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The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
February, 2001, Vol. 01, Issue 02
Pelvic Pain in Pregnancy
By Kate Jordan, NCTMB
The most common reason women seek the services of massage therapists during pregnancy is for back pain. In order to treat such discomfort effectively, it is helpful to differentiate between pain originating in the lumbar spine and pain arising from dysfunction in the posterior pelvis.
Pregnancy places unique stresses on weightbearing joints in the torso.As a woman's pregnancy progresses, her uterus enlarges, moving her center of gravity forward of her feet. This causes her to rotate her rib cage posteriorly, shifting her weight to the lumbosacral joint and the sacroiliac joints in the pelvis.
Numerous studies of back pain in pregnancy have found that as many as 50% of pregnant women experience some back pain, and 10% experience severe pain. About 30% of these women had no history of previous back pain.
When women make pain drawings of their back pain, only 25% show pain in the lumbar area. More than 50% draw their pain below the crest of the ilium and lateral to the sacrum. They describe this pain as deep in their gluteal area, traveling down the back of the thigh. Even though this appears to be "sciatic" pain, only about one of every 10,000 pregnant women have actual disc disease in pregnancy, and usually those who do had disc problems before they got pregnant.
The number of women complaining of back pain in pregnancy has increased in the past 20 years perhaps because more women are working, often in ergonomically stressful jobs. In one study in Sweden, 70% of all working pregnant women took sick leave, mostly for back pain.
It's important to differentiate between lower back pain and pelvic pain. They should be approached in different ways, and the treatment for back pain may make pelvic pain worse. A woman whose back pain comes from her pelvis will locate it in her gluteal region on one or both sides; she will have a free range of motion in her back and hips; and her pain will not be constant, but related to the movements she makes.
There is a simple test that will confirm that a womens pain originates in the pelvis, rather than being referred from another area. This is called the posterior pelvic pain provocation test. With your client well-supported in a side-lying position, with her painful side facing up, position her upper leg in 90 degrees of hip flexion, with flexed knee on a pillow support. With one hand stabilizing her sacrum, compress the knee and femur into the acetabulum. If this pressure reproduces her pain, either in the symphysis pubis or the sacroiliac area, her pain is likely to be coming from one of the ligaments around those joints.
Pelvic changes in pregnancy were noticed as far back as the days of Hippocrates. The pregnancy hormones relaxin, estrogen and progesterone cause a measurable widening of the pubic symphysis anteriorly, and a shifting of the SI joint posteriorly. Widening of the pubic symphysis begins as early as the eighth week of pregnancy. Any pain felt in the pubic symphysis is a direct result of dysfunction in the sacral area.
Pelvic pain may be noticed around the 18th week of pregnancy. Women experience higher pain intensity with pelvic pain than back pain, and the higher a woman's relaxation levels, the more pain she will experience. This pain is caused by stretching of the pelvic ligaments, causing the pelvic muscles to attempt to establish stability by increasing muscle tension, leading to chronic pain in the area. Because the discomfort is primarily caused by hormonal changes, it cannot be prevented during pregnancy.
On the other hand, secondary muscle pain can be prevented. If your client receives supportive bodywork during her pregnancy, she is likely to have no further pain after her baby is born. Some studies have shown that more than 35% of women who had no treatment during pregnancy suffered persistent pelvic pain afterward.
In particular, if a woman has pelvic pain, she should not be encouraged to do back exercises, or any kind of vigorous exercise. Exercise will only increase her pain, especially the following day. She should avoid stairs, standing on one leg, extensive walking, extreme ranges of motion of her back and pelvis, standing, heavy lifting and prolonged sitting. She should also avoid bed rest, since this will weaken supportive muscles. One of the most helpful support measures for pelvic pain is the use of a pelvic belt. These should be worn throughout the pregnancy whenever your client is upright. Bodywork techniques should focus on the pelvic musculature, particularly the gluteus maximus,gluteus medius, lateral hip rotators, the hamstrings, hip adductors, the rectus femoris, and the quadratus lumbuorum. Techniques that will be particularly effective for pelvic pain include neuromuscular therapy, muscle energy techniques, and positional release techniques. Clients should also be taught side-lying positioning that supports a neutral pelvis (no rotation) for sleeping and resting.
After giving birth, posterior pelvic pain disappears in most women within three months. When a woman begins to exercise again, she should start with strengthening exercise for her pelvic muscles, before she begins any back exercise.
Click here for previous articles by Kate Jordan, NCTMB.
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