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A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
July, 2001, Vol. 01, Issue 07
When Is It Tendinitis?
By Whitney Lowe, LMT
Tendinitis is one of the most common diagnoses for soft tissue pain resulting from repetitive motion. As repetitive motion disorders have dramatically increased, so has the incidence of tendinitis.However, recent investigations into the cellular nature of tendon pathologies have brought forth interesting discoveries that may alter the way tendinitis is treated. In this month's column, let's take a look at some of these fascinating discoveries.
The first stop along the way is to take a closer look at the anatomical and biomechanical characteristics of tendons. Tendons are connective tissue structures that are primarily composed of collagen and elastin fibers. Collagen fibers primarily give the tendon its strength, and elastin fibers give it a small amount of flexibility.
Since the tendon fibers are primarily designed to transmit a strong tensile (pulling) load from the muscle directly to the bone, the tendon is not designed to be very flexible. If it were very flexible, much of the muscle's contraction force would be absorbed by the tendon and not transmitted to the bone. It would be like trying to pull a heavy object across the floor with a bungee cord instead of a rope.
The tendon gets its strength not only from the quantity of collagen fibers it contains, but also from the arrangement of the fibers. In tendons, the collagen fibers are arranged mostly in a parallel direction, in line with the direction of the muscle fibers. This arrangement will give the tendon the greatest amount of strength in the direction that the muscle fibers are pulling. Ligaments, on the other hand, have a greater quantity of elastin. In ligaments, the collagen fibers are arranged in a slightly more random fashion to give the ligament strength against forces in several different directions.
Tendons throughout the body are surrounded by a thin connective tissue membrane called the paratenon. The paratenon is primarily designed to reduce friction forces between the tendon and other surrounding structures.7
Tendons in areas such as the distal extremities are exposed to much higher friction forces, as the tendons bend around the joints and are held closely by retinacula. These tendons are surrounded by an additional connective tissue layer called the epitenon. The epitenon is commonly referred to as the tendon sheath. Keep in mind that not all tendons have the tendon sheath, only those exposed to specifically high friction forces against adjacent structures, like a binding retinaculum. In some instances, an inflammatory condition will develop between the tendon and its sheath. This usually occurs from excessive friction. Adhesions may also develop between the tendon and the sheath. This condition is called tenosynovitis. However, in order for tenosynovitis to be present, the tendon in question must have an epitenon (sheath).
In some instances a diagnosis of tenosynovitis may be made because of an observed fibrous adhesion between the tendon and the paratenon but there is no tendon sheath. This happens commonly with the Achilles tendon.3 It does not have a synovial sheath (epitenon) but its paratenon is quite visible. Degeneration or adhesion of the paratenon or tendon fibers in this instance is not tenosynovitis. For many years, the term tendinitis has been used to describe painful overuse conditions of the tendon. It has been thought that the pathology involved the tearing of individual tendon fibers and a subsequent inflammatory response in the tendon. Treatment, therefore, has focused on the inflammatory nature of the problem. However, a number of recent scientific investigations into the nature of overuse tendon injuries have painted a very different picture.1,2,5,6
In these investigations, most tendinitis complaints have been found to be devoid of inflammatory cells. It appears that tendon fiber tearing is not the primary part of the problem. The main problem in these overuse tendon disorders appears to be collagen degeneration from overuse. It has also been suggested that this would explain the frequent lack of success in treating tendinitis complaints with anti-inflammatory medication. Numerous authors and clinicians have suggested that the term "tendinosis" (literally meaning "pathology of the tendon") is a much more appropriate term than "tendonitis," which specifically indicates inflammation.
So what does this mean for the treatment of tendinitis with massage? The good news is that these findings are an even stronger support for the benefits of massage for treating these overuse tendon injuries. Collagen degeneration is a primary part of most tendinosis pathology. Therefore, what is needed is a treatment that can help stimulate collagen production in the healing process.
Interestingly, several recent studies have found that the primary benefits of deep friction massage may be the stimulation of collagen production in damaged tendon fibers, rather than the breaking up of fibrous scar tissue in chronically inflamed tendons as previously thought.4 We have known clinically for years that massage works well in the treatment of tendinosis; now we may be closer to understanding why.
Click here for more information about Whitney Lowe, LMT.
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