1 wk 1-2 wk 2-3 wk <4 wk 3 mo <11 wk <21

Grade II 1 wk <4 wk <4 wk <4 wk <4 mo <29 wk <33

Grade III 1-2 wk <10 wk <10 wk <10 wk <6 mo <56 wk <76

Grade IV 2-3 wk <16 wk <12 wk <20 wk ....4 ....4 ....4

Grade V Surgical stabilization necessary—chiropractic/massage care is post-surgical

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Slide 17 Example care plan

P: Pt will come in for rehab care 3/week for the next 4 weeks then re eval. Upon positive re eval pt will decrease to 2x/week for 6 weeks then re eval. Pt during the first month will receive LMT care for 2x/week for 30 min for the first 3 weeks. Then progress to 1 hr care 1x/week for the following 2 weeks. GOALS: ST: Pt will be able to sleep undisturbed for 6 hours Pt will be able to walk for 20 min LT Too be determined at first re eval on 12th visit

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Slide 18 SOAP

SOAP Note - A is for ASSESSMENT Massage Therapists use this part of the SOAP Note to document the immediate results of a treatment. At the end of a session the therapist reanalyzes and documents the changes in the client's posture and range of motion.

SOAP Note - P is for PLAN The last part of the SOAP Note is the treatment plan. The plan should include: Treatment Frequency Recommendations Home Care Instructions Recommended Exercises Reminders for Next Session

SOAP Note - O is for OBJECTIVE This part of the SOAP Note is the objective observations. These objective observations include symptoms that the massage therapists can actually see or feel. The subjective observations should include the therapist's observations about the clients clinical presentation. BOTH physical and psychological

SOAP Note - S is for SUBJECTIVE This initial portion of the SOAP note is made up of subjective observations. These are symptoms the client verbally expresses to the massage therapist.

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Slide 19 LMT Note addition

Pt states that they has been getting intermittent HAs and upper back mm spasm throughout the day but the txs seem to be helping take the edge off.

Pt presents with high R shoulder with mod TTFs and palpable TPs in the upper

traps, the lower lumbar mainly on the L side is guarded but not hurting.

Myofascial Release to the neck, shoulder, chest. Sternocleidomastoid treatment before treating scalenes. Pt gained more ROM

and states that the pain scale went from a 8 down to a 4 /10

Pt will resume home care stretching along with contrast hydrotherapy showers. Pt will be seen in office 2 more times then follow up with Doctor

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Slide 20 Coding

CPT code 97124 is for massage therapy. Massage therapy includes effleurage (circular movement), petrissage (lifting, squeezing), and/or tapotement (stroking, compression, percussion). Massage therapy is a therapeutic procedure on one or more areas, each for 15 minutes. Massage therapy could be used as a preparatory procedure on the same day as a therapeutic procedure to restore muscle function, decrease stiffness, reduce edema, improve joint motion, or for relief of muscle spasms.

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Slide 21

https://www.youtube.com/watch?v=IiJx4a1cxRk

http://www.youtube.com/watch?v=kaAs47A7f-s

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Slide 22

Copy Right 2014 DrHawley

Case 2

Client: Matt referral from MD with a Dx of Sciatica

•Has LBP and Sciatica pain every day but gets worse late afternoon

•Travels Down to R foot/big toe

•Has Xray Local Ortho Surgeon

•No recent Trauma or Past Surgery

•Taking OTCs anti inflams (only temp help)

•NCV taken last week produced Negative results

•At times when sitting R foot will tingle and twitch at night

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Slide 23 Matt’s Film

Copy Right 2008 Practice4Success

L5/S1 degeneration

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Slide 24 Matt’s Acute Care Plan

20 Visits 3x/week for 3 weeks 2x/week for 3 weeks 1x/week for 5 weeks Txs will consist of CMT PROM – AROM Modalities the first week Passive Rehab – Active Rehab Massage Therapy 2x/week for 2 weeks 30 min = 1 60 min massage 1x/week for 2 weeks 60 min = 2 60 min massage 2x/mo for 1 mo = 2 60 min massage 1x/mo for 2 mo = 2 60 min massage

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Slide 25 Various Clinical Conditions We Treat

on a Daily basis

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The most common symptom of sciatica is lower back pain that extends through the hip and buttock and down one leg. The pain usually affects only one leg and may get worse when you sit, cough, or sneeze. The leg may also feel numb, weak, or tingly at times. The symptoms of sciatica tend to appear suddenly and can last for days or weeks.

Sciatica

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Discogenic sciatica

Peripheral entrapments

Chemical induced

Gestational


Types of Sciatica

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Peripheral entrapment

This is an entanglement or entrapment of one or more of the branches of the Sciatic nerve along its pathway. This can either be from osseous, scar tissue, fascial tissue, or muscle tissue or a combination of the above.

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Slide 30


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Piriformis Syndrome / Sacral Deviation

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Piriformis work

Start working from the sacral border out to the femur in a slow methodical approach. Use a penetration ratio of approx 1/3 downward pressure 2/3 medial pressure This will also fluctuate depending on patients habitus and physical profile.

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Slide 33 Piriformis muscle stripping

2011 copyright Dr Bryan Hawley

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Slide 34


Look for the Root cause

This is where the LMTs and other care members can really assist in the patient care.

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Slide 35 Pes Planus

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Slide 36 Clients may exhibit Internal capsular restriction usually on the opposite leg of the Flat foot. On the side with the flat foot they usually will exhibit External restriction.

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Slide 37 Passively Working the capsule

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Slide 38 Passively Stretching the capsule

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Slide 39

TPs

TPs/Ant tilt

TPs Posterior View

Trigger Points

TPs

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Slide 40 Deep Back Muscles

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Slide 41 Facet Syndrome

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Slide 42

Facet Syndrome and Scoliosis

Working with Facet Syndrome

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Slide 43 Deep supporting muscles

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Slide 44 Start with BROAD contact and short lever arm stretch

Spine Neutral

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Slide 45 Progress to focused contact short lever stretch

Spine Neutral

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Slide 46 Long Lever arm stretch

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Slide 47 Fibromyalgia

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Slide 48

48

• What is Fibromyalgia?

Clinical Features and Diagnosis of Fibromyalgia

• Management of Fibromyalgia

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Slide 49 ACR-Recommended Manual Tender Point Survey* for the Diagnosis of FM

Manual Tender Points Survey:

• Presence of 11 tender points on palpation to a maximum of 4 kg of pressure (just enough to blanch examiners thumbnail)

OCCIPUT – At nuchal muscle

insertion

GLUTEAL – Upper outer quadrant of

gluteal muscles

GREATER

TROCHANTER – Muscle attachments just

posterior to GT

SUPRASPINATUS – At attachment to medial

border of scapula

TRAPEZIUS – Upper border of trapezius,

midportion

LOW CERVICAL – Anterior aspects of C5,

C7 intertransverse

spaces

SECOND RIB SPACE – about 3 cm lateral to sternal

border

ELBOW – Muscle attachments to

Lateral Epicondyle

KNEE – Medial fat pad of knee

proximal to joint line

RIGHT FOREARM

FOREHEAD

LEFT

THUMB

Control Points

Tender Points

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Slide 50 Marketing your practice

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Slide 51


BOWLING GREEN

165 Natchez Trace Ave., Ste. 201

Bowling Green, KY 42103

Phone: 270-746-9400

Fax: 270-746-0240

Patient Name: ___________________________ Date: _______________

Disc Decompression Therapy

Including any modalities this patient may need in conjunction with Disc

Decompression, such as electrical stimulation, ultrasound, myofascial release,

hot/cold packs.

Other Treatment Options

Chiropractic Manipulation Therapy

PNF Stretching Hot/Cold Packs

Neuromuscular Re-education Myofascial Release

Therapeutic/Stabilization Exercises

Evaluate and Treat

9:02 am, Nov 14, 2008

Signed:

Date:

Doctor’s Name (typed or printed):

IF YOU HAVE ANY QUESTIONS PLEASE DO NOT

HESITATE TO CALL OUR OFFICE.

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Slide 53


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Slide 54

Notes and recording will be sent out tomorrow

Certificates will be emailed

1 week out

Email ([email protected])


Housekeeping

___________________________________

___________________________________

___________________________________

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Documents

Housekeeping - nebula.wsimg.com