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Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
November, 2001, Vol. 01, Issue 11
Reflex Mechanisms of Massage Therapy, Part II
By Ross Turchaninov, MD
Editor's note: Part I of this article appeared in the October 2001 issue of Massage Today, available on line at www.massagetoday.com/archives/2001/10/05.html.
Why do stimuli from the stomach that are delivered to the central nervous system (CNS) radiate to somatic structures, and why in turn are the stimuli from reflex zones activated by the flow of motor impulses to the stomach? The phenomenon of convergence is responsible for this effect. The number of afferent sensory neurons delivering information from peripheral receptors to the spinal cord is greater than the amount of spinal neurons in the posterior horns of the spinal cord. The posterior horns accept and primarily process this information (see figure 2).
In other words, there is more than one sensory neuron in contact with each spinal neuron in the posterior horns of the spinal cord. In this instance, the information brought to CNS by sensory neurons from the stomach excites the entire neural plate of the spinal neuron. The sensory information delivered by sensory neurons from the peripheral receptors in the skin or skeletal muscles also excites the entire neural plate of the same spinal neuron. This stimulation by sensory stimuli from the stomach or reflex zones activates the lower motor cells in the anterior horns of the spinal cord. They generate motor input not only to the location of the original abnormality (the stomach, in our example), but also to the somatic structures innervated by the same segment of the spinal cord.
Simpler mechanisms of reflex zone formation are applied in cases of somatic abnormalities. This mechanism is responsible for the reflex zones' formation along the pathway of irritated or compressed peripheral nerves. For example, the chronic irritation of the sciatic nerve by overtensed piriformis muscle will produce pathological symptoms through the entire lower limbs. In this manner, irritation of peripheral nerves in the upper part of the body will cause the formation of reflex zones in the lower extremities, supported by the affected peripheral nerve.
Finally, reflex zone formation can be caused by direct compression of the spinal nerve by a herniated disc. As a result of irritation or compression of the spinal nerve, various areas of pathological excitement develop in the spinal cord, especially in the lower motor centers in the anterior horns. Abnormal impulses flow from the spinal cord to the inner organs, and to other parts of the body that are innervated by the affected spinal nerve. Further development follows the same pattern of relation between reflex zones and inner organs or parts of the body as mentioned previously.
Let's now look at another important issue, and ask another important question: "What local events lead to the formation of reflex zones?" First, let's briefly review the physiology of excitation and the conduction of nerve impulses. A nerve impulse or "action potential" is a propagated electrical disturbance originating in the peripheral receptors or in the upper nervous centers; it is conducted through afferent, ascending sensory or efferent, descending motor neurons. Both ascending information to the central nervous system about any kind of peripheral receptors activation, and descending motor commands from the central nervous system, are delivered as a series of action potentials. Any single action potential is the result of changes in the conductance of sodium and potassium through the membrane of the nervous cells. Every action potential has a threshold. A threshold is the firing level of the action potential. This means that if applied stimuli are weak, they are unable to evoke an action potential. In this case, full action potential is replaced by a local response.
A local response is a weak electric excitement that stays within the stimulated receptor, rather than propagating along the neuron. As soon as the stimuli are strong enough, the action potential is generated and conducted through the neuron. This mechanism protects the nervous system from overflow with useless information. Normally, the threshold activation of peripheral receptors has stable electrical magnitude. The continuous radiation of motor impulses to the reflex zones in skin, connective tissue, muscles, or periosteum evokes unusual phenomena in these tissues. The magnitude of the threshold is reduced in all receptors located in these areas. As a result, receptors start to generate action potentials as a response to even the weakest stimulus, even those that normally had subthreshold levels and have never produced action potentials. (Korr, 1947). This phenomenon is called hyperirritability. The affected soft tissues respond by building up tension, especially in contractile elements. Vasoconstriction and local edema are formed, further diminishing blood circulation and decreasing tissue metabolism.
The decrease of the threshold of peripheral receptors, i.e. the condition of hyperirritability, is the starting point of reflex zone formation (Korr, 1947; Glezer, Dalicho, 1955; Kunichev, 1985; Shterngertz, Belaya, 1994; Loginova, 2000). Figure 3 shows how the action potentials are generated, both in the receptors of the normal parts of the body and in the areas of reflex zones.
In 1947, in a series of brilliant clinical experiments, Prof. I. Korr showed that hyperirritability is a key to understanding reflex zone formation. In his experiments, Korr inserted microelectrodes in muscles with clinical symptoms of hypertonic abnormalities, then exposed his subjects to different types of stimulation: physical activity, decreased and increased temperature, loud sounds, bright light, etc. When subjects were exposed to each of these stimuli (even visual and auditory) the skeletal muscles in the area of reflex zones reacted with increased tension, which was detected by electromyography. This caused the additional decrease of peripheral circulation in already-affected areas. Thus, as Prof. I. Korr showed, any type of sensory stimulation of the CNS causes the further development of reflex zones in the tissue which are no longer protected from theactivation of peripheral receptors by subthreshold stimuli.
A number of clinical abnormalities can be found found in the areas of reflex zones in the skin, connective tissue, skeletal muscles and periosteum. During diagnostic examination, the practitioner should detect all abnormalities and record them on prepared diagrams of the body. At the end of the diagnostic examination, the practitioner will have a complete picture of somatic abnormalities for the patient. Such an approach to diagnostic examination allows the practitioner to formulate the optimal treatment protocol.
I. Cutaneous Reflex Zones
II. Connective Tissue Zones (CTZ)
Connective tissue zones are also examined by palpation. Several diagnostic techniques target the CTZ in the each level. In general, the practitoner is looking for following abnormalities in the areas of CTZ:
III. Reflex Zones in Skeletal Muscles
Reflex zones in the skeletal muscles are examined by palpation and direct compression. The moderate compression of muscular tissue elicits sharp pain in the area of hypertonic muscular abnormalities. Patients show the so-called "jump symptom." Sharp pain elicited during moderate compression is another example of hyperalgesia.
IV. Periostal Reflex Zones
The periosteum is the thin connective tissue membrane covering all bones. It supports bone metabolism and remodeling. The periostal reflex zones are available for diagnostic examination only in the areas at which bone structures are covered by skin only. Examination of periostal reflex zones is conducted by palpation and direct compression.
Following diagnostic examination, the practitioner will able to formulate the proper protocol of medical massage therapy. The formulation of a correct protocol is of course key to successful treatment. As mentioned, this protocol is a combination of different methods and techniques. For example, connective tissue massage is the best way to work on the connective tissue zones, but it is useless in the areas of periostal reflex zones, where periostal massage is the most effective therapy. The practitioner must utilize the particular methods and techniques created for the treatment of particular type of reflex zones. For example, if the patient does not have abnormalities in the periosteum, periostal massage techniques must be excluded from the protocol. However, if one measures the clinical validity of different methods of medical massage, I believe that segment-reflex massage is as appropriate as all known methods of Western medical massage therapy. The major advantage of segment-reflex massage is its integrative approach to treatment.The modern protocol of segment-reflex massage includes therapeutic massage, connective tissue massage and periostal massage, as well as its own therapeutic techniques and approaches. This unique combination allows the practitioner to target the reflex zones precisely and deliver an effective therapeutic impact to the affected areas of the body. In any case, the protocol of medical massage therapy must be individually adjusted to each new patient, because there are no two identical cases.
In conclusion, I want to emphasize that reflex mechanisms of massage therapy allow the massage practitioner reach a completely new level of professional expertise. At first, the clinical application of reflex mechanisms of massage therapy is a challenge. However, the professional benefits are far more rewarding than the time spent by the practitioner to achieve this level of expertise.
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