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Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
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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