Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
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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