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Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Breath: The Movement of Oxygen and Energy
I remember with surprising clarity the first time a patient started crying during an acupuncture treatment I was giving. This is now quite a long time ago, back in 1999, when I was a student.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
The Year to Make Things Happen
It is hard to believe that the Year of the Ram – 2015 is half over. Time seems to be moving especially fast. This is the year for things to happen for the acupuncture profession.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients, in May 2014, researchers showed that drinking the equivalent of 2 to 4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
What Does Success Mean to You?
Recently, I was asked to speak to young, budding businesswomen about running a successful business — and at first I thought, "Me? You want me to speak to others about success?!"
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
The Source-Luo Point Combination
The luo collaterals are part of the acupuncture channel system presented in the Su Wen and the Ling Shu (The Nei Jing). The function and clinical application of the luo mai are primarily presented in chapter 10 of the Ling Shu, however, they are also found in others chapters in the Su Wen and the Ling Shu.
Use Technology to Gain New Patients and Improve Efficiency
From the smartphone in your pocket to your microwave oven, advancements in technology have made almost every aspect of our lives easier.
TMF 2015 Scholarships
The Trudy McAlister Foundation (TMF), a nonprofit organization established to support students who are on track to make contributions either to clinical practice and/or to the understanding of the role of Traditional Oriental Medicine, has announced the 2015 scholarship recipients.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
The Nectar of Plants: Essential Oils and Chinese Medicine
Essential oils are a very hot topic these days, especially with the likes of the Ebola virus and the resurgence of measles lurking in our awareness, but when I first became interested in Chinese medicine, essential oils weren't on the radar screen for acupuncturists.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
The Modern Acupuncturist
You studied ancient Chinese medicine, but I'll bet you don't practice it! Contrary to popular belief, our medicine has evolved A LOT over the years. Let's take a brief walk through history and discover the differences between ancient and modern acupuncturists.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Calculating Billable Units
I recently learned of an office that was audited based on the number of acupuncture sessions performed in one day. Is there a maximum number of sessions that can be performed in one day?
Acupuncture in the U.K. Today: A Personal View
When asked to write a short piece on the current state of the U.K. acupuncture profession, my first response was to say it has all been relatively quiet.
How One Little Symbol (#) Gets You More Patients
Are you struggling to get more fans or followers for your acupuncture practice? Or are looking for ways to simply connect with your patients? Or do you just want to know how to keep them engaged (comments, retweeting, liking and sharing)?
September, 2001, Vol. 01, Issue 09
Common Structural Oddities in the Human Body
By Neal Cross, PhD, NCTMB
There are a number of common anatomic variations and developmental changes related to aging. Some of these structural "oddities" can be mistakenly interpreted as abnormalities, or worse, a neoplastic disease of some sort.Usually these anatomic variations are nothing more than the result of normal developmental changes, daily activity patterns, or some genetic-based multivariate characteristic. Examples of each of these will now be discussed.
One common phenomenon is the presence of "extra" muscles or absence of common muscles. Perhaps the most well-known variation in this category is the palmaris longus in the anterior compartment of the forearm. This muscle lies superficial to the flexor digitorum superficialis and is roughly in the exact center of the forearm. Its tendon is long and thin and travels over the carpal tunnel to blend with the palmar fascia. You can easily determine if you have one or both muscles by flexing your wrist against resistance and looking for the prominent centrally located tendon.
This muscle is absent about 11 % of the time either bilaterally or unilaterally. More interesting for our purposes here is the fact that the position of the muscle belly can vary quite dramatically. The small muscle belly is usually situated proximally along with the muscle mass of the common forearm and digital flexors. Occasionally, however, the muscle belly of palmaris longus is situated distally just proximal to the flexor retinaculum. In this position it can be confusing. No muscle should be there -- what is wrong with this person? Nothing's wrong; these are just thoughts that might run through the mind of the naïve examiner.
Another similar example is the peroneus (fibularis) tertius. This muscle is commonly present but very variable in its presentation. Arising from the extensor digitorum longus, it runs to the lateral aspect of the ankle and foot and attaches at any number of places, usually including the fifth metatarsal. Palpation in this region of the foot will lead one to discover nothing; a rather dramatic muscle mass; and everything else in between. Unless these sorts of variations are accompanied by other clinically significant findings, they are usually just the result of normal anatomic variation.
Recently in a palpatory anatomy course I teach, one of the students became concerned because of a large and significant bulge right in the middle of her fellow student's popliteal fossa. She called me over, and I examined the young healthy male. My first impulse was correct. After asking a number of questions related to his medical history, I learned that he had a third head of gastrocnemius. This is often referred to as the gastrocnemius tertius. It was particularly prominent in this muscular young male.
Just yesterday in my medical gross anatomy course, I had two students approach me somewhat concerned about unusual muscle masses in the anterior forearms. In the first case, a young healthy male showed me large bilateral masses just medial to the tendon of the palmaris longus and three fingerbreadths proximal to the flexor retinaculum. They certainly did not look pathological at all. I simply asked what he did that might lead to this dramatic hypertrophy of the medial sides of both the flexor digitorum superficialis and the flexor digitorum profundus. At first, he couldn't think of anything; then suddenly he said, "Lacrosse -- I played lacrosse." The repetition of "twirling" the stick led to the muscular hypertrophy we were observing.
Not 10 minutes later, a young woman approached me and showed me the exact same situation, only just on her right forearm. I jokingly asked if she played lacrosse with one arm. She looked puzzled. Then I explained the situation with her classmate; she then saw the humor. I asked her if there was anything unusual about daily activities. She immediately put together her "anomaly" with the fact that her job as a pharmacy technician required her to inject solutions out of a 30ml syringe into a container. This was done hours on end and resulted in the observed muscular hypertrophy. I have found that many if not most of the muscle "abnormalities" I have witnessed over the last 25 years are in this category.
Of course, not all palpatory findings that might concern someone involve muscles. Another very common tissue that can fool us is lymph nodes. Normally lymph nodes are very difficult to palpate unless they are inflamed or the site of neoplastic disease. There are some exceptions to this, however. The superficial inguinal nodes lying along the inguinal ligament and surrounding the cribrifrom fascia in the femoral triangle can sometimes be very large. I distinctly remember a young female student in palpatory anatomy who had herself and her fellow students in a fit over her lymph nodes. Not only were they readily palpable, they were visible! After calming the group down, I discussed variability of lymph nodes with them. It turns out that her inguinal nodes were the largest I had ever seen in a healthy individual, but as the conversation continued, the "patient" described an interesting situation. She had been concerned about these "bumps" for several years, but was too scared to have a physician check them out. Had they been pathological, this could have been a terrible mistake. Palpable nodes can sometimes be felt in the axilla. A physician should always check these in female patients, but by far the most common nodes I have palpated are associated with nearby insect bites (we do have plenty of mosquitoes in Maine) or a recent cold.
As an example of a dramatic developmental change that can lead to unnecessary concern, let us consider the xiphoid process. This structure is found at the inferior end of the sternum. It begins as a pliable cartilage structure with an osseous core. Upon palpation in the epigastric fossa, one can feel the xiphoid give against digital pressure. However, as we age, the bony core enlarges at the expense of the cartilage. This can lead to a structure that feels like a bone growth -- which it is -- but it is part of the normal aging process. I always try to remember to tell the students in my palpatory anatomy class to be wary of such changes in their more mature classmates.
I never tire of the rich variation I experience in the cadaver lab or in the palpation lab. I always try to pass on this experience to my students and clients.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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