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News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
April, 2001, Vol. 01, Issue 04
By Neal Cross, PhD, NCTMB
On several occasions in the past 10 years or so, students and practitioners have asked me about the existence of a new muscle they had recently heard or read about. As an anatomist with over 30 years experience, I immediately questioned such claims.The human body exhibits a very rich structural variability. As this variation is beyond the scope of most anatomical textbooks, it is, unfortunately, not fully appreciated by many clinicians. On the other hand, experienced gross anatomists and surgeons encounter this variation on a daily basis.
The most recent "new muscle" to be brought to my attention was a muscle that has been called the sphenomandibularis. It was described in a few journals in the mid-to-late 1990's as a heretofore-unknown muscle of mastication. It was also implicated in the etiology of certain types of headaches -- especially trigeminal pain. Ybarra and Bauer recently published a clear, concise rebuttal and explanation of this "new muscle" in the journal Clinical Anatomy.1
The temporalis muscle is a much more complex structurally than textbooks would have us believe. This structural complexity often reflects an underlying functional complexity as well. The first detailed description of the medial portion of the temporalis occurred in the early 1800's. Ybarra and Bauer discuss several other early descriptions of this portion of the temporalis in their article. After dissecting several specimens and giving an exquisitely detailed description of the complex origin and insertion of the medial head of temporalis, these anatomists discuss the possible clinical relevance of its dysfunction. They paid particular attention to the complexity of this portion of the temporalis muscle's attachment to the sphenoid. The authors describe the possible entrapment of the lateral portion of the maxillary division of the trigeminal nerve (V2) in relation to facial pain. They describe the differences in pteryogopalatine fossa anatomy as a possible factor associated with specific pain patterns. These musculoskeletal-based pain patterns may be confused with CNS based pain patterns. Even though the various authors may disagree on the definition of the medial portion of the temporalis (whether should be considered a separate muscle or not), they all agree that it may be involved in certain cases of headache.
The specific muscles associated with headache may be much more complex than we now know. Travell and Simons2 have described many of the muscles commonly (and not so commonly) associated with headache. We also need to consider specific parts of muscles that may be involved in the etiology of headache.
The point is this: the muscular system is quite variable in nature, and some of this variation may be related to complaints of pain. These variants may confuse the practitioner, or worse, may lead to a missed assessment or a clinical mistake. For example, one of the most common muscle variations in the human body is the absence of the palmaris longus. This muscle is absent 10 -15% of the time. Its absence leads to the median nerve being less protected, just proximal to its entering the carpal tunnel. You can easily test to see if you have a palmaris longus by isometrically contracting your wrist flexors against resistance (for example, place your supine hand under the edge of a desk and attempt to flex your wrist). If you have a palmaris longus, it will be seen protruding anteriorly as it passes over the carpal tunnel.
Other common muscle variants, such as the presence or absence of the peroneus (fibularis) tertius, have little or no known (at least to this author) functional or clinical significance. Another type of muscle variation can be considered hypertrophy. In this case, I am referring to the intentional or habitual overdevelopment of part or all of a muscle. One very interesting example of this kind of "functional" variation can be seen in the pronator teres in some fast-pitch softball pitchers. One common method of throwing a drop ball [i.e., a "sinker"] requires strengthening the pronators of the forearm. The resulting hypertrophy of this muscle can put pressure on the median nerve, which travels into the forearm between the two proximal heads of the pronator teres. The resulting complaint can mimic carpal tunnel syndrome, yet have nothing to do with the median nerve at the carpal tunnel. All efforts to correct the problem at the tunnel will result in no diminution of symptoms.
These are but a few examples of muscle variations. This information is definitely something to keep in mind when a patient presents with any very unusual pain pattern. It also points to the need for continuous refreshing of our anatomical knowledge and advanced anatomic study.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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