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DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
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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