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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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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?
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.
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.
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."
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.
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.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
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.
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
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.
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.
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.
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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