Medical Massage Therapy in Brentwood, TN

Medical Massage Therapy

Medical Massage Therapy by definition is a massage that is performed after an evaluation by a Licensed Physician who can diagnose your condition and develop a treatment plan.  The Massage Therapy can then be performed by the Physician or by a Licensed Massage Therapist under their direction.  The most common place to receive a Medical Massage is by a Chiropractor or a Physical Therapist both of which are allowed in their scope of practice to evaluate and diagnose a condition.  Medical Massages are directed at correcting musculoskeletal issues creating pain and disability.  The type of method used during a treatment vary but usually entail deep tissue, myofacial release, trigger point therapy, sports and myofacial stretching.  This type of massage is not what you would find in most massage settings.  The clinical nature of this type of massage separates the service from the spa industry.  While it is still considered massage therapy it is a diagnosis based treatment protocol with an outcome of measurable changes such as increasing range of motion.

What our Office Offers

Dr. Aiello has been performing Medical Massage Therapy for over 20 years.  He incorporates it at varying degrees in all of his treatment protocols.  With certain patients he recommends getting longer sessions than what he offers during a regular Chiropractic Session.  If postural imbalances are extreme enough he incorporates up to 60 minute sessions in his treatment protocol.  Many of patients have been living with muscle imbalance for so long that to attain relief they require a more detailed approach to multiple myofacial structural dysfunctions.  People who have had past history of major traumas, chronic repetitive work injuries, chronic poor posture, failed surgeries and extreme anxiety/stress develop muscular imbalances that overtime become so ingrained it leads to chronic pain.  These specialized massages will help people who have tried everything else with no results

Everything you need to know about getting an adjustment

What I need to know about getting an adjustment

If it is you first time getting an adjustment we will describe everything you need to know about getting an adjustment in this blog.  First Chiropractic Care is growing as people are becoming aware of the benefits and safety of this option versus what the medical profession has to offer.  Annually 22 million people visit a Chiropractor to receive spinal manipulative care.  The benefits for many common conditions have well been established.  35% of the 22 million are seeking care for low back pain, the rest are consulting a Chiropractor for care of other condition of the spine such as neck and middle back pain.  What many do not know is Chiropractic Care can benefit pain anywhere in the body.  I have many patients dealing with chronic pain in their extremities in conjunction with a spinal condition and are amazed that getting an adjustment in their spine gives them relief in other parts of the body.  Chiropractic is also an effective option for conditions such as asthma, irritable bowel syndrome, allergies, and anxiety.  Chiropractic has been a proven safe alternative to pain care and should be the first option when seeking relief from pain.


Getting Your First Adjustment

On the day of your first adjustment expect to have a physical exam to discover what your issues may be.  Sometimes an X-ray may be be necessary to evaluate more serious underlying causes of your pain.  After an exam is performed most Chiropractors will give an adjustment on the first day.  It is recommended that you wear appropriate attire that is loose fitting to make the treatment easier. It is very rare that a Chiropractic evaluation would require removal of clothes or wearing a gown. During a treatment you are on a specific chiropractic table which allows the Chiropractor to position you in different positions to perform the adjustments.  After an adjustment you should not be in more pain many people feel immediate decrease in their pain.  Many Chiropractors will also incorporate modalities such as contrast therapy, low back stretching, neck stretching, cold laser therapy, and massage therapy.   After your treatment depending on the severity of your condition you will be put on a corrective treatment plan.  Many people opt to continue care after their problem is resolved to enjoy the benefits of maintenance care.

What is Spinal Decompression?

Spinal Decompression


Spinal decompression therapy is an excellent nonsurgical option for the treatment nerve impingement.  A study in 1998 showed a 71% success rate on the 778 participants in the study. Nerve impingement related to a disc herniation or degenerative stenosis can safely be treated with this therapy.  Nerve impingements related to muscular causes will not respond and may even be exacerbated by this type of care.  It is very important to have a physician evaluate the body as a whole and not rely on just an MRI finding to differentiate the cause of your nerve impingement.

Spinal decompression can be performed in many ways in a Chiropractic Physicians office setting and even at home.  The theory behind spinal decompression is very simple, traction is performed to the spine to separate the bones and open up the disc space.  When the disc spaces are opened it creates a vacuum effect within the disc increasing blood flow to the area.  The separation also results in decreased pressure on the pinched nerve and more importantly allows impinged veins and lymphatic’s to drain swelling in the area.  During a session in a physicians office the decompression will be intermittent so you also get a pumping effect further decreasing inflammation.  With repeated visits the goal is not to suck the herniated disc back into place but to increase fluid within the disc resulting in more height and separation between the vertebrae. Recent studies are suggesting that disc herniation’s have been showed to get smaller after repeated sessions but no large studies have proven this yet. Repeated visits will also decrease the swelling around the irritated segment of the spine.

Decompression therapy can be done on the lumbar and cervical spine but in this article we will focus on methods for the lumbar spine.  Cervical methods are very similar and different tables are incorporated in the care of cervical spine therapy.  Studies on cervical decompression are much fewer and honestly I have little experience with using any table assisted methods.  I prefer using my hands for cervical decompression and home care with neck hammocks.

3 Types of Tables

  1. Cable and Pulley: Cable and pulley units have the patient lying on a table with a belt wrapped around the waste.  The patient can be lying on the their back with or without their legs being elevated. At the foot of the table a machine pulls the cable which is attached to the belt on a preprogrammed therapy.  The machine will slowly traction the back to programmed tension and then slowly release the tension. This is a mechanical traction method.
  2. Separating Table: This method has the patient lying on their back with their legs elevated.  The body is strapped to one section of the table and pelvic restraints are used hold the desired position.  The table then has separates section to create decompression of the lumbar spine. This is a mechanical method.
  3. Flexion Distraction Table: This type of table can be mechanical or manual.  This type of traction has the patient lying face down with a strap around their ankles.  The bottom section of the table tilts downward at the foot during treatment.  This motion of the table creates the traction by flexing the spine.  During a manual treatment the physician controls the downward motion with one hand and uses the other hand to apply pressure to the vertebrae above the treated area.  During a mechanical treatment the table moves the lower section based on preprogrammed  parameters.

All three of the above methods are very safe and comfortable.  They are all highly effective at accomplishing decompression and have research behind them.  I prefer to use the manual flexion distraction model in my office.  This method is most controlled by the Physician with a hands on approach.  The only downside of this type of table is it relies on the skill of the Physician to apply the needed to be effective.  The other methods are protocols that can be reproduced by a computer program.

2 Types of Homecare Decompression

  1. Straight Leg Table: This type of table the person attaches their ankles to the table while standing and then lays back.  The table the allows them rotate the table backwards to invert. The person is able to control how far back they invert themselves to apply traction to their back.  During this type of treatment the entire spine undergoes spinal decompression in a general manner.
  2. Bent Leg Table: This type of table the patient stands up against a pelvic support and they lean forward into the table bending their knee around a cushion behind their knees.  During this type of inversion the legs are supported and holding the user inverted.

I endorse the bent leg approach for one very important reason.  When the hips are flexed the low back muscle will relax and allow decompression to occur.  The straight leg tables keep the low back curved and the muscles tense preventing a an optimal decompression.

4 Common Types of Headaches

Types of Headaches

The 4 most common types of headaches people can suffer from are Tension, Migraine, Sinus, and Cluster Headaches.  The National Headaches Foundation has a list of 29 different types of headaches.  In our practice we do see some of the other types of headaches they list such as TMJ, Trigeminal Neuralgia, Post-Traumatic Head Injury, and Menstrual Headaches.  Many of the other headaches are classified due to severe health conditions such as aneurisms of the brain and cancer.  Although severe causes are rare to see they can exist and must always be ruled out with a recent onset headache.


Tension Headache

Tension Headaches are by far the most common headache complaint we see in the office.  Tension headaches are pain in the back of the head at the base of the skull.  The pain can be on one side of the head or both.  When they are intense they can radiate over the entire head to the eye.  The good news is that this headache is easily treatable with conservative care.  The pain is coming from inflammation within the sub-occipital muscles at the base of the skull.  These muscles get overworked from stress and poor posture.  When we hold our head too far forward these muscle work extra hard trying to hold the head upright.  Over time they get inflamed and will develop painful trigger points.  Trigger points in the sub-occipital muscles can refer pain into the head and the neck.  Chiropractic Care, Massage Therapy, and Lifestyle modifications can easily resolve this type of headache.  Life style modifications include home stretching, workplace ergonomic optimization, and in some case dietary avoidance of trigger foods.

Migraine Headaches

Migraine headaches are the most complex and least understood of all headaches.  Many theories have tried to explain what causes them to develop and it is probably the result of different factors from person to person.  The pain symptoms that arise from a migraine are the result of first vasoconstriction with the blood vessels within the brain.  The vasoconstriction results in increased chemicals being produced by the brain cells as a result of oxygen deprivation.  These chemicals then result in a rapid vasodilation of the blood vessels causing increased pressure and pain.  The different phases of the migraine are a result of this process.  Early in a migraine symptoms are related oxygen deprivation then late in the migraine pressure is causing the symptoms. Migraine headaches respond very well to Chiropractic Care and Massage Therapy especially if treated early during onset or used as maintenance to prevent the onset.

The 4 phases of a migraine

  1. Prodrome: 24 hours prior to the onset of symptoms people report feeling off not right.  Some have water retention, mood swings, yawning, or food cravings.  This phase more than likely correlates with what starts the process such as a dietary triggers, hormone shifts, or stress to name a few possible culprits.
  2. Aura: Just before or during the headache any neurologic symptoms could develop but commonly flashes of light, seeing zig zag lines, decreased visual acuity, numbness or weakness anywhere in the body.  This phase is a result of oxygen deprivation to the brain.
  3. Headache: This phase starts with gradual onset of throbbing pain to onside usually or both sides of the head.  As this phase progresses the headache can become severe followed by sensitivity to odors, light, and sound.  You may also develop nausea and vomiting.  It has been noted that any of the mentioned symptoms of this phase may be absent including the headache.  This phase is due to rapid vasodilation and pressure in the brain.
  4. Postdrome: This is felt after the symptoms of the Headache phase resolve.  During this phase you feel wiped out tired for a day.

What causes migraines?

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include

  • Stress
  • Anxiety
  • Hormonal changes in women
  • Bright or flashing lights
  • Loud noises
  • Strong smells
  • Medicines
  • Too much or not enough sleep
  • Sudden changes in weather or environment
  • Overexertion (too much physical activity)
  • Tobacco
  • Caffeine or caffeine withdrawal
  • Skipped meals
  • Medication overuse (taking medicine for migraines too often)

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include

  • Alcohol
  • Chocolate
  • Aged cheeses
  • Monosodium glutamate (MSG)
  • Some fruits and nuts
  • Fermented or pickled goods
  • Yeast
  • Cured or processed meats

Sinus Headache

Sinus headaches can be a seasonal pollen related issue or a year round issue from foods, dust, and pets.  The pain felt is the result of pressure building up within the sinus cavities.  The sinuses are located behind the bones of the forehead and below the eyes in the cheek.  The common symptom is forehead, eye, or face pain almost always to one side.  The nature of the pain is dull aching pressure.  Some people experience these headaches even though they have no congestion or drainage in the nose.  To treat these headaches it is necessary to treat the allergies.  We have found great success using our Allergy Desensitization treatment.  If the allergy can be eliminated the headaches no longer occur.

Cluster Headache

Cluster headaches are usually the most painful of all headaches.  Some people wake up in intense pain when one hits. The name cluster headache refers to clusters of time not location. These headaches will come and go with long periods of remission. Cluster episodes can last from a week to a year occurring daily. The attacks can happen multiple times per day. Most commonly the onset occurs at night waking a person up. The pain lasts from 15 minutes up to 3 hours.

Symptoms of a Cluster Headache

  • Excruciating pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head and neck
  • One-sided pain
  • Restlessness
  • Excessive tearing
  • Redness of your eye on the affected side
  • Stuffy or runny nose on the affected side
  • Forehead or facial sweating on the affected side
  • Pale skin (pallor) or flushing on your face
  • Swelling around your eye on the affected side
  • Drooping eyelid on the affected side

The cause of cluster headaches is unknown at this time but it is theorized that the symptoms are related to dysfunction of the autonomic nervous system.  Using steroid medications has been shown to give some relief telling us that it has an inflammatory component.  We have found success combining Chiropractic Care to correct autonomic nervous system imbalances and the Anti-inflammatory Diet to decrease possible causes of inflammation

Home Chiropractic Care in Brentwood and Franklin, TN

Many Chiropractic offices offer home care as part of their service or are exclusively mobile based.  The benefit of home visits you will never be stuck in a waiting room.  You will never have to drive in rush hour traffic rushing to be on time.  The doctor will not be in and out of the room seeing 3 patients at once just to make enough money to pay the employees and brick and mortar costs.  You will get the care you need on your schedule without driving to get there. Clients using this approach range from people who want to stay out of the public eye, stay at home moms that can’t find the time to get away, visitors staying at a local hotel, to groups of 4-10 people working together in a large office.

Home Chiropractic Care can be offered in different ways.  Some Chiropractors have a mobile van they use to drive to a location with everything set up inside their vehicle.  Others arrive with a portable table and bring everything inside the home, office, or hotel room.  Our office has a physical location before and after hours we do offer a mobile services performed inside the home, office, or hotel room.  Rates are different then offered in the physical location.   Higher rates reflect travel time and setup but treatment sessions are also longer then an office visit.  If house call services are something you are interested in feel free to call the office to discuss the details.

How Many Times a Week Should I See a Chiropractor?

How Many Times a Week Should I See a Chiropractor?

How Many Times a Week Should I See a Chiropractor is a question that varies depending on the office you go to. On average studies show that common neck or low back issues take 2-4 weeks of care at a 3x per week schedule with a chiropractic care.  If at the end of 4 weeks at 3x per week full resolution is not attained a re-evaluation will be performed.  In our office we see people 2x per week and at the end of 2 weeks I would expect most people to be close to resolution.  At that point we drop down to 1x per week until resolution is attained.  Simple low back pain usually takes 4 total visits and simple neck and shoulder pain around 6 visits.  If the neck or low back pain are also combined with radiating pain into arm or leg it takes longer.  When pain is radiating from the neck or low back it is usually the result of a nerve compression.  In these cases we usually need 10-12 visits to resolve the issue.

After care is completed and the presenting problem is resolved some patients benefit from maintenance care.  We do not always recommend it to everyone.  If you put excessive physical demands on your body at work or play I usually suggest a monthly visit.  I also suggest regular maintenance to people who have desk jobs. Sitting for prolonged periods of time with poor posture does put excessive physical demands on your body.

Do Chiropractic Adjustments Hurt?

Getting a chiropractic adjustment by a well trained Chiropractor should not hurt. People are usually more surprised by the pop sound after an adjustment.  During a Chiropractic Adjustment you are put in different positions which allow the Chiropractor to perform the adjustment correctly.  An adjustment is performed to the spine to restore motion back to an immobile segment of the spine.  The segment becomes immobile do to muscle tension compressing the joint.  The adjustment is performed in the direction that will easily open the joint and fast stretch the muscle which is causing the problem.  The adjustment is performed at a high velocity (quick) with a short amplitude (small movement) to free the joint without the muscle being able to prevent it.  After the adjustment is performed an audible pop sound is made as the joint surfaces separate.  When the joint surfaces open it causes a negative pressure in the joint fluid causing a nitrogen bulb to form resulting in a pop.  The pop sound is called a cavitation.  A chiropractic adjustment that hurts while being performed is due to either a sore muscle being under the contact hand during the adjustment or the patient not relaxing during the adjustment.  In either case the discomfort is only temporary.

A more common reason for any discomfort felt after a chiropractic treatment is due to the changes being made in your muscular tone.  After a visit the treatment changes the general posture tone which your muscles have to get use to.  Also locally in the area of the adjustment the new motion can cause muscles to be sore as they readapt to normal function.  If you experience discomfort other than general soreness it is important to talk to the doctor who treated you.  It is possible that you may need to get in sooner than your scheduled appointment.  I have found that when you start making corrections with someone who has been in pain for a long time they may have new pains after each visit.  This is due to compensations being removed during care.  When we have structural issues in our body we tend to develop compensations for the root problem.  The pain that initially prompted a person to seek care may be a compensation for underlying issues.  In the beginning of care we are correcting compensations which will cause the root problem to arise.

Is Chiropractic Science Based Medicine?

Science based medicine?

The Chiropractic profession in its early development had very little science based medicine theories backing up initial philosophy.  Early Chiropractic pioneers didn’t have a consensus of what physiologic or anatomic affect spinal manipulation corrected.  In time rapid changes have occurred within the profession as schools became larger. As the profession grew funding increased for large scale research increased.  Currently the profession has numerous science based peer reviewed studies demonstrating effectiveness in treating musculoskeletal conditions. Condition such as low back pain and neck pain now have science based data proving Chiropractic effectiveness.  So over time more and more studies will be performed on additional conditions but until then many conditions responding to Chiropractic are purely anecdotal to mainstream medicine..  In the world of research funding is the key, the medical community has very large funding for new surgical of pharmacologic therapies through vigorous large scale studies.  Chiropractic research is building up steam as the profession grows.  Currently many new research projects are underway in the profession.  A great resource that is accessible to everyone is the American Chiropractic Association website which has a link explaining everything new in science based medicine.

What does Science based medicine mean?

Science based medicine by definition is performing care that is backed up by scientific research. The findings back up a methods to deliver care.  The backbone of Science Based Medicine is research data accumulated over time.  This includes large scale studies conducted in Universities which when completed are then vetted by peer review.  After this process standards of care are set up and regularly changing as additional studies adjust protocols.

Conditions which Chiropractic Care has reported to help despite validated research:

  • Allergies
  • Irritable Bowel Syndrome
  • Fibromyalgia
  • Peripheral Neuropathy
  • Carpal Tunnel
  • ADHD
  • Tennis/Golfers elbow
  • Rotator cuff tendonitis
  • Achilles tendonitis
  • Arthritis of peripheral joints
  • Patellar tracking
  • Migraines
  • Shin Splints
  • Plantar Fasciitis
  • Asthma
  • TMJ
  • Vertigo

What is the difference between a manual spinal adjustment and Chiropractic Activator Tool spinal adjustment?

Activator Methods

The Chiropractic Activator tool is used by Chiropractors to deliver a precise manipulation to the spine.  This hand-held tool is squeezed by the Physician while a rubber end is placed on the area of the spine  to be adjusted. When fully squeezed the Chiropractic Activator tool releases and performs a high velocity push to the spine.  The procedure is painless and very safe.  The goal just like a manual manipulation by hand is to rapidly open a restricted spinal joint freeing it up and restore normal joint motion.  Physicians who use this tool attend seminars to be trained in the use of this tool.  The Activator Methods is the most widely accepted program that teaches methods of assessing the spine and the proper way to perform safe corrections.  Activator has published science based evidence backing effectiveness of the tool. Some Chiropractic Clinics perform all of their treatments with the Chiropractic Activator tool while other offices will use a combination of both methods.

Is the Activator effective?

The Chiropractic Activator tool is extremely effective in restoring motion to the spine when it is in the hands of a trained professional.  It is very important to understand patient positioning combined with direction and level of force to deliver to the area being treated. I find it to be very effective to patients of all ages and body types.  In our clinic we choose to use it in high risk areas such as where a spinal surgery has been performed, children new to chiropractic, patients with osteoporosis or bone cancer.  We also have patients who are nervous about manual manipulations so we use this technique for their comfort.  In my clinic I find that the only difference is a patient will require a few more visits when I only use Activator vs. manual manipulations.

Is Chiropractic Safe, can neck adjustments cause a stroke?

Can neck adjustments cause a stroke?

This topic is brought up in the media over and over again. People have been scared by anti-chiropractic groups saying a neck adjustment can cause a stroke. A RAND study puts risk of Chiropractic Adjustment adverse reaction including but limited to neck adjustments causing a stroke at 6.39 per 10 million adjustments.  The Rand study included other adverse reactions such as paralysis in this study which is also very rare.  Odds of getting struck by lightening are 1 in 500,000. The RAND study conclusion for Chiropractic adverse reactions is similar to odds of getting a stroke at the hair salon during a shampoo. Cases have been reported of strokes during shampooing in the salon when people have their head tilted back. Although very uncommon an artery in the upper neck has a section where a very rare blood vessel defect can occur causing an aneurysm. When an artery loses its structural integrity due to a defect within the arterial wall resulting in a ballooning of the artery.  This area of ballooning is obviously very weak and can burst.  It is more common to see aneurisms in the brain and the main artery called the aorta in the chest or abdomen.  Just like in the rest of the body an aneurism has no symptoms until they are about to burst.  Some people experience no symptoms before the artery bursts but in the case of the brain, people may have a headache as a precursor to a stroke just as with aortic aneurisms people may experience middle or low back pain before a stroke.  In the case of the upper neck aneurism it is common to experience neck pain and a headache at the base of the skull.  It is believed the patient shows up to the doctor when more than likely anything even turning their head fast, getting a massage, chiropractic adjustment, or time will reveal the impending stroke.

Can the chiropractor break my back?

Spinal Manipulations performed by a trained professional are very safe.  During a spinal manipulation the Physician will put the spine in different positions to quickly open spinal joints to free up the motion of restricted segments.  The thrust used to open the joints is very small allowing just a small opening of the joint causing the audible pop.  Any reported cases of fractures which are very rare mainly are related to underlying diseases of the bone such as cancer or osteoporosis.  This is why a detailed exam is always performed to screen out these risk factors.  In the case of osteoporosis your Chiropractor may use alternative techniques with less force such as Activator Methods or mobilization techniques.