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Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
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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