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Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
September, 2001, Vol. 01, Issue 09
How Accurate Is That Test?
By Whitney Lowe, LMT
Physical assessment is considered one of the most accurate ways to assess function of the locomotor tissues of the body. While we can often gain valuable information about structural problems through high-tech diagnostic procedures like X-ray or MRI, these procedures tell us very little about the function of the tissues involved in creating and limiting movement.
Some of the most detailed information practitioners gather from physical examination comes from a group of procedures called special tests. This group includes methods such as active range of motion; passive range of motion; manual resistive tests; and special regional orthopedic tests. The special regional orthopedic test is a particularly important element of the assessment process. This test is designed to give information about a particular injury or condition.
A practitioner's success in identifying a client's problem is often directly related to his/her ability to perform good assessment procedures such as special regional orthopedic tests. The practitioner must be able to perform the test correctly. Other factors also come into play in determining how effective that assessment procedure is, and consequently how effective the practitioner is at identifying the client's problem.
Accuracy in special regional orthopedic tests is affected by the relationship of two related concepts - sensitivity and specificity of the test. Sensitivity is the percentage of subjects with the condition who also show a positive result on the test. It determines how "sensitive" (accurate) the test is at determining the condition when it is present. Specificity is the percentage of subjects without the condition who show a negative result on the test. It determines whether the test can show if someone doesn't have the condition.
Take as example a sample of people in an experiment: some with carpal tunnel syndrome, and some without. If a special regional orthopedic test like the Phalen's test is performed, and everyone tests positive for carpal tunnel syndrome, it means that everyone in this group who had carpal tunnel syndrome got a positive test. The sensitivity of the test in this instance is considered high. However, all the people who don't have carpal tunnel syndrome also tested positive; there were no negative tests, even for people without the condition. Therefore, this test's specificity is low.
Certain commonly utilized special orthopedic tests may not have a high degree of sensitivity or specificity, yet are frequently used as guidelines for evaluating the presence of a particular condition. A good example of this is Adson's maneuver, used for identifying thoracic outlet syndrome. To perform Adson's maneuver, the practitioner finds the client's radial pulse at the wrist, then brings the client's arm back into extension and lateral rotation. The client is instructed to look over his/her shoulder toward the affected side and take in a deep breath. If the intensity of the pulse diminishes, the client is suggested to have entrapment of the brachial plexus and subclavian artery by the anterior and middle scalene muscles -- commonly referred to as thoracic outlet syndrome. The problem with this procedure is that a large number of people who do not have any symptoms test positive (diminishing radial pulse) when this test is performed. Thus, this test does not have a high degree of specificity.
The most accurate special regional orthopedic tests have high degrees of specificity and sensitivity; however, this is not always easy to demonstrate. Many studies attempt to evaluate the effectiveness of different assessment procedures, and to illustrate the strengths and weaknesses of each. The more you know about the clinical accuracy of these procedures, the more capable you are of identifying your client's primary complaint.
Click here for more information about Whitney Lowe, LMT.
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