resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Correcting Kid Logic in Health Care and Research Design
A recent broadcast on public radio described a fascinating phenomenon known as kid logic.
Going Shoeless: The Pros & Cons of Barefoot Running
With the subculture of barefoot runners and the products catering to them growing daily, just about every chiropractor has been asked at one point or another about their opinion regarding barefoot running.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
Why You Should Get to Know the National Vaccine Information Center
Barbara Loe Fisher has been a diligent advocate for providing parents with the information necessary to make informed decisions regarding the usage of vaccinations for their children.
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
Medicine Presents: A Great Opportunity
The changing nature of health care presents both opportunities and challenges. While we tend to focus on our profession, we can sometimes forget the impact other health care professions can have on us.
Research Abstracts From the Journal of Manipulative & Physiological Therapeutics
Effect of Pain Relief on Lumbar Muscle Function and Activation; Effects of Thrust Amplitude and Duration of HVLA Spinal Manipulation; Immediate Effects of Upper Thoracic Manipulation on Cardiovascular Response.
Remembering Joe Weider (1920-2013)
With the death of Joe Weider, the world's most famous body-building visionary, crusader, fitness magazine publisher and icon, on March 23, 2013, chiropractic has lost one of its greatest friends and supporters.
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
We Get Letters & E-Mail
Patient Perception and the Farce of "Fast Relief"; A Fly in the Ointment; Persecuted for Choosing to Practice Chiropractic.
Have a Heart: Say No to Soda
It's not enough that soft drinks and other sugar-sweetened beverages have been linked to cavities and weight gain, among other negative health consequences.
Are They Finally Fixing Medicare Reimbursement?
Even with federal sequestration cuts taking effect in March, including a 2 percent reduction in Medicare reimbursement to health care providers, hope may be on the horizon in the form of a much-anticipated, perpetually suggested overhaul of Medicare's Sustainable Growth Rate formula, which serves as the basis for determining physician reimbursement.
News in Brief
Controversial Florida PIP Law Under Review; D'Youville Chiro. Students Learning Art of Co-Managing; And the Award Goes To...; F4CP Recognizes Major Contribution by ChiroTouch.
What the Science Says About Magnesium Stearate
It's often been said that scientific studies can be used to support just about anything. But discoveries are never made one study at a time.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
The Potter's Wheel: Reflections on Practicing in a Technology-Driven World
In my very early years of practice, an older patient named Cora would call me at home, usually late Sunday night after she had consumed an unknown quantity of beer.
Some Thoughts on the TMJ
The temporomandibular joint is an interesting and dynamic articulation that can cause a lot of problems.
What They Don't Say Could Hurt You
I have written previously regarding the difficulties of drawing information from patients who are poor historians, forgetful or just plain uncooperative. The thought to revisit the topic occurred recently during preparation for an upcoming seminar.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Chiropractic: The Right Choice for Relieving LBP
"Low back pain (LBP) is a common threat to medicine and a reasonable threat to all national health care systems. ... Reducing ineffective treatments is necessary to decrease the LBP associated costs."
A Building Block of Healthy Aging
Coenzyme Q10 has gained enormous attention in recent years, and with good reason —it's the Energizer Bunny of the cellular world.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
Side Effects From Big Pharma: Wellbutrin – Dangerous for You and Your Baby
Are some of your pregnant patients taking Wellbutrin? If so, it could be a danger to them and their baby. This drug is extremely popular, but it has a serious history.
SOAP Notes: It's Time for a Cleaning
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
November, 2001, Vol. 01, Issue 11
What Is the "End Feel"?
By Whitney Lowe, LMT
Some of the most valuable assessment information is derived from relatively simple procedures such as passive range-of-motion tests. While many massage practitioners have been exposed to the fundamental concepts of active and passive range-of-motion testing, most have not learned how to use this information effectively in a clinical environment.In this article, we will focus particular attention on the "end feel" that is evaluated during passive range-of-motion testing. Valuable information can be derived from thorough examination of the end feel.
To perform a passive movement evaluation, the practitioner instructs the client to relax as much as possible preceding the movement. It is important to have the greatest degree of muscular relaxation prior to beginning the movement, to improve the accuracy of the evaluation and eliminate muscular effort as the cause of any pain that is felt.
One of the most important factors to investigate with passive range-of-motion testing is the end feel. The end feel is the quality of movement perceived by the practitioner at the very end of the available range of motion. The end feel can reveal a great deal about the nature of various pathologies. James Cyriax, the British orthopedic physician who developed one of the most commonly used systems for physical examination, specified six different end feels when he first described them in his writings.1
Bone to bone - This is the sensation when motion is stopped by two bones contacting one another. An example is the end feel for extension of the elbow.
Muscle spasm - When muscles are in spasm, they may abruptly halt motion prior to what should be the normal range of motion. It is likely that pain will be felt at the end of this range, because the muscle in spasm will be stretched.
Capsular - This is the end feel described for range of motion limited at the end by the joint capsule. The sensation often described is a "leathery" feel to the end of the motion, such as in external rotation of the shoulder. A true capsular end feel occurs when the joint capsule is the primary limitation to the end range of motion. Some authors have called this end feel the "tissue stretch" end feel and extended it to other tissues, such as muscles, that may stretch normally at the end of their range of motion. An example of the tissue stretch with muscles would be hip flexion with the knee held in extension, in which motion is stopped by the hamstrings.
Springy block - This end feel is the sensation of motion stopping short of where it should, accompanied by a rubbery or springy sensation at the end. It occurs most often in joints in which a piece of loose cartilage (like the meniscus in the knee) may be blocking full motion and causing the limbs to "bounce back" a bit.
Tissue approximation - This is the end feel in which motion is stopped by two masses of soft tissue pressing on one another. An example is in flexion of the elbow, in which the elbow flexors and wrist flexors press on each other to limit further motion.
Empty - This end feel has no mechanical limitation to the end of the range, but the client will not let you go any farther because of excessive pain. An example would be in shoulder impingement, in which pain from the supraspinatus tendon being compressed will limit how far the arm can be abducted. Mechanically there is no further restriction, but the pain will prevent the individual from allowing further motion.
The end feel for a particular joint may be the joint's normal end feel, or it may be pathological in nature. For example, in elbow extension, the normal end feel would be bone to bone as the olecranon process contacts the posterior aspect of the olecranon fossa. If you were performing a passive range-of-motion evaluation with your client and you got a tissue stretch end feel for the elbow in extension, it would most likely indicate some form of restricted range of motion that should be treated.
On the other hand, if you were evaluating medial rotation of the shoulder, you would expect a tissue stretch end feel, and that would be normal for medial rotation. If you performed medial rotation and got a bone- to-bone end feel, it would be abnormal for that joint and would certainly indicate a more serious joint pathology requiring evaluation by another health professional.
Passive range-of-motion evaluation can provide a great deal more information than just how far an individual can move his/her joint. When you know what kind of end feel should be apparent with each joint, you can effectively evaluate and analyze pathological limitations to motion.
Click here for more information about Whitney Lowe, LMT.
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