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Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
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.
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!
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."
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
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 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.
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.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
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.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
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.
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.
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.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
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.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
March, 2001, Vol. 01, Issue 03
Manual Resistive Tests
By Whitney Lowe, LMT
Many practitioners learned how to perform simple assessment procedures, such as active or passive range-of-motion, in their basic training. However, despite their exposure to these concepts, many massage practitioners don't realize the tremendous amount of information that can be derived from these simple procedures when they are performed correctly.In this article, let us focus our attention on the manual resistive test (MRT) and the valuable information we can derive from this procedure.
The MRT may also be referred to as a resisted isometric contraction, or simply as muscle testing. The primary purpose of this procedure is to investigate the nature of problems with muscles and tendons, those tissues that are actively involved in the contraction process. A MRT is performed by having the client attempt to engage in a muscle contraction against some resistance (usually offered by the practitioner). Figure 1 shows an example of a MRT for abduction of the shoulder. The practitioner offers resistance to the client's attempt to abduct the shoulder. This is accomplished by placing a hand near the client's elbow and preventing the client from abducting any farther.
The most valuable information in MRTs comes from combining information derived from the test with that derived from the other procedures. For example, if a client has pain during active motion and no pain during passive motion, you might suspect a problem with the muscle tendon unit. We can validate our suspicion with a MRT. It is likely that the client will have the same pain when a MRT is done, because it is also using the muscle tendon unit. Since a MRT consists of restricting motion at the joint, it is unlikely that the pain is originating from a joint pathology that involves tissues such as the joint capsule, ligaments, bursa, or any of the other inert tissues of the joint. An inert tissue is one that does not actively cause a contraction, such as the joint capsule or nerve.
Often a client will describe a motion that hurts, such as lifting the arm out to the side of the body while carrying a weight. For example, the client may describe that carrying a heavy briefcase causes shoulder pain. In an effort to hold the briefcase away from the legs, the shoulder is attempting to abduct slightly. When you perform an active range of motion in abduction, the client reports that it does not hurt. When you perform a passive motion in abduction, the client also reports that it doesn't hurt. This seems puzzling.
Why does it hurt when the client attempts to abduct the arm with the briefcase, but not in your office during the evaluation? The difference is the absence of weight (resistance) in the arm. The briefcase is acting as an additional resistance when the client is holding it away from the body. This is a perfect chance to use a manual resistive test to validate your suspicions. If you have this client attempt to abduct the arm against resistance, the client will describe the same pain as when lifting the briefcase.
What we see here is a common pattern. The muscle injury is not severe enough to be perceived when the client is only lifting up the weight of the arm. However, when overcoming additional resistance (applied by the therapist or the briefcase), the pain is evident. This indicates a lower level of injury to the muscle tendon unit. The pain can be felt when there is greater demand on the muscle fibers, but not when the demand is low, such as lifting the arm by itself.
Another factor that is very important to consider when using MRTs is what the information from the test actually means. For example, what might be the problem if your client reports pain during a manual resistive test? A frequent error of many practitioners is misinterpreting the results of a MRT. If there is pain during a manual resistive test, it is likely that there is a problem with the muscle tendon unit. However, the nature of that problem still needs to be identified. Practitioners like massage therapists who spend a great deal of time dealing with myofascial trigger points and muscular tension may jump to the conclusion that a myofascial trigger point is the cause of pain during a MRT. Myofascial trigger points often do not cause pain with a MRT. They are much more likely to be painful when you press directly on the trigger point itself.
The primary causes of pain with a MRT usually involve a disruption in the fibers of a muscle-tendon unit, such as a muscle strain, tendinitis, or tenosynovitis. Information that is derived during the client history and palpation of the primary region of pain will help verify suspicions as to the cause of the pain. While the manual resistive test is a simple procedure to perform, its value in identifying numerous musculoskeletal problems should not be underestimated.
Click here for more information about Whitney Lowe, LMT.
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