resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.