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Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
April, 2006, Vol. 06, Issue 04
A Reflexogenic Relationship: The Muscle/Joint Battle, Part 1
By Erik Dalton, PhD
Reflexogenic - Producing or increasing reflex actions between muscles and joints.
Myoskeletal - All soft tissues forming from the mesoderm including muscles, ligaments, joint capsules, discs, fascia and bones.
Surprisingly, the "key" that unlocked the door to this muscle/joint mystery initially was revealed in a presentation to the American Back Association by the legendary osteopath Dr. Philip Greenman when he stated, "In the presence of vertebral dysfunction, palpable fourth-layer muscle hypertonicity will always be found." The fourth-layer transversospinalis muscles include the rotatores, multifidus, levator costalis and intertransversarii (Fig. 1). These phylogenetically old laminar-groove muscles are the first structures neurologically stressed by joint blockage, and often are the very same tissues that prolong the dysfunction.
Working with the understanding contained in Greenman's statement, the massage therapist can maximize therapeutic outcomes by:
Under normal conditions, the superior vertebra of each joint smoothly flexes, extends, sidebends and rotates on its inferior neighbor. Too often, however, hypertonically short spinal muscles bind one side of a joint altering its axis of rotation and center of gravity (Fig. 2). When therapists continually palpate lumpy, stringy or wiry fourth-layer intrinsic muscles session after session, underlying joint dysfunction is present and must be addressed.
According to John Mennell, MD, all of the body's synovial joints must have at least 1/8 inch of movement not controlled by voluntary muscle contraction. The term "joint play" was coined to describe this essential principle of normal, pain-free, non-restricted vertebral movement. Deep-tissue myoskeletal techniques focus on restoring joint play and stopping the reflexogenic battle between muscles and joints.
This article offers an overview of current theories and myoskeletal strategies for preventing and correcting "catch 22" pain/spasm/pain cycles perpetuated by abnormal muscle/joint reflex actions.
Fourth-Layer Spinal Muscles
Working through the bulky paravertebral muscles and fascia, bodyworkers' sensitive fingers frequently encounter small, hard and sometimes tender knots in the deep transversospinalis muscles of the erector spinae group. These highly innervated tissues located in the medial groove adjacent to the spinous processes contribute to rotation, sidebending and extension in each spinal segment. According to Greenman, "Fourth-layer muscles are dense in spindles and function more as proprioceptors than prime movers. When dysfunctional, they alter joint mechanics locally and alter the behavior of the larger muscles of the erector spinae group." Therefore, muscles such as the multifidus and rotatores (and suboccipitals) are perceived as dynamic ligaments designed to stabilize the spine. Acting as supporting, information-gathering ligaments, they allow the brain to coordinate more gross movements of the vertebral column via longer-lever muscles that have greater leverage and mechanical advantage.
The power generated by short fourth-layer spinal muscles is easily underestimated. These highly innervated little critters readily pack enough punch to lock spinal joints open or closed with their strong torsional forces (Fig. 3). Holding a telephone with the shoulder to one ear is a perfect example in which prolonged cervicothoracic sidebending unilaterally compresses joint surfaces, creating reflex transversospinalis and erector spinae spasm. This predictable neurological firing pattern represents the beginning of many functional scoliotic cases seen in the clinic. However, specially designed deep-tissue massage techniques can be very effective in releasing hypertonic myofascia and recovering joint play to fixated facets. Regrettably, some of the tightest transversospinalis muscles are buried deep to more superficial groove muscles such as the multifidus and spinalis, making it difficult and sometimes impossible to mobilize them with fingers and thumbs (Fig. 4). So, how can massage therapists access and release short, concealed spinal muscles that bind joints and perpetuate aberrant pain and posture problems? In part two of the "Reflexogenic Relationship" series, I will demonstrate innovative soft tissue techniques for creating joint-play in fixated facets.
Editor's Note: Part two of Erik Dalton's article, along with a complete list of references, will appear in the May 2006 issue of Massage Today.
Click here for more information about Erik Dalton, PhD.
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