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Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
September, 2001, Vol. 01, Issue 09
Miles, Myths and Musings
By Keith Eric Grant, PhD, NCTMB
Last Sunday was one of those idyllic summer days on which the inland temperatures were moderated by a gentle inflow over the hills from the San Francisco Bay. I found myself sitting with friends at a table outside of a coffeehouse in the early afternoon, pouring over maps and charts spread out before us. What had brought us together was the common purpose of running a 199-mile relay from Calistoga to Santa Cruz.
The preamble to this meeting for me has been a spring and summer reckoned by a week-to-week increase in my running. It has meant a return to some familiar places and routes, after several years of letting my distances dwindle amid the pulls of professional and parental responsibilities. In an interesting synchronicity, I had started increasing my running about six weeks before I was asked to join the relay team. It was a reminder for me that, when we set ourselves to a goal, things often occur around us to aid and further motivate us. As I've spent time running up ridges and over hills, I've had opportunities to muse on the physiology and psychology of training.
Challenging Our Lactate Threshold
There is a persistent myth that massage relieves muscle soreness by flushing out lactic acid. In truth, lactic acid, which dissociates in solution into lactate and hydrogen ions, is only present in excess during and immediately following high-intensity exercise. It is metabolized within 30-60 minutes after such exercise ceases. Moreover, lactate is not a toxic end-product; it is an efficient energy-storage and transportation medium.
As we increase the pace of exercise, our bodies produce pyruvate, the end product of glycolysis, faster than it can be processed. To keep us moving, our bodies perform a metabolic "trick" of sorts, shuttling the pyruvate to lactate. The lactate formed from pyruvate can slip quickly and quietly out of cells and into surrounding tissues and blood, where it can be picked up and used as an energy source by less active muscles . As long as our exercise intensity is only producing lactate within our body's ability to process it, blood lactate limits will only rise slightly, then stabilize. If we exceed this level of exercise intensity, the lactate levels in our blood will increase dramatically - we have passed through our lactate threshold (LT). The good news is that by designing our training to regularly challenge our LT for short intervals, our LT will increase. In running, LT is one of the best predictors of race performance.
Delayed Onset Muscle Soreness (DOMS)
Soreness occurring 24-72 hours after exercise is termed Delayed Onset Muscle Soreness (DOMS). The exact mechanisms involved in DOMS are uncertain, but researchers believe they involve micro-trauma to individual muscle fibers resulting in calcium ion leakage and a cycle of inflammation response. Most DOMS is experienced following suddenly increased workouts, particularly those resulting in eccentric contractions - muscles being lengthened while resisting against the lengthening, as in walking down stairs or running downhill. Increasing eccentric exercise gradually conditions our muscles and avoids the soreness.
Musings on Exercise and Massage
Eliminating lactic acid removal as the focus of post-exercise massage, we are left with a therapy that sports experience shows to be effective, yet lacks a clear mechanism for such effectiveness. Research indicates that the simple post-exercise administration of effleurage does not result in a increase in local blood flow or in accelerated recovery. Other research indicates that massage, combined with an active cool-down, increases the rate of recovery during short breaks between maximal efforts.
One difficulty in interpreting such results comes from the early 20th century tendency to view the body as a simple machine. We mistakenly look for massage to have direct mechanical effects. What seems more likely is that massage acts as a new input to a system with a memory. In my observation, fatigued muscles tend to remain hypertonic and shortened. When we cajole specific muscles to relax and lengthen via mechanical and neurological input, we reduce their metabolic activity and the compression they exert on surrounding tissue. In my opinion, it is not the direct action of massage, but the action of massage to create a new homeostasis, that allows the natural process of recovery to occur more efficiently.
When I run intensely, I notice results beyond the obvious. Running involves not just my legs, but the core muscles of my trunk, the stabilizers of my hips and ankles, and the coordinated movement of my arms. It requires training my determination and mental focus to challenge my muscles and breath when going up hills, and the speed and efficiency of my neuromuscular motion patterns when going down hills. At times, the fatigue and soreness bring an increased sense of vulnerability and the need for nurturing human contact - another role that massage can fill for athletes.
As I finish writing this article, I'm preparing for a backpack trip into the eastern escarpment of the Sierras -- a journey with a loaded pack along a creek, from the sagebrush-covered hillsides of the trailhead, through the miles and several thousand feet of climbing, to a high alpine lake nestled at the foot of an even higher pass. It strikes me as the perfect preamble for a massage.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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