Physical Therapy Continuing Education: Clinical Prediction Rule Vs Segmental Dysfunction

As a Physical Therapist, ever wondered when to use the clinical prediction rules for manipulation Vs assessing for a specific joint dysfunction?

We recently had a chance to ask that exact question to a spinal manipulation expert. This is what he said:

Interviewer: I'd like you to expand a little bit more on that thinking. I think as a manual therapist, with our assessment we enjoy the part of the puzzle of trying to figure out is there a specific level joint dysfunction going on and comparing that to a clinical prediction rule. Could you just give us some of your thoughts on the use of the clinical prediction rule versus trying to address specific level joint dysfunction?

Spinal Manipulation Expert: I think that's a very good question. I almost think it's really a sequence, in my mind. Kind of the first pass of the patient coming in with say acute back pain, if they meet this rule go ahead and employ that technique. Then your second pass you begin to look - okay continued pain and disability, now I'm going to start my second pass through, begin to see if I can find areas that might be additional contributors to that patient's presentation.

Interviewer: Right.

Spinal Manipulation Expert: So, I don't see this really discounting us trying to be segmental in orientation and looking segmentally at different levels of joint dysfunction or perhaps specific levels of muscle-joint complex dysfunction.

Also, I would comment that we went through an examination process, through flexion-extension ranges and palpation at segmental levels to determine if dysfunction was present, but that dysfunction just wasn't - first of all, the reliability is not very good there and those factors weren't very predictive of this particular technique being responsive. But again, I grew up in the manual therapy world on lots and lots of practice of trying to find "Is this one more left, right? Is this one worse in flexion, extension?" I always tell folks that I never discount that training in making my hands I think softer and much more tuned into a patient response, and so I always looked at that training was very helpful.

I think the stories behind it or our ability to really discern these small movements is probably - not probably, I think we can say pretty strongly in the lumbar spine it's really an illusion that we're actually palpating those things or rotations. That doesn't mean that we're not gaining information. In other words, we do know the pain responses and a sense that there's a difference here. We may not know it as right or left but it just, there's a sense that there's something not right, per se at L2 versus L4 or something. So again, I don't discount our ability to do that. I think there's something therapeutic about someone laying their hands on in a way that's very methodical and done methodically and from the patient's perspective knowing that someone's really trying to figure out what's going on in my body and I think there's a therapeutic element of that whether we want to like it or not. That there is probably some effect that occurs with that.

Massage For Digestive Disorders

We all know that massage is an excellent therapy for treating stress, for "unknotting" tight muscles, for relieving aches and pains, for easing stiffness and for helping us to sleep, but massage is also an excellent natural therapy for treating digestive orders.

Massage and Digestion

Have you ever felt "butterflies" in your stomach before an exam, meeting or surgical procedure? That all too common feeling of your stomach churning or doing flips? This is because stress has a tendency to attack our digestive system. Worry goes straight to our stomachs.
Stress and our busy lifestyles, which often don't give us chance to sit down and take our time over a meal, can lead to a whole range of digestive troubles and disorders. Add to that the fact that we often eat junk food, take-outs and wash it all down with a huge quantity of caffeine, and you've got a recipe for a digestive disaster!

So, how can massage help our digestive disorders?
 
Constipation - Constipation is no fun, and it can lead to bloating, headaches, skin problems and bad breath, as well as pain and discomfort. Massage can aid and improve digestion by stimulating peristalsis, the wave-like muscle contractions which move the food we have eaten through our digestive tract. This stimulation of natural peristalsis helps our digestive system to function efficiently and prevents us from becoming constipated.
 
Digestive enzymes - Digestive enzymes help us to break down the food that we eat so that our bodies can absorb and use essential nutrients. Massage encourages the body to release these enzymes, thus helping digestion and our overall health.
 
IBS - Irritable Bowel Syndrome is a common digestive disorder which is characterized by abdominal bloating, cramps and either constipation or diarrhea. It is often triggered, or exacerbated, by stress, anxiety and tension, so massage therapy, which relieves stress and promotes a feeling of well-being, can be beneficial in improving symptoms. Massaging the affected area can also stimulate peristalsis, help remove blockages in the digestive tract and reduce bloating, gas and cramps.
 
Stress-related disorders - IBS is not the only digestive disorder which is related to stress. Stress, anxiety and a busy lifestyle can also lead to indigestion, heartburn, stomach ulcers and intestinal problems. General massage lowers our stress levels by causing the release of endorphins, the body's "feel-good" chemicals, and abdominal massage can relieve indigestion, abdominal pain and bloating. Back massage is also great for indigestion and gas.
 
Detox - Back massage and abdominal massage can assist with detoxification, when used with a detox program. The massage will have a cleansing effect on the digestive system by helping it to eliminate waste and toxins quickly and efficiently.

Best Ways to Find the Best Lomi Lomi Massage Training

Traditional Lomi Lomi massage is widely known for its relaxing benefits. And what is it all about? It's a massage technique that has a very deep style that has its emphasis on soothing rather than more pointed techniques like acupressure. This type of massage is like a rhythmical dance that that gently rocks one into a blissful release of tension. Lomi Lomi massage originated in Hawaii. It follows the idea that a belief can block energy flow as much as muscle tension can. It helps release blockages and simultaneously gives the energy a new direction.

Thus making it not just a physical experience, it also facilitates healing on the mental, emotional and spiritual levels. And if you are more interested why not take a Lomi Lomi massage training in Hawaii. And how would you find the best Lomi Lomi massage training in Hawaii? I'll tell you how. There are a lot of schools that offer training and most of these schools are the cream of the crop.

But of course there are always schools that stand out above the rest. One of the things to find out if the school is a top of its game is by looking at its faculty. In any school the faculty is always important. A great school should offer a faculty that creates a dynamic learning environment to bring out the best in their students. Each faculty member should exemplify excellence in their teaching and clinical practice and all must be skilled professionals.

With this characteristics, together a faculty can inspire and challenge students to discover their own unique gifts and relationships to the healing arts. Another sign of a top school would be its curriculum. In a curriculum you can see what the school teaches and how it teaches it. In a curriculum the interested student should also know the span of time of each class. Class schedule also matter, especially today that there are a lot of young professional who want to develop their careers and learn more. A schedule that would accommodate their time would be okay. A schools location would also be another characteristic to make it a great school. Then schools offering massage training in Hawaii would make things great if they also had tuition options.

Tuition options that offer student loans,scholarship grants and payment options. By offering these financial aids, you can see also that the school is not just about profit but also help those low income students. So with that, we have laid out the characteristics of a great school offering the best Lomi Lomi massage training in Hawaii. We know what we look for, now we must start looking for it. Good luck.

Massage Expectations For New Clients

You slept wrong last night and your neck is stiff and sore. Maybe you have been working in the garden all weekend and your back hurts from being bent over. You are under a lot of stress from your job and can't seem to relax or sleep at night. A friend suggested you get a professional massage to help ease the pain. It sounded like a great idea, but you have never been to a massage therapist. You are a little apprehensive because you are not sure what to expect.

If you are reading this, you have taken the first (and right) step to improving your health and well-being. There are many benefits of massage. But how does it work? What really happens in a massage therapist office?

What are all these forms? I just want a massage.

In a professional massage therapist office, the first step to receiving a beneficial massage will be the filling out of some basic forms. They include a client intake form, a health history, and an informed consent form.

The Client Intake Form- This form will tell your massage therapist some key information about you. It will let the therapist know what areas of concern you have (ie: back pain, stiff neck, leg pain, etc.). If you are under a doctors care for anything that may be important to the outcome of the massage. It also informs the therapist if you have ever had a professional massage.

The Health History Form- Why do I have to fill out a health history form? It is very important for you, and the massage therapist, that this form be filled out completely. It informs the therapist of any medical condition that may dictate the use of a certain massage technique, or a technique that may be contraindicated (should not be used).

The Informed Consent- This form is more of a legal form than anything else. It is for your protection as well as the therapist. It gives the therapist written permission to perform a massage.

Okay, I filled out the forms, what's next?

Your therapist will take you to the massage treatment room. Before the massage begins the two of you will discuss your concerns and health history in a little interview. This interview usually takes 5 to 10 minutes. This is when you and your therapist will start to get to know each other. You will discuss your expectations of the massage. Your health history, if there is information that will determine the massage techniques used during the massage. This is a good time to ask your therapist questions. After the interview, the massage therapist will leave the room so you can get undressed.

Undressed? Do I have to take all my clothes off?

Massage is best received fully unclothed. But you may undress to the level of your comfort. What does that mean? If you are not comfortable with removing all your clothes, you may leave some or all of them on. The therapist will adjust the massage to what you leave on. Keep in mind that it will limit the therapist to what techniques may or may not be used. It can effect the over-all outcome of your massage.

But He'll See Me Naked If I Remove All My Clothes!

NO, he won't. A professional massage therapist is bound by standards of practices and codes of ethics to provide draping for you, the client. What do you mean draping? Draping is a technique that uses the sheets on the table to keep all private areas of your body covered at all times. There are techniques used during the draping process that ensures you are not exposed at any time. This is accomplished with a bed/table sheet, pillow case, and/or towels.

How Does Draping Work?

The massage table you will be receiving treatment on, has a full set of bed sheets on it. A bottom sheet you will lay on, and a top sheet you will use to cover yourself with. When the therapist leaves the room, you will undress. You will then get on the massage table between the sheets. Your therapist will give you time to do this. He or she will knock on the door, awaiting your authorization to enter. When you are ready, the therapist will enter the room.

After the therapist re-enters the treatment room, you will receive pillows or bolsters to provide comfort while you are on the table. The therapist will adjust the face cradle and check with you for anything else you may need at this time.

During the massage, your therapist will lift back the top sheet exposing only the area he or she is working on. What does that mean? If the therapist is working on your back, the sheet will be pulled down exposing your back for treatment. When the treatment is complete, your back will be re-covered. Your therapist will move on to a new area of your body. That area will be uncovered (ie: gluts, leg, arm), receive bodywork and then recovered. This will continue in this fashion throughout the massage.

How Do I Turn Over To Have The Other Side Of My Body Massaged

Your therapist will help you turn over on the massage table. The technique for this is simple. Using his legs, the therapist will "pin" one side of the top sheet to the edge of the massage table. Then reaching over your body, he will hold the other side of the sheet. Lifting the sheet slightly to form a "tent." This provides room for you to roll over, all the while without being exposed.

I'm A Female And Want My Stomach Massaged. How Will This Be Done Without Exposing My Breasts?

This is where the therapist uses the extra towels or pillow cases. The pillow case will be placed over your breasts, on top of the sheet that is covering you. The sheet will then be slid out from underneath the pillow case. The pillow case remains in place, covering your breasts. The sheet is pulled further down to expose your stomach for treatment. After the bodywork is complete, the sheet is returned to it's original position. This time it will be placed on top of the pillow case. The pillow case will be removed from under the sheet.

I Still Don't Understand Why I Have To Undress Completely

Your body and the muscles that control all of your body's movement are a complex system. Do you remember that old song about your bones? "My toe bone's connected to my foot bone. My foot bone's connected to my leg bone. My leg bone's connected to my thigh bone." If you remember this song, it is probably playing through your head now. Massage is the manipulation of the soft tissues (such as muscles) of your body. You can replace the word "bone" in that old song with muscle. Although it is a little more complex than that song, you can get a little mental picture of how your muscle structure is connected throughout your body.

I'm going to use low back pain (the most common complaint) for an example as to why massage is best received fully unclothed. Most of your back muscles are connected to the top edge of your pelvic girdle. Your gluteal muscles are also connected to the top edge of your pelvic girdle. While your back muscles extend from the pelvic girdle upwards, your gluteal muscles extend from pelvic girdle downwards. If your "gluts" are tight, they are pulling on the top of your pelvic girdle. This in turn, is pulling on your low back muscles. You are feeling the pain in your low back. It is not the "cause" of your pain, it's the result.

To relieve low back pain, a massage therapist may have to work on your gluteal muscles. While this can be accomplished with clothing on, it limits the techniques the therapist can use. It is not as thorough and will take longer (more visits to the therapist) to achieve the desired results. If your clothing is completely removed, your therapist can use a variety of techniques. Achieving more positive results in a shorter time.

Communicate With Your Therapist

All aspects of massage therapy requires communication between the therapist and the client. Draping is a big concern for most clients. Do not be afraid to talk with your therapist about draping techniques. Your comfort and understanding is a top priority of your therapist.

Before You Become A Massage Therapist

Everyone has to ask themselves whether they have passion for what they are doing for a living. For example, you can ask an accountant whether he or she likes their job and the nature of numbers. The same goes to a massage therapist. Different careers have varying questions. But all of them come to one thing. Are you prepared to do this for your whole life?

That is the honest question everyone has to ask themselves besides knowing about their true passion.

When you massage someone, do you like it? Do you feel yourself as an important person giving value and helping people alleviate their problems?

When you consider a career in massage, you have to be a certain type of person. If you have been massaging strangers for a while, what do you feel about it? If you are a massage therapist type of person, you should feel that these people are not strangers. Instead, they are like other human beings that you can relate to. How do you relate? Well, using your massage skills of course.

The work of massage is actually a work of empathy. You will notice the professional massage therapists touch other people in caring ways and helping them take relieve the stress. Moreover, massaging people makes them feel secure and wanted, an important quality in life. In short, massage therapists are there for the people.

After reading the previously mentioned points, do you see yourself in those descriptions? Do you empathize with others? Do you think of other people as human beings instead of strangers? If you do, then massaging is indeed a career for you in the long term.

Travel Physical Therapy Companies

The first thing you'll want to look for in a travel therapy company is a company that specializes in jobs exclusively for traveling therapists. You might find an agency or two that typically do local placements but only have a few traveling jobs. These agencies are not best suited to place you in travel therapy positions because they lack the experience to help anticipate and avoid many of the common pitfalls that can occur when placing people in travel therapy jobs.

When you pair up with an experienced travel therapy company they'll know exactly what they need to ask for with you in mind. For example, typically all or some combination of your traveling, housing and meal costs will be covered by the company you work for. These are issues that must be negotiated and clearly outlined for you. It's best to leave these issues to the people who've focused an entire business on them.

You'll also want to choose a company that specializes in travel physical therapy placement because they'll have the largest variety of positions to choose from. Even if you think you know exactly the type of position you want, it's best to keep your options open. A few months from now you might find that you'd like to try out a rural area or a smaller hospital than you're used to working in. If you've chosen a travel therapy company that has a variety of positions available they can help you move on to the right job for your next move.

Obviously you will also want to make sure that you're being fairly compensated for your work. Often times with travel physical therapy jobs the pay will be on a different scale than a long term position would be. As previously mentioned, you will also need to negotiate things like travel costs and housing. Travel therapy companies specializing in these types of travel jobs will know exactly how much you can get for your services and will be in a much better position to get you what you deserve.

Taking a travel physical therapy job can be a lot of fun in the right circumstances. As long as you have adequately planned for your job and know exactly what to expect, it's likely it will be an experience that you'll remember fondly for a lifetime. Just be sure that you're pairing up with an experienced company that knows the ins and outs of the traveling physical therapy circuit to help put you in the best position to get everything you're looking for and deserve.

Sports Medicine Colleges - Getting the Right Education to Launch Your Career

Staring your sports medicine career is going to require getting your sports medicine education underway. You will need to spend a little time researching and exploring your options for sports medicine colleges. You choice of college should be based on a few simple criteria, which include:

繚 Matching your career choice and college curriculum.

繚 Cost of the school.

繚 Location of the school

繚 School Reputation

Defining Your Career Choice is the Starting Point of the Search

One thing to be very cautious about when choosing a sports medicine college is to not lose sight of your personal goals and ambitions. You may have made a decision to become a Physical Therapist with a specialty in sports medicine and during your search you suddenly get distracted by all the other career choices and their potentially lower costs. Stick to your plans or you may discover you have headed into a career you will not enjoy.

The choices for certain specialties become limited very quickly. As an example, to pursue a sports medicine education to become a Sports Medicine Physician means you will be acquiring a four year Bachelor of Science degree, spending 4 years in medical school, 3 years in residency, and possibly more time in a fellowship to acquire acceptance into your specialized field. Since only a small percentage of schools are accredited medical schools your choices reduce rapidly. You must first qualify and be accepted into the college. Here are couple examples of top medical programs for Sports Physicians:

繚 Stanford University - The University offers one of the few fellowship programs in the nation for specializing in this field. The program offers access to their Human Performance Laboratory which explores sports medicine using cutting edge technology and works in partnership with the Stanford University athletic teams and departments.

繚 Ohio State University - Another fellowship program offered through a top medical university. The program offers many of the same advantages as Stanford.

It is important to note both of these programs require you have already finished college, medical school, and your residency. Sports Medicine Physicians are not created in medical school but in their continuing training after becoming a Doctor. These two programs make Stanford and Ohio State the two top sports medical universities in the nation.

Schools for Medicine - Other Career Areas

When you change your focus away from being a physician to selecting other careers within medicine your choice of schools expands rapidly. As an example, if you wanted to pursue a career as a massage therapist working with athletes you can find schools in many states including the following schools:

繚 Denver School of Massage Therapy

繚 Woodridge School of Massage Therapy in Chicago

繚 Omaha School of Massage and Healthcare at Herzing University

繚 Nevada School of Massage Therapy - Las Vegas, Nevada

繚 Arizona School of Massage Therapy

Is Sports Physical Therapy the Right Direction for Your Career?

Another educational pursuit is in becoming a Physical Therapist. This is one of the better paying careers in medicine. You can choose from one of the 212 accredited colleges. Of these 212 schools for sports medicines 203 offer doctorate degrees in Physical Therapy with the other 9 offering Masters Programs. Your requirements to become a Sports Physical Therapist are as follows:

繚 Complete a Bachelor Degree program. No specific degree is required but including courses on biology, anatomy, physiology, and other related sciences is highly recommended.

繚 Earn your graduate degree in Physical Therapy. The doctorate programs take approximately 3 years to complete, with masters programs averaging 2.5 years.

繚 Residency in Physical Therapy - An average 1500 hours of on the job work under the supervision of a licensed therapist is required.

繚 Pass Licensing Exam - This is administered on a state by state basis.

繚 Pass Exam to Become a Physical Therapy Specialist in Sports. This specialty designation is offered through the American Board of Physical Therapy Specialties and requires you have practiced physical therapy for 2000 hours plus passed their exam. This is not required to work in sports medicine but does give you added credentials.

With the slight difference in time to receive a doctorate or masters it would be in your own best interest to pursue a doctorate degree. With over 200 schools offering specialties in Physical Therapy you will be able to find a school within your budget and in a location near you.

As can be seen by our three examples your choice of sports medicine degree colleges is highly dependent on the career path you select. Your starting point is choosing whether you wish to be a trainer, doctor, physical therapist, or other choose a different career. You can then quickly uncover the right sports medicine colleges for you.

Massage for Rejuvenating Your Mind, Body and Soul

Massage can have such a profound effect on the entire body that sometimes a three hour spa treatment can be more relaxing than a seven day holiday abroad. Now, this doesn't mean a full three hours of massage but two hour of massage and then an hour of relaxing within the spa area in the sauna, steam room etc, deeply rejuvenates you entirely and fully.

Massage has not only shown to relax the body in various studies, but the effect is almost instantaneous!

Here are some of the following studies that were done over the last few years with mainly positive results:

Over a 5-week period, women suffering from depression were either given three 30-minute massage sessions per week, practiced progressive muscle relaxation for 30 minutes, three times per week, or received just the standard treatment. At the end of the study, the massage group reported less depression and anger, along with numerous physiological benefits.

A group of 14 people suffering from hypertension were monitored and provided with a 10-minute back massage to 8 of these sufferers, three times a week, while the other 6 relaxed in the same setting for 10 minutes, three times a week. After the 10th session, the people receiving massage showed lower blood pressure than the control group.

The effect of massage was tested over a 5-week period on 24 randomized chronic low back pain sufferers. After having received two 30-minute treatments per week for the duration of the study, the massage group reported less pain, depression, anxiety, and improved sleep.

A study on the short-term effects of massage on chronic pain showed positive improvement. 101 patients were randomly divided, half of which received 15 minutes of massage, while the other half discussed their pain through talking about it. One hour after the treatment, the massage group showed significantly less pain and anxiety.

Eighty-four depressed pregnant women were divided into three groups of the following; massage therapy, progressive muscle relaxation, and a control group. The massage group received two 20-minute massages per week for 16 weeks and reported lower anxiety, depression, and back pain. Interestingly, neonatal outcomes were better for the massage group than the other, leading the authors to conclude that both pregnant mothers and their children may benefit from massage therapy.

The effects of massage therapy was studied on pregnant women versus relaxation therapy. After five weeks of twice-weekly 20-minute sessions, both groups experienced reduced anxiety and leg pain, but only the massage group reported improved mood, better sleep, and less back pain.

One study performed a comprehensive review of massage therapy and its affect on stress reduction. After numerous studies, the team concluded that single treatments improved stress-related conditions and longer-term benefits were apparent in blood pressure, but they were unable to prove longer-term stress-related benefits for massage.

It can be concluded that the effects of massage therapy are simply wonderful and enlightening!

A Career in Massage? 5 Vital Questions to Ask Yourself Before You Begin a Massage Career

If you are considering a career in massage, this article prompts you to ask yourself five vital questions.  Answering these questions will not only give great insights into many important aspects of what a massage career entails, it will also help you determine if a massage career is right for you.

1 - Do You Care About People?  

Firstly let me elaborate on the question. Everyone cares about at least some people. I mean do you generally care about people, do you enjoy caring for people.  

This is an important first question to ask. If you want a long term career in massage, you want to be able to answer honestly that you do, because it's the primary role you will have in your career. Everything you learn in preparation for your massage career is to prepare you for your primary role, caring for people.  

2 - Are You a Good Self Manager?  

After embarking on your career in massage you will need to be a good self manager. While some will find employment in spas, sports facilities or medical clinics, most will enter into their own business which means you are the boss of you.  

You will need to have good time management skills and manage your book keeping, although you will be able to outsource some of that if you wish. Also you will need to manage your discipline as you will predominantly work unsupervised.  

At the very least you need to understand that self-management is an important asset to have in a massage career. You should be willing to learn the skills if you don't feel you already have them.  

3 - Do You Have Good People and Communication Skills?  

This is an important question. Some people think that a massage career is perfect for a quiet, maybe even an introverted person. In many ways this is true, but keep in mind that you will need very good people and communication skills for 2 reasons.  

• You need to deal with clients before and after treatments, including dealing with initial face to face or phone inquiries. If people don't like you, they will not book a massage with you, no matter how good you are as a massage therapist.


• You need to effectively communicate to find out any health issues they may have prior to treatment. Sometimes health issues are of a sensitive nature and they will not divulge them unless they feel very comfortable with you, so people skills are vitally important to ensure the best treatment for your clients.

4 - Do You Enjoy A Quiet Work Place?  

Obviously working as a massage therapist means working in a quiet work place. No busy office chatter, and during treatments it means up to an hour of quiet, although it is common to have relaxation music in the background.  

Of course this can be extremely desirable for many people. Most massage therapists actually love this environment and enjoy the quiet of treatment time. They even find it meditative and it can be very therapeutic for them even while they perform the treatment.  

Also, if you choose to work part time in your massage therapist career, perhaps from home, then this quiet time may be a very welcome respite after your busy and noisy day.    

If however you love busy chatter and noise in the workplace as some do, maybe this would not be an ideal environment for you and you may want to reconsider a massage career for yourself.  

5 - Do You Have An Interest In The Human Body?  

This might sound like a strange question. I recommend you ask it to yourself for 2 reasons.  

First the obvious one, during a career in massage you will spend many hours per week in personal contact with human bodies, not working near people like in most jobs but actually touching their bodies. While it is always non-sexual, it certainly is an intimate profession.   

From personal experience and from speaking with other therapists I have found that it really helps job satisfaction if you have a genuine interest in the human body and how it functions.  

Second, the not as obvious. Many people seeking out schools for massage to begin their journey into massage therapist career are attracted by the 'art' of massage. And rightly so, the best therapists are certainly masters of their art.   

However don't forget that massage is also a science, and in the course of training for your massage career you will have to do intensive study of the human body; anatomy, physiology, biomechanics, structure and function. A genuine interest of the human body will help make this time not only more valuable but intensely enjoyable as well.  

Conclusion  

Firstly let me say that while answering each of the above questions with a resounding 'YES' would certainly make you a perfect candidate for a massage career, it is NOT necessary to have a 'perfect score.'  

I would simply encourage you to take time to have a conversation with yourself where you ask these questions and most importantly, you answer them honestly.  

These questions are designed to give you insights into what a massage career entails, and to clarify your thinking about whether a career in massage is right for you. They should also help to reveal potential challenges that you may need to deal with either now or during your massage career.

Massage and Stress Relief

Few people need to be convinced of why and how massages are relaxing, so in this article, you'll see just how much of a difference massage therapy can make and how to incorporate a massage routine into your stress relief agenda. According to the American Massage Therapy Association, in 2006, 39 million Americans, or one in six, received at least one professional massage. Clearly, Americans are seriously interested in stress relief as well as the many other benefits of massage.

The Mayo Clinic identifies massage as a valid medical method to reduce stress and pain and reports, "Massage reduced anxiety in depressed children and anorexic women. It also reduced anxiety and withdrawal symptoms in adults trying to quit smoking." The Australian and New Zealand Journal of Psychiatry conducted a study that concluded, "Massage therapy had immediate beneficial effects on anxiety-related measures."The Franklin Institute reports, "Massage releases endorphins that calm the peripheral nervous system." The PsychoOncology Journal in 2008 reported that, "Massage in patients undergoing intensive chemotherapy reduces serum cortisol (stress hormone) and prolactin...A significant reduction in cortisol could be safely achieved through massage, with associated improvement in psychological well-being."

To incorporate massage into your stress relief routine, you can see if your insurance plan at work covers massage treatments under some type of physical therapy clause. Often insurance programs like this will allow you a set number of "covered" (i.e. free) massages per year which you can use all at once or stretch over the course of the year. Another option is getting a massage membership. For example, the company Massage Envy located throughout the United States offers a monthly membership plan starting around $50. They allow you to "roll over" un-used massages and add on family members for a reasonable fee. Another affordable option is to find a massage school nearby and find out how you can get a discounted massage from a student. All of these options will ensure that the price of a massage doesn't add to your stress or anxiety.

If your budget prohibits even these stress relievers, you can swap massages with a family member, significant other, or trusted friend. You can also learn many effective massages to do on yourself. For example, a popular component of stress can be tired eyes. To re-energize your eyes, close them and put your thumbs under your eyebrows at the inside corner of each eye. Press in gently and make tiny circles with your thumbs. Work towards the outside of your eyebrows and continue this movement all around your eyes, finishing back at your nose. Spend a little extra attention where the bridge of your nose meets your eyebrow-you may notice that it is a bit tender here. There are many auto-massage techniques like this that you can use for effective stress relief.

Finally, remember what the Mayo Clinic says, "Brush aside any thoughts that massage is only a feel-good way to indulge or pamper yourself. To the contrary, massage can be a powerful tool to help you take charge of your health and well-being..."

Massage Technique - Percussion Movements or Tapotement

Description

Percussion movements (tapotement) involve a series of light, brisk, striking actions applied with alternate hands in rapid succession. Two of the main percussion strokes are cupping and hacking; they may be performed on many areas of the body, although they are especially effective when used on fleshy and large muscular areas of the body such as the thighs. Other tapotement movements include flicking, beating and pounding. When performing tapotement movements the action originates from the wrists and not from the elbows or shoulders, which remain still throughout. Many beginners make the mistake of practising percussion movements from the elbows and shoulders, resulting in frustration and clumsiness.

Cupping is performed with your palms facing downwards, forming a hollow curve. It is sometimes known as 'clapping'. As you bring your cupped hands down on to the body in quick succession, a vacuum is created which is released when you bring your hands up. The sound should be hollow like a horse trotting. Listen for the sound.

Hacking is probably the best-known massage stroke since it is the movement almost always shown in films. It is achieved with the edge of the hands (the ulnar border). Hold your hands over body with the palms facing each other, the thumbs uppermost. Flick your hands rhythmically up and down in rapid succession. Use these movements at the end a massage to wake the person up! Obviously, if you are trying to relax someone totally hacking may be omitted altogether. If you are nervous about using these movements, practise them first on a cushion or a pillow placed on your lap.

Flicking is a movement similar to hacking and is often described as 'finger hacking'. To perform this movement flex your wrists slightly and bring only the sides of your little fingers into contact with the body (not the edge of the hands as well). Flicking is a much lighter, softer movement than the usual hacking movement.

Beating and pounding movements are both applied with your hands in a closed position with your fists lightly clenched. Beating is performed with the ulnar border (little finger side) of the closed fists, whereas in pounding the palmar surface of the hands are employed. The closed fists are applied to the body in quick succession.

Benefits

• Percussion movements are very stimulating. Tapotement is extremely useful for athletes before an event.


• As the blood is drawn to the surface the circulation is improved.


• Cupping is beneficial when performed over the upper and middle back area as it loosens mucus in the lungs aiding expectoration.


• Percussion movements are also valuable in inducing muscle tone as well as strengthening muscles since they stimulate the muscle to contract.


• They are also useful in reducing fatty deposits and flabby muscle areas and are often used over the buttocks and thighs.


• Gentle tapotement given over the abdomen increases peristalsis, thereby aiding conditions such as constipation.

Errors to avoid

• Make sure that when cupping, your hands are really cupped - otherwise a smacking sound will be heard, which is stinging and painful.


• When hacking do not tense up the fingers of your hands or the movement will feel like a karate chop.


• Keep your hands relaxed and loose and ensure that the movements are coming from the wrist. Keep your elbows tucked closely in; if you use your elbows and shoulders you will be exhausted quickly.


• These strokes must not be performed over the bony areas ­ they will hurt.


• Try not to concentrate on the strokes, otherwise you may lose the rhythm.

Inada Massage Chair

The many benefits of massage therapy have been recognized since 4-500 years B.C. Records show that massage was widely used in China, Greece, India, Egypt, Rome and more. These ancient societies fully recognized the many benefits of massage therapy. Since prior to 1980 massage chairs have been available. These chairs provide a full range of computer-driven massage programs. It's like having an expensive weekend at the spa available at any time for their owners.

The chair designers and engineers have been very successful in their continual efforts to capture the techniques of a well-trained professional masseuse. These massage techniques have been included in the functions provided by high-quality chairs for convenient use in your own living room. In a market of nearly a dozen manufacturers, the Inada Massage Chair is the worldwide leader.

Why Would You Want A Massage?

Among the many health benefits attributed to regular massage sessions is that of endorphin release. Endorphins are a family of neuro-transmitters with properties similar to those of morphine in terms of relieving pain and in promoting a sense of well-being. During the massage process, these marvelous compounds are created and released into the body.

It is reported that nearly 90% of all visits to primary care physicians are for stress-related issues. These include headache, back aches, eye-strain, anxiety, depression, neck pain, anger and cardiovascular problems. The latter include heart disease and high blood pressure. Physical and emotional exhaustion are among the more common ailments, as well.

The 90% figure matches well with my own daily experience as a pharmacist. Medicines used to treat these problems comprise the majority of our daily dispensing. When I discuss these issues with patients, I hear the same words used all the time. Exhaustion, fatigue, anxiety etc, etc.

A substantial number of these patients could use a regular dose of mother nature's endorphins to help with their symptoms.

Endorphins can also flow through our bodies as a result of vigorous exercise. The intensity level of exercise needed to release endorphins can be quite high, however. Getting your endorphins to flow by receiving a massage is much easier and more fun, too.

Moreover, the beneficial effects of massage are additive! This means that continual and frequent massages lead to more and more favorable results even if you can spare only 15 minutes at any particular time. Practiced routinely, massage can help to prevent unnecessary strains and injuries that might otherwise occur due to tension build-up. It's nice that something so comfortable, indulgent and convenient helped so many people feel better, play better and perform better.

Why would you want to choose The Inada Massage Chair?

The Inada Massage Chair is very unique amongst its competitors. It is actually programmed to analyze the contours of your body. The software responds to body shape and size so as to detect and focus on shiatsu points along the spine. Shiatsu points are particular areas of the body that focus and respond to finger pressure. Shiatsu is a Japanese term and is part of a very old holistic approach to healing. Similar to acupuncture, Shiatsu pressure is thought to work on imbalanced areas of the body and to restore the natural flow of energy or qi (pronounced chee) through the body.

The surface area covered by the Inada Massage chair extends to 3,048 square centimeters.

This feature alone is foundation for the claim that the Inada Massage Chair provides the most thorough massage of any chair on the market today.

Proprietary Inada "dreamwave technology" in some models provides gentle, undulating figure-8 motion that mimics how a massage therapist would do it. The software also offers extension and flexion plus gentle rotational stretching of the shoulders, mid-back and hips.

There are over a half dozen pre-programmed massage sequences with the Inada. This is just one of the many reasons that the Inada Massage Chair has been the undisputed worldwide leader for many years.

FINDING A GOOD DEAL!

First you should visit the applicable online store and check out the current price. Keep a research file which you can update from time to time. For example: As of a certain date the (XYZ) chair costs a certain dollar amount which is less than chair (ABC). So any good deals should fall under that price.

Start by searching websites of your local stores for the cheapest price on your select massage chair. Following this advice, you may find good deals without getting into shipping and warranty risks. Move on to popular retail stores like Amazon.com which is noted for good prices and finally try moving on to auction sites like eBay where you might find a quality massage chair for an attractive price.

As long as you know how to do some research before parting with your hard-earned money you may well find a great deal.

Ideally, you can find BEST PRICE info and enjoy some great savings without compromise.

To your good health, Brandon Fields

How to Start Your Career Being a Massage Therapist

If you love to work with your hands, perhaps you should be in a profession that does exactly that such as massage therapy. In fact, the US Department of Labor has shown in their latest report that there is demand for such professionals until the year 2012. If this sounds appealing to you, then you should know how to become a massage therapist.

Those who want to become massage therapists should enroll in a program that is accredited by the National Certification Board for Therapeutic Massage and Bodywork or NCBTMB. To become a licensed professional, you must complete at least 500 hours of training including subjects such as ethics, anatomy and physiology among others.

If you happen to study massage therapy in a school that is not accredited by this body, you will not be allowed to take the national certification exam. This may prevent you from practicing in states that require this prior to employment which is why you should check first if the school you plan to enroll in is in the program.

Should you somehow be able to find work without getting a license, you could be penalized with fines and even be banned from every practicing there.

The advantage of enrolling in a program under the NCBTMB is that you can apply for federal financial aid if you don't have the funds to pay for your schooling.

But the big question is how much do massage therapists earn? One research group has pointed out the median salary is $45,611. The report also says that half of those working earn between $36,930 and $55,920 as this varies with experience. If you are new, you will probably just have one or two clients a day while more experienced individuals will have more than 5. This isn't bad because massage therapy program can go as high as $12,000.

If you are serious about pursuing this as a career, ask yourself some questions. Are you patient? Are you customer oriented? Do you really want to help the patient? If your answer to all three questions is yes then the next thing you have to do is check what specific interests do you have.

Just like medicine, massage therapy has various specialties and these include sports massage, clinical massage and Swedish massage to name a few. While you will probably learn all of these in school, you should already see which one you want specialize in after graduation.

To help you out, it will be a good idea to visit massage parlors and talk to those who are already working. You can also do some research online as there are articles that have been written about the profession.

Once you get your degree and the license, you have the option of working for someone or opening up your own establishment. This will be easy if you had the capital since you will need to buy your own massage table, chairs, pillows, sheets and lotions. But if you want to learn first, then go find work, learn the tricks of the trade and then set up shop.

Now that you know how to become a massage therapist, the ball is already in your court. The right attitude will get you through school because with that you will be able to understand the techniques in helping a customer.

Acupressure Schools - Career Training Options

Though traditional forms of medicine are highly effective many individuals prefer to obtain alternative health care to relieve ailments. Students that want to enter natural healing careers can prepare for the industry by completing one of several educational training programs. Students can start by learning about the different career training options available in acupressure schools.

Acupressure training teaches students to target specific points on a person's body to relive pain, promote health, and increase circulation. This can include diagnosing illnesses, managing migraines, and removing energy blockages. Training examines many topics and techniques to prepare students to understand today's commonly used procedures. For example, a popular form of treatment is using Tui Na massage. This form of acupressure focuses on working with soft tissue and structural realignment. Students will gain the correct skills to utilize their hands, elbows, and acupressure tools to help relieve pain. Training is invaluable, as students need to complete education to successfully obtain careers.

Training incorporates multiple areas such as Eastern and Western medicines, business practices, massage techniques, meridian pathways, and more to prepare students for professional careers. The most common training programs available are in the form of one-year certificate programs and two-year associates degree programs. Other forms of training are also available inside natural healing programs at the bachelor's and master's degree level where students gain a comprehensive understanding of Traditional Chinese Medicine. The main programs offered prepare students for state licensing exams, which makes having a certificate or associate's degree the main requirement that needs to be met by aspiring acupressure specialists.

Programs at the certificate level require students to complete at least 600 to 800 hours of training. Students study acupressure techniques and Eastern medicine practices to prepare for careers. Tai Chi, first aid, and kinesiology are other major areas that may be included to supplement educational training. Possible courses may include topics on shiatsu massage, Asian bodywork, anatomy, and diagnostic procedure. When exploring Asian bodywork students are taught a complete overview of acupressure points, the six body divisions, meridians, and disease theories. Once training is completed students are eligible for state certification examinations. The National Certification Commission for Acupuncture and Oriental Medicine provides students with certification. Students will take the knowledge gained in schooling and apply it to the Asian Bodywork Therapy exam, which shows students know how to properly administer acupressure.

Students that want to further their knowledge can enter bachelors degree programs for Traditional Chinese Medicine. The practices, theories, and modalities that make up the industry are learned, which provides students with the skills to perform acupressure. Students study physiology, qigong energy, medical terminology and more to prepare for careers. Students with proper education can step into many careers that may include working in:

• Health Spas


• Hospitals


• Research Facilities

The training needed to become an acupressure specialist is obtainable inside a variety of acupressure degree programs. Students can enter training by enrolling in accredited natural healing colleges across the country. The National Certification Board for Therapeutic Massage and Bodywork ( http://www.ncbtmb.org/ ) fully accredits qualifying programs that offer the best acupressure training.

DISCLAIMER: Above is a GENERIC OUTLINE and may or may not depict precise methods, courses and/or focuses related to ANY ONE specific school(s) that may or may not be advertised at PETAP.org.

Copyright 2010 - All rights reserved by PETAP.org.

The Benefits Of A Foot Massage

A foot massage is something that almost everyone craves, but very few can actually get. It can be both sensual as well as relaxing. This is a very simple idea that can help to keep even the most on edge person relaxed and at ease. A simple foot massage can relieve many of the tensions of the day and can make you feel revitalized. It can do this in many different ways. It will help to relax the tense muscles in your feet and it will also give you a feeling of relaxation.

In regards to the sensual aspect, there can be many benefits to this as well. A simple foot massage of your loved one will tell them that you care and will help in the creation of an atmosphere of peace. By simply touching and caressing your partner's feet you set the tone and the atmosphere for the time that lies ahead. This simple gesture will let your partner know what you are willing to do for them and how much you care by caressing their feet and letting them take some tension off which will lead to a night of potential romance.

A simple foot massage can be something that is very helpful to those who have high stress jobs or for someone who is on their feet for the better part of their day. This simple tension reliever will lead to not only your feet feeling better, but your mind and soul will be relaxed as well. This simple pleasure will make your whole day better. A simple foot massage helps to sweep the tension away from your body by making your feet feel comfortable and relaxed again which will rejuvenate your entire body. It is a great end to a long day and a wonderful way to start your night. It will send you on your way to a relaxing evening and a good night which will allow you to have a great start to your next day.

A foot massage has many benefits not only physically, but mentally and emotionally as well. It also helps to relieve the stress as well as provide physical relief. It can relax the muscles and tendons in your feet and help to soothe away those aches and pains that you get from standing on your feet all day. As far as mentally, the fact that someone is pampering you and showing you the affection and attention that you need and crave. It is also just a simple relaxation and stress relief technique that for all intents and purposes allows you just put your feet up. So go home and find someone to give you that foot massage that you so richly deserve or you can go to a massage parlor and let someone else do it for you while receiving some of the other perks of the massage service. It is something that everyone deserves every once in a while or even more so. So go and treat yourself, you deserve it.

Some of the Important Benefits of Sports Massage

For professional athletes maintaining muscle condition and suppleness is not just a beneficial perk it is a vital component of their training regimen. When your lively hood depends on your body operating at its full potential, risking a torn ligament or a pulled muscle is just not worth it. Maintaining peak physical conditioning at all times, being constantly prepared for sports activity requires a lot of different practices. So massage techniques specially designed for sports people have come about and been integrated into most professional athletes repertoire of training practices.

Big league soccer teams, American football teams, basketball teams and any other sport where global excellence in sporting acumen must be matched with almost superhuman levels of physicality will typically have a sports masseur or even a team of massage specialists on hand to keep the athletes ready for play.

Before matches it is used to help loosen up muscles as part of a stretching and limbering routine to help prevent any cramps or strains occurring during the match or event. It has the added benefit of helping the athlete relax and focus their mind in preparation for the match which can require levels of concentration as intense as the levels of fitness required.

Of course, having the therapist there on the sidelines of a match is necessary for when an athlete does eventually strain a muscle or a tendon during play. Again, after the match or event, therapeutic sports massage can help muscles in the cooling down phase after intense activity and help the muscles in their natural healing process by moving blood through the area to allow for new muscle cells to form.

But for the rest of us who are not multimillionaire sports superstars this kind of massage therapy may seem superfluous. The fact is its just as important for ordinary fitness as it is for professionals. A professional athlete's body is conditioned over years for intense activity. For those of us who can only make it to the gym a few times a week or play with a local team for fitness at the weekends muscle injuries are a much more likely occurrence. And puling a muscle in your neck or leg can mean you miss a week of work or at least make it very uncomfortable. A professional athlete may only have a few weeks of actual events they have to attend throughout the year so are more likely to have the time to rest an injury.

Finding time on a lunch break once or twice a week for a sports massage can ensure that you don't receive any injuries that may put you out of work for a few days. Even if an injury doesn't prevent you from working it will likely prevent you from working out. Anyone who has an ordinary day job knows how quickly you can get out of shape just from missing a week or two of training. Months of hard work sweating at the gym or the pool can be undone in a few days of being stuck on the couch.

Physical Therapy Billing

Physical therapy billing is often misunderstood and taken for granted by most private practices which result in thousands of dollars lost each month, if not more. Proper PT billing and CPT coding can make or break a practice. Those who know rehab billing secrets and techniques and do it well are more successful overall. Those who do not fully understand billing for physical therapy don't do as well.

What You Don't Know Will Hurt You!

Your billing system is the life blood of your private practice. The billing system keeps the revenue flowing that in turn keeps the business going. Most physical therapists want to treat patients and not deal with the billing. They think it's a "headache" and would rather dump it off on someone like a billing service or company or an employee. As a result of this mentality most practices across the country are losing out on a lot of money! The typical practice collects only 40% of what they should be and could be collecting. Billing is more than generating a claim with diagnosis codes and CPT codes. It is much more than that.

What the Most Successful Practices are Doing

1. They get all the right tools. They don't use borrowed (stolen) forms from past employers and copy someone making a lot of mistakes. They don't use MediSoft, Lytec, TurboPT, PTOS, or Clinicient. Instead they have...

 Good Software with few bells and whistles.

 Good Patient Intake/Registration Form .

 Good Assignment of benefits (AOB) form containing important legal language. It should secure legal rights from the patient allowing you to deposit checks made out in their name, file a complaint with the insurance commissioner on their behalf, receive checks directly from the insurance company on their behalf (even when their policy states otherwise. A good AOB will give you solid legal recourse should the insurance company or the patient ever try to evade payment.

 Good New patient interview form.

 Good Fee slip that's easy to read and understand.

2. They present a bill and collect patient portions at the time of service. They don't waive and discount co-pays and deductibles. Which is illegal without documented financial hardship.

 A good staff member handles the new patient interview with professionalism and tact and the patient is made aware of their financial responsibilities, not a minimum wage receptionist.

 All pertinent personal and insurance information is gathered at initial interview and/or first appointment.

 Services and codes are strategically chosen based on the type of insurance the patient has and the payer rules.

 Modifiers are applied to maximize billing. All staff are trained well on how to use them.

 Patients are presented with a bill with their portions clearly stated and they pay that day.

 The billing person receives the charges and codes daily.

3. They collect insurance portions within 60 days! They don't accept insurance company stall tactics such as, "we don't have record of your claim", "it's being processed", "we need more information", "it wasn't medically necessary", etc. They apply the state and federal provider rights laws and get paid fast.

 Billing data is input into the computer timely

 The AOB is manually sent to the insurance company payer

 Bills are generated and submitted electronically. Electronic claims are paid within 14 days whereas paper claims can take as long as 60-90 days.

 If payment is not made within 30-45 days, a tracer is sent with a notice warning of a possible complaint with the insurance commissioner.

4. They collect 90-100% of Billed Charges! They don't accept denials of any kind such as, "Untimely submission", "Not UCR", "Not Medically Necessary", "No Benefits", and "We sent the check to the patient so go after the patient", etc.

 Appeal letters are sent to the insurance company in response to all denials. (View sample)

 The insurance commissioner and patient are sent a "CC" (copy) of that letter.

 If a reimbursement check is sent to the patient, a demand is made to issue another check referencing the instructions made on the AOB form.

 When a request for "more information" is requested, they charge the insurance company a medical request fee ($35) so they stop using that stall tactic with them. And much, much more...

 If a patient has an outstanding balance owed they don't use weak collection letters, bargain, or write-off the debt. They use collection letters that work and encourage the patient to do the right thing which is to pay the debt!

 They have payment plans available for their patients that are easily setup and administered.

 They make sure to charge patient coinsurance/co-pay's at the time of service each and every visit!

5. They maximize reimbursement! They don't bill every patient exactly the same way. They don't just bill ther-ex, manual therapy, ice and ems (97110, 97140, 97010, 97014) with every patient for a mere $79 reimbursement.

 They use modifiers like -59 and -22 to get paid more for those patients who require more time and energy to treat, such as the patient who c/o neck, shoulder, back, buttock and knee pain.

 They also use the modifier -52 for when services are reduced.
6. They preserve patient loyalty They don't allow insurance companies to maliciously splice the relationship between provider and patient by using derogatory language such as "Fee's are excessive for that geographic region", "Fees are Not usual, customary, or reasonable", "Services rendered were unnecessary or not professional".

 Template letters are sent to insurance companies every time they use derogatory language in the Explanation of Benefits statements to patients/providers.

 The insurance commissioner and patient are sent a "CC" (copy) of that letter.

 They collect patient coinsurance/co-pays at the time of each visit so the patient won't have to later pay a lump-sum-bill three weeks after discharge which most people can't pay and quickly come to resent.

Studies show that patients who owe you money are more likely to file a malpractice suit against you. Studies also show that patients who pay something out-of-pocket for their healthcare services each visit get better faster.

Billing Options Available

1. Contracting out to an independent medical billing service

Most of the so called "medical billing services" are stay-at-home moms who took a weekend course on "How to Make $40,000/yr Working From Home". They learn how to purchase software, collect and input data and submit claims. They're also taught how to print business cards and present themselves as a professional organization. The problem is most of these individuals have little to no experience.

PROS Cheaper and more personable. Allows you time to market and advertise your services.

CONS Lacks experience. Most likely won't know how to appeal denials or respond to stalling tactics. Most likely paying for simple data entry.

CHARACTERISTICS

o No setup fee.

o 4-10% of gross reimbursements.

o They collect patient info and billing by fax, Fed-Ex, or PC Anywhere

o Not very good about updating you on status of claims and collections

o Reports are not very good

Results typically are 40-50% of money lost by falling through the cracks and never getting appealed and collected. Most do not know how to appeal denials, file complaints with the insurance commissioner, respond to derogatory language in EOB's, train your staff on modifiers and good coding for different type of payers, or respond well to insurance company tactics on stalling and refusing payment--all the things that make a billing system great.

If you want to find a decent billing person, one who is organized and knows the basics, ask them these questions:

o Do you have any physical or occupational therapy billing accounts now?

o Can I contact them for reference?

o Can you send me a sample of 3 reports?...monthly claims submitted, monthly paid items posted, aging report on every outstanding claim.

o What type of billing software do you use? Is it HIPAA compliant?

o How will you collect the charge/patient data from me?

o Will you teach me code strategies for each payer type (ie. workers comp, blue cross, medicare, medpay, etc)?

2. Large Medical Billing Companies

The larger medical billing companies usually work with many providers and have many accounts. They typically have more experience but that is no guarantee they know how to go beyond data entry, claims submissions and payment postings either. There is not much money in it for them to appeal denied claims because it takes human resource and time to write letters, make phone calls, and submit complaints. They would much rather do the simple data entry and get their percentages from that.

PROS Reports are better. They have more experience. Allows you time to market and advertise your services.

CONS More expensive. Probably won't do all appeals, letters to insurance commissioner and patients especially if you are a small account (less than $10,000 per month).

CHARACTERISTICS

o Setup fee

o 8-15% of gross reimbursements.

o They collect patient info and billing by website log-in, fax, Fed-Ex, or PC Anywhere

o Not very personable

Results typically are 30% of money lost by falling through the cracks and never getting appealed and collected. Most will not file complaints with the insurance commissioner or respond to derogatory language in EOB's.

If you want to find a good billing company, one that appeals denials, files complaints with the insurance commissioner, provides detailed reports of claims submitted monthly, claims paid monthly, and aging reports with 30-60-90-120 day statuses then make sure to screen them well. Ask the following questions:

o Do you have any physical or occupational therapy billing accounts now?

o Can I contact them for reference?

o Can you send me a sample of 3 reports?...monthly claims submitted, monthly paid items posted, aging report on every outstanding claim.

o How will you collect the billing/patient data?

o Will you teach me code strategies for each payer type (ie. workers comp, blue cross, medicare, medpay, etc)?

o Do you appeal denials?

o Can I see sample appeal letters that you use?

o Do you ever send patients letters? If so, what and can I see a sample?

o How do I ask you questions? What are your support hours?

Prices are always negotiable with outside billing companies and independents but be ready to pay if you want them to do everything listed above.

3. In-house billing where an employee does the billing

I recommend doing billing in-house with an employee after a year of solid marketing, advertising, and promoting your practice. Most owners do not have the time necessary to do both adequately (as well as treat patients). If you are considering hiring an employee to do the billing be prepared to learn the in's and out's first. Even if the employee boasts about knowing billing. It's a good idea to learn it yourself, setup the system, and work closely with the employee until they demonstrate competency.

No one will go after the money owed to you and look out for the welfare of your business like you.

PROS More control over the system. Better collection rates. If monthly billing is more than $20,000/month you will save money by using an employee versus an outside service. They can also assume other admin tasks.

CONS Takes time to learn the system and set it up.

CHARACTERISTICS

o Employee wages

o Employer taxes

o More control over billing procedures Results typically are less than 10% of money lost. Less money will fall through the cracks and get lost. Complaints with the insurance commissioner will get filed and derogatory language in EOB's will get responded to.

If you want to find a good employee, one that will do the job well, you may want to hire someone who tried to start an independent billing service at one time. It's not necessary but they may already know the basics. Ask them these questions?

o Do you have any experience with medical billing?

o How much do you think this job should pay? Look for someone in the $12/hr or more range.

o What type of work do you enjoy more, office work or person-to-person work?

Learn more ways to get paid better and succeed in private practice>>> http://indefree.com

The Rolf Method of Structural Integration Verses Rolfing & Trade

Have you ever heard the saying six one way, half a dozen the other? One of my most influential mentors used to say this to me all the time as a child when I would ask questions about something that was essentially the same. I remember it driving me so crazy hearing this answer over and over as a young child. Then one day it clicked. I asked a question and he gave me the same six one way, half a dozen the other answer and I looked at him and he smiled. I smiled as it finally made sense.

As we work very hard to bring Structural Integration out of the mystical mountains and into the forefront, people can often be confused by what this therapy is being called. When we look at the most common and mainstream types of manual therapy everyone knows of physical therapy and massage therapy. The amount of people that have heard of and have received Rolfingor Structural Integration or the Rolf Method of Structural Integrationor whatever term a school puts on their graduates, are just a fraction compared to physical therapy and massage therapy. Not only does Joe public not really know much about Structural Integration or Rolfing but the medical community is in the same spot as Joe public. So how can we clear up this confusion of terms?

Rolfingis a trademarked and reserved term for practitioners of Rolfing Structural Integrationthat have graduated from the Rolf Institute. Anyone who has completed training at any of the other schools of Structural Integration may not use the terms, Rolfing, Rolfer, or Rolfed at any time. Rolfing is a brand name for the process of Structural Integration.

Over the years, as Ida P. Rolf developed her life's work, her clients and students referred to the process as Rolfing for short, over her name of the work, Structural Integration. The common lingo could go something like, I was Rolfed today, or I am going to see my Rolfer, or do you know anything about that Rolf stuff? The politics surrounding this confusion can create a difficult and cumbersome task for people who are looking for, and learning about, Structural Integration. Let's say a person has worked with a Rolfer and has moved to a new city. They go to find another Rolfer to receive continued care but none can be found because there may not be any Rolfers in that particular city. It is possible that their Rolfer never referred to the work as Structural Integration, the actual name for the process, and the person does not know what to do. In this new city there may be Structural Integrators though, but the person does not know that this Structural Integrator has been taught and practices the same thing as their Rolfer.

We are now in a period of time where we have many great schools that are teaching some derivative of the Rolf Method of Structural Integration. Most schools refer to their graduates as Structural Integrators, but a few may have their own label or term. A good example of a language issue can be seen when we look at automobiles or cars. I remember my best friend's family and how they referred to their cars. His parents would say "alright everyone let's get in the car". My friend would always say "okay let's go get into the Chevy". They both were referring to the same car, but my friend was referring to brand of car and his parents just called it a car.

There was a rough time period in the political aspect of the world of Structural Integration and great rifts were developed between certain schools. As a result, there are some that will tell you that if you are not seeing a Rolfer you are not getting the true work of Ida P. Rolf. That Structural Integrators and Rolfers are totally different, practicing and performing different lines of work. This is absolutely not true. If someone has graduated from a credentialed school of Structural Integration you can feel safe knowing that you are receiving quality care. As a practitioner who did not graduate from the Rolf Institute I deal with this situation all the time. I have clients that come to me and say "I was Rolfed 20 years ago I think it's time to be Rolfed again, can you Rolf me?" I then have to take the time to explain the legal bindings and ramifications of terminology and trademarks. This can be confusing for people.

Imagine if there was only one school or college in all of America, or the world for that matter, that could teach a particular therapy or degree program. There would be millions and millions of people that would have to go without having the opportunity to receive that education or the help that could come from that person's education.

As there are more quality schools of Structural Integration coming into the picture we are able to know that more and more people are being trained at high levels in the Rolf Method of Structural Integration. As a result, more people can receive and experience this amazing process. A good example of this concept is looking at people who work to obtain their Masters Degree. When we see that a person has achieved their Masters we do not say "well your Masters Degree is from Washington State University and not Gonzaga University so it does not count." We know both schools are reputable and offer great programs.

There are things that we do need to watch out for though. With the addition and development of more people or schools teaching Structural Integration how do we know the students graduating from these schools or programs are capable and competent? There are people and programs that say they are teaching Rolfing or Structural Integration, but come up quite short. Many of them will teach weekend workshops or call Structural Integration another form of deep tissue work. This is where we need to spend our time protecting people.

So, how can you know if your practitioner has had proper training? One of the best resources is the International Association of Structural Integrators (IASI). IASI's mission is to be the leading professional organization for the advancement and promotion of Structural Integration as a cornerstone to health and well-being through education, community and communication. IASI has a list of schools that they have approved to teach Structural Integration. You can find this list on their website at http://www.theiasi.org.

IASI has established standards of education, ethics and professionalism that schools must meet in order to receive approval. These standards are what separate people who are truly teaching Dr. Rolf's work from those teaching a watered down severe variation of the work. IASA was also the driving force in the development of the Certification Board for Structural Integration (CBSI). The CBSI strives to examine and maintain standards of ethical and professional practice in the delivery of services through a credentialing program that promotes the competency of practitioners of Structural Integration. You can learn more about the exam at http://www.siexam.org. The CBSI helps identify individuals who have received adequate training in Structural Integration by using a psychometrically-valid exam. This process is another huge step in unifying the world of Structural Integration as well as differentiating it from other manual therapies.

As a practitioner and teacher of Structural Integration, I believe it is my responsibility to try and share this information with as many people as possible. Each and every day that I wake up and get to share my knowledge and passion of the Rolf Method of Structural Integration I am truly grateful. I am able to do this through my clients in my practice, the students in my school, my fellow Structural Integrators and Rolfers, and the community as a whole through lectures and presentations. But, the level that this happens can be held back and made stagnant by getting stuck and caught on the political tensions of terminology.

As you are looking for your Structural Integration practitioner, I invite you to ask lots of questions and research the same as you would or should when seeking out any other health care practitioner. Use the tools that were mentioned above and when you do I believe that you will find the difference between a Rolfer and a Structural Integrator is six one way, half a dozen the other.

Massage Therapy - Different Styles of Massage

One of the great things about a career in Massage Therapy is the endless variety of massage styles you can bring to the table. You can truly follow your inner promptings and even create a combination of styles that are uniquely you.

Its not uncommon for massage therapists that are really dedicated to continue to take classes and workshops to learn different massage styles throughout their entire career.This has many benefits. It keeps the work interesting, for both you and your clients. It continues to give you an edge over your competition. And if it interests you, the more you learn, the more your massage sessions can shift from a feel good experience, to a deeply healing experience.

Your main interest in becoming a massage therapist may be to deal with muscular problems and pain. There certainly is, and always will be, a great need for this. If this is your focus you may want to find a school that focuses on Sports Massage. Sports Massage is designed to relieve tension, get rid of painful, tight, knotty areas, and re-align scar tissue. It can also help rehabilitate injuries in ligaments, tendons and muscles. Some of the massage styles and techniques you could learn include, Deep Tissue, Trigger Point therapy, Myofascial Therapy, Neuromuscular.

On the other hand, if your interest is more in create a deeply relaxing massage experience, you might pick of different school with a different focus of massage styles to start your training. More and more you see schools appearing that focus on more New Age styles. These often start with the basic Swedish-Eselan style. This is a common combination of the more vigorous stokes of Swedish and slower more relaxing style of Eselan. With this as your basis, its common to then learn and add such techniques as Reiki and Polarity Therapy, Acupressure, Shiatsu, Cranial -Sacral, Thai massage and Reflexology.

It seems as more and more Massage Therapy schools open, the new massage styles and techniques that are available to learn continues to grow. Being a massage therapist never needs to become boring, if you are willing to learn. Attending workshop and trainings to learn different styles of massage is practically always a fun and inspiring experience.

Still if you find the expense of attending classes a little daunting, there are other approaches. It is possible to find on the internet an abundance of massage training videos.These can be excellent if your not interested in receiving certification. They can also be really helpful if you have received formal training and just want to learn new techniques and styles.

Whatever approach you take, massage Therapy can continue to be a fun and interesting career. Just remember to keep getting massages from others to experience different massage styles and techniques and be open to exploring the different directions you feel inspired to go. If its something you personally love to receive, most probably you will be very good at giving it. Keep learning as your work will continue to become more effective, and you career will continue to be fulfilling and interesting for years to come.

The Benefits of Massage Therapy For Stress Reduction

Everyone loves a well done massage, especially if they have been injured or stressed with work, family or other problems. The time spent getting a massage can be just as beneficial as a therapy session with a psychotherapist. The massage, however leaves one feeling more relaxed and not emotionally drained. So, the benefits of massage therapy may SEEM to only be physical, but in reality, they extend to the mind as well.

An obvious benefit of massage therapy is that it helps alleviate stress. It happens to everyone, this terrible thing called stress, but it does not need to stay in one's body and keep polluting it with toxins. For example, why should one allow a nosy mother in law or new co-worker, who believes he is sent from Heaven and knows everything, to ruin their day? Just because the mother in law makes it her business to critique everything from last night's taco salad to the manners being instilled in her grandchildren, does not mean one needs to see a psychotherapist. Just make an appointment with the local masseuse and in fifteen minutes, it will be as though it never happened.

Another benefit of massage therapy is that it not only works on tight muscles and makes them looser, it helps alleviate pain. For the unfortunate driver who was rear ended by a fully loaded city garbage truck, that is excellent news. This therapy could become a way to avoid a costly surgery on a torn rotator cuff or a chiropractic need for a spine injury, while allowing a little pampering along the way. These therapies have been successful in returning some lost mobility of joints and in some cases they have returned all of the previous mobility of the victim's joints.

Athletes like to use massage therapies to ready their bodies for the games they are about to play. By doing this, they stimulate the blood circulation in their bodies and get oxygen and adrenaline to their various body parts. They also use massage therapies if they become injured during the game. This could help their bodies and the injury relax long enough for them to finish the game or allow a doctor access to the injured site without creating more pain to the player. Win or lose, when the game is finished, a massage always is welcomed to ease away the aches and pains of the game and to restore the normal blood flow throughout the body.

Understanding Massage Therapy

We've all heard of massage and many of us have even experienced it, in one form or another. By a masseuse who happened to be an amature, loved one or professional. If the person knew what they were doing, you came away feeling like a million bucks. But what is massage, really!

Massage or massage therapy as it has come to be known in our time, began with the ancient Egyptians, then the Greeks and finally the Romans. Yes these ancient cultures used massage therapy for both healing and pleasure. The science of massage therapy had also spread to other early cultures such as India, China and Japan. The last three went further by integrating it to form an integral part of their systems of medicine and healing.

Massage is the organized form of touch. It is performed by the hands, elbows and forearms gliding over the skin and applying pressure to the underlying muscles by a system of movements. These movements involve stroking, rubbing, pressing and kneading. Massage is not a panacea, but can greatly aid in the normal functions of the body and restore balance as well.

How Massage Works

Massage works by the body responding to the various touch techniques given to it. These touch techniques causes the body to engage in there normal functions. Massage itself, acts like a natural stimuli for the body to respond with positive effects in many different ways. Some of these therapeutic effects are, stimulating the circulation of the blood and lymph, loosening of muscular tension, toning and firming the muscles.

When fibers stop sliding over each other easily, it's most likely the cause of people not getting enough exercise, too much exercise, physical or mental tension. These factors cause the drop of any increase in muscle tone. The waste products from muscular activity, like carbon dioxide, lactic acid and urea, build up in the muscles. Massage therapy fosters drainage of those wastes, therefore restoring there normal functions.

Massage therapy also fosters the drainage of lymph, causing better circulation of the blood. Because of this, the skin looks much better than if drainage was difficult. Why bother with the how the skin looks? Because the appearance of the skin, is usually a good indicator of a persons inner condition. In reference to muscles, massage therapy has a good effect on the fibrous tissue surrounding the joints.

The effects of massage upon the autonomic nervous system gives birth to the feeling of relaxation. How? By stimulating the sensory nerve endings located within the skin, signals are sent to the brain by the central nervous system. This in turn produces the experience of feeling good. Once again because of this action, a new reaction takes place by causing a significant reduction in the body's stress level. When a person is relaxed, abdominal breathing becomes more natural. I can assure you, your abdominal organs appreciate this. It's quite clear that the nervous system plays a crucial role in massage therapy. It's also responsible for the vascular system, since it controls it. A decrease in efficient drainage and supply of blood, is caused by a reduction of vascular.

Massage works by reducing stress, managing the body's waste products, fostering normal bodily functions, providing a sense of well being and boosting mental health.

The Logic of Massage

The gradual development of massage therapy into a full blown art and science can be determined as only logical. When we fall, bruise or sustain any sort of physical injury, we usually tend to touch it. Even if that act produces no form of healing solution, or does it? Touch in itself is very comforting to us. It reassures us, make us feel loved and accepted. Whenever someone is in pain, we tend to want to hug, hold or touch that person in someway. Somehow sensing that the very act of physical contact will contribute to the overall holistic health of the person. Guess what? You are correct in that assumption.

Studies have shown that, touching among other comforting and intimate contact, does assist in the overall recovery and health of a person. Whether that person is in need of physical, mental, emotional or spiritual healing or comfort. In looking at the big picture, I see massage therapy continuing to play an important role in human history for a long time to come. What are you waiting for, join the minions.

Herniated Discs May Respond to McKenzie Physical Therapy

Conservative treatment should always be the first port of call when someone has a herniated disc causing either back and leg pain or sciatica. This should also be the case if a patient is suffering from neck and arm pain. There are many forms of physical therapy (or physiotherapy) but one that is established, well-researched and proven is called the McKenzie Method or McKenzie Care.

The McKenzie Method was developed by New Zealand Physiotherapist Robin McKenzie in the 1950's. Robin was treating a patient called Mr Smith. Mr Smith laid face down on a treatment table that had been left elevated from the previous patient. This meant Mr Smith had his back in an arched position which in the 1950's was thought to be a dangerous position for people suffering back pain or herniated discs.

So what happened next? Mr Smith improved rapidly in this arched position with all his leg pain rapidly reducing with only pain experienced in the center of his back. He was actually the best he'd been in over 3 weeks. Robin then experimented with different movements and positions and slowly developed the method which bears his name.

The phenomenon of pain moving to the center of the back while lying in a certain position (as was experienced by Mr Smith) is now called centralization and is associated with a good outcome and means the patients will recover quickly. Research has shown centralization is associated with pain from disc herniation or disruption.

McKenzie therapists have undertaken extra post-graduate training provided by the McKenzie Institute International. The Institute's website has a world-wide list of trained McKenzie therapist. However, many patients recover from their back pain just by reading Robin's book "Treat Your Own Back."

The VMO - Three Tips on How to Strengthen it After a Knee Replacement

After having knee surgery whether it was an arthroscopic procedure or an entire knee replaced, getting the VMO to function again will be a priority for a properly functioning knee. The VMO does get some indirect work from other exercises when working on the quadriceps as well. There are three exercises that I always recommend to my clients after knee surgery while seeing them in their home to isolate this muscle.

1. Isometric Quad Sets: I have the client squeeze their thigh muscles by pressing the back of their knees down into the surface and hold that position for a slow count of five. You can gently turn your toes outward and that will place more emphasis on the VMO. You can also place a small rolled up towel under your knee or knees and that will help you isolate the VMO as well.

2. Terminal Knee Extensions: You place your affected leg up onto a bolster or a rolled up pillow will do. That will place your knee or knees at roughly a 45 degree angle, lift the bottom portion of your leg up leaving your knee on the bolster and hold that position for a slow count of five. Again turn your toes slightly outward to hit those muscle fibers that make up the VMO.

3. Wall Slides: This is a more aggressive exercise then the previous two mentioned. Once the knee has healed further and is getting stronger, you can go find a smooth surface like a door for instance. Lean up against the door with your back touching only. Slide down the door until you get about a 45-50 degree bend in your hips. Hold that position for a slow count of five also. Then slowly go back up. You will feel this really hit the knee and with those toes pointed outward also it will put the workload on that VMO. Remember to always keep your back against the door to maintain proper body mechanics.

These three exercises have produced great results with my clients in their home before they are sent off for further rehabilitation in the community. Give these three a try. A properly functioning VMO is vital to having a complete and successful outcome after knee surgery.

The Importance of Continuing Professional Development as a Massage Therapist

Some professionals, such as physicians and nurses, are required to complete a certain amount of continuing education each year. This is to make sure they keep up to date on the newest techniques available to help their patients. While having a massage therapist license might not mean you must take continuing education, it is still very important and you should consider it a high priority. After all, you are helping heal individuals just as doctors and nurses are. It is important that you provide the utmost up-to-date service to your clients. Most professional associations require it these days and you insurance may depend on it.

Continuing professional development or education as a massage therapist will not only benefit your clients, but you and your employers (if you work for a company) as well. Employers love for their employees to keep up-to-date on the latest techniques that apply to their field. This means that no only do they have a skilled and qualified employee, but they are providing the best service possible to their clients. Even if you work as an individual massage therapist, the same rules apply. By continuing your professional development, you can let your clients know that you have the skills needed to provide them with excellent massage therapy. This will keep clients happy and happy clients are returning clients. Acquiring new skills will also allow you to charge more for your services. Clients who find a quality massage therapist with credentials to back up their services will be willing to pay more for a massage. You can also increase your business by offering different types of massages. If you were trained in Swedish massage, consider looking to other types of massages to help expand your massage repertoire. Look at continuing your massage development by taking classes in different types of Asian massages such as Thai massage, Thai foot massage, Thai herb compress massage or Chinese Tui Na massage. You may want to study more conventional western forms, such as sports massage, pregnancy massage or aromatherapy massage.

If you are already well versed in Asian massage techniques, maybe you should focus your continuing professional development on a specific part of the body. There are courses which concentrate on the assessment and treatment of upper limbs, cervical and thoracic spine, freeing the shoulder, freeing the lower back and hips, focusing on the lumber spine hip/pelvis and lower leg. There is deep tissue or Remedial massage, which works on specific joints or muscle groups. Going even deeper we have neuromuscular therapy, which focuses on pain relief in specific 'trigger points' and deepest of all, there is myofacial release, which works to release tension in the connective tissue layers.

To continue your professional development as a massage therapist is very important to both you and your clients. Check with your local clinics and community colleges to see what classes are offered that might help compliment the techniques you already know.

Sports Massage - Pre-Event

Massage before an event can be an integral component of the pre-event preparation for many athletes. Pre-event massage can create a state of readiness in the muscles and tissues so that the athlete's performance can be optimized. Whilst some therapists consider that a pre-event massage can take place up to 48 hours before an event, most Sports Massage therapists judge that, strictly speaking a pre-event massage is one given just before the time an athlete is scheduled to compete (ideally 15-45 minutes before the event). This article will concentrate on massage immediately prior to the event.

A question that is often posed is should the pre-event massage happen before or after the athlete warms up. To answer this one needs to understand the physiological effects of a warm-up: to increase heart rate, body temperature and respiratory rate; and to prepare the body's nervous system. Hence a pre-event massage done after the warm-up would defeat it's purpose and you would not want the athlete's heart rate, body temperature and respiratory rate to drop during the massage.

In general a pre-event massage should assist in increasing the circulation of blood to the muscles to allow the muscles to be flushed and oxygenated. Tight muscles may be relaxed so that joints can be moved through their range of motion. Emphasis should be placed on the muscles used during the activity so improve performance and also reduce the chance of injuries. The athlete can use the time to focus on their event, to relax or complete their mental preparation. At the end of the massage, the athlete should feel great!

More specifically before giving a pre-event massage, the therapist should ask several key questions which relate namely what techniques should be used and what is the intent.

These question include:

- what type of event is the athlete competing in? Are lightening quick reactions required as a pre-event massage given too close to the event may dull reaction times?

- does the athlete's sports permit the use of oils or lotions during the pre-event massage?

- is the athlete required to be "loose" prior to the event (eg boxing) or relaxed (bowling)?

The massage should generally be done at a moderate pace, non-specific, relatively light, warming and short in duration (no more than around 15-20 minutes). It certainly does not have to be a complete routine. As with most massage treatments, it is preferable to be conservative - too little is better than too much. The massage must not be painful or include high impact techniques such as deep cross-fibre frictions or deep muscle therapy. The techniques most commonly used are general Swedish techniques (petrissage, vibration or percussion), compression, jostling, broadening strokes and general frictions.

It is important to note that no two individuals respond to massage in quite the same way and this can present a problem to the therapist seeing an athlete for the first time for a pre-event massage or in the last couple of days before an event. For example, two days before an event the massage can be deep so that the athlete can obtain the maximum recuperative benefit from the pre-event taper. However the depth required to address specific problem areas will vary considerably between athletes. An athlete should see how they respond to a massage in the last 48 hours/pre-event at a competition (or simulated training session) that is non-critical. So please don't leave it until the day before the City to Surf or your big event to have your first massage!