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Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
February, 2002, Vol. 02, Issue 02
The Tuina Treatment of Tennis Elbow
By Bob Flaws, LAc, FNAAOM (USA), FRCHM (UK)
In 1982, I was studying acupuncture at the Shanghai College of Chinese Medicine and working as an intern in the acupuncture department at the Long Hua Chinese Medical Hospital. Sometimes, during the heat of the summer, there were not that many patients to see in the acupuncture ward, so I would wander through the hospital to see what else I might learn.As a graduate of what was then the Boulder School of Massage Therapy (BSMT), I had practiced massage for several years prior to studying acupuncture. Thus, I was immediately fascinated by what I saw when I discovered the tuina, or Chinese medical massage, ward.
The movements I witnessed were unlike anything I had learned at BSMT. I was especially enamored with the idea of specific protocols lasting 15-30 minutes for the remedial treatment of specific conditions. Therefore, I arranged to study tuina the following year and to work as a tuina intern at the Yue Yang Chinese Medical Hospital, also in Shanghai. Eighteen years later, I am still as enthusiastic about tuina as I was then.
Below is the tuina protocol I learned for the treatment of tennis elbow. It is based on the rolling school (guan fa pai) of tuina popular in Shanghai founded by my personal teacher, Ding Ji-feng.1 Dr. Ding had been practicing this method for over 50 years when he taught it to me.
Western Medicine and Tennis Elbow
Lateral epicondylitis, also called tenosynovitis (and more colloquially, tennis elbow), consists of inflammation of the tendons attached to the lateral side of the elbow at the epicondyle of the humerus. Patients with tennis elbow experience pain in the lateral aspect of the elbow, which may radiate into the forearm, and occasionally into the hand. The pain occurs with grasping activities and may be accompanied by a sense of weakness. An achy discomfort may also be present at rest or at night after activity. This inflammation may be caused by a sudden violent injury, repetitive strain or microtrauma. Tennis elbow occurs equally in men and women and is most commonly seen in patients between the ages of 35-50. Tennis elbow is found not only in tennis players, but in baseball players; swimmers; carpenters; plumbers; meat cutters; musicians; or anyone who repeats an arm motion over and over.
The Western medical diagnosis of lateral epicondylitis mainly consists of physical examination of the affected area eliciting abnormal tenderness to palpation over the lateral epicondyle. X-rays may show calcium deposits on the lateral epicondyle but are not typically required to make this diagnosis. Bone spurs only occur in 20% of tennis elbow patients. The Western medical treatment of tennis elbow mainly consists of rest, anti-inflammatory medication and the application of ice. This is supplemented by stretching and strengthening exercises; straps; wrist braces; and cortisone shots. Surgery is indicated in approximately 5% of cases when all of the above measures have failed over a course of several months and pain continues to prevent activity. The success of tennis elbow surgery is generally 85-95% excellent relief of pain.2 However, patients typically require 3-6 weeks of recuperation before returning to work, and several months before returning to sports or heavy use of the arm.
Chinese Medicine and Tennis Elbow
Chinese disease categorization: Tennis elbow is called zhou lao (elbow taxation); zhou tong (elbow pain); and shang jin (damaged sinews) in Chinese medicine.
Chinese disease causes: Taxation detriment with possible contraction of wind cold evils.
Chinese disease mechanisms: Overwork taxation causes detriment and damage to the sinews and vessels of the elbow. On the one hand, there is insufficient blood to nourish the sinews; on the other hand, there is blood stasis obstructing the free flow of the vessels. This may be complicated by external contraction of wind cold evils due to defensive qi vacuity.
Treatment principles: Soothe the sinews and free the flow of the network vessels; quicken the blood and transform stasis; regulate the qi in the channels and vessels.
Other adjunctive measures may include the use of moxibustion locally on the elbow (either indirect, roll moxa or direct, non-scarring, "grain of rice" or thread moxa), or warming with a TDP heat lamp.3 Internal administration of Chinese medicinals based on the patient's individual pattern discrimination is also quite helpful.4
To get a satisfactory result with tennis elbow, the patient needs to refrain from all activities, be they work or play, that aggravate the condition. Until or unless the patient is willing to allow the inflammation of their lateral epicondyle to heal, no amount of tuina or Chinese medicinals is going to get a satisfactory effect. If the cause of this inflammation is work-related, the patient should be advised to modify their equipment or work habits. This may mean using a lighter hammer or tennis racket or seeking professional advice from an ergonomic specialist or kinesiologist.
While ice is indicated within Chinese medicine for recent traumatic injuries and acute inflammations with redness, swelling and palpable heat, it is usually contraindicated for tennis elbow. Even though Western medicine defines lateral epicondylitis as a species of inflammation, it does not usually present heat signs and symptoms according to Chinese pattern discrimination. In fact, given the common age range of patients with tennis elbow and its Chinese name, elbow taxation, this condition is usually a vacuity condition complicated by cold and/or blood stasis, all of which may be worsened by the application of cold. This is why the external application of warmth is usually so important for the treatment of this condition.
In my experience, both in China and the U.S., tuina is definitely an effective therapy for the remedial treatment of tennis elbow.
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