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F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
April, 2002, Vol. 02, Issue 04
Anatomy of an Inversion Sprain
By Neal Cross, PhD, NCTMB
Ankle inversion sprains make up the greatest majority of ankle sprains (Snider, 1997). The anatomical damage subsequent to this biomechanical event goes beyond the ankle and its adnexa.The principle structures stressed during forced hyperinversion of the ankle are the three components of the lateral collateral ligament (LCL) of the ankle: the anterior and posterior talofibular ligaments and the calcaneofibular ligament.
The anterior talofibular (ATF) ligament attaches to the anterior margin of the lateral malleolus and runs distally to attach to the anterior aspect of the talus. It is readily palpable, especially at its proximal end, and is the first structure stretched or torn following an inversion sprain. The calcaneofibular (CF) ligament attaches to the distal tip of the lateral malleolus and runs inferiorly to attach to the lateral aspect of the calcaneous. You can easily palpate this ligament at its proximal portion. In the sequence of events following an inversion sprain, this is the second ligament to be compromised. The posterior talofibular (PTF) ligament is not readily palpable, as its runs from the posterior margin of the lateral malleolus to the posterior aspect of the talus. Damage to the PTF usually occurs only following severe sprains. In fact, the severity of inversion ankle sprains is often defined by the damage to these three ligaments making up the ankle LCL. For example, Anderson and Hall, 1995 note that 1st , 2nd and 3rd degree sprains are associated with the ATF; ATF+CF; and ATF, ATF+CF, ATF+CF+PTF, respectively.
The LCL is not the only structure on or near the lateral aspect of the ankle that is liable to injury following an inversion sprain. The peroneus (fibularis) longus and brevis muscles run from the lateral aspect of the leg and have their distal tendons running in a groove (peroneal groove) on the posterior aspect of the lateral malleolus, on their way to the distal attachments on the foot. These tendons are held in place by two (superior and inferior) retinacula. Following an extreme acute sprain or a series of milder inversion sprains, these two structures may be stretched or torn. Subsequently, when everting the foot (against resistance), the tendons of the peroneal muscles "pop out" from behind the lateral malleolus. Injuries to any of the above ligaments and retinacula may result in swelling, ecchymosis and tenderness over the lateral aspect of the ankle and foot. Pain may often be more severe over tissues experiencing the most damage. Bone injuries also can occur with severe inversion sprains and need to be ruled out by a physician.
The lateral malleolus comprises the distal end of the fibula. Since inversion sprains of the ankle negatively impact this end of the bone, it makes sense that it would have to impact the proximal end as well. In fact, a loss of fibular motion usually occurs following such a sprain. If you check yourself or a client, you can gently rock the fibular forward and backward ever so slightly. The fibula may become "stuck" following an inversion sprain -- this motion would cease. The sprain also would cause increased tension on the interosseus membrane between the fibula and tibia. The proximal part of the fibula (fibular head) is closely associated with the knee joint complex via the lateral collateral ligament of the knee. As a result, there may be significant forces running though the lateral aspect of the knee.
The entire lower limb wrapped in a thick fascial layer. In fact, in the thigh this layer is so dense it has a special name; the fascia lata. On the lateral aspect of the thigh, and continuing down to the proximal leg, this fascia lata is thickened further by the apposed tendon of the tensor fascia lata, which together form the IT band (iliotibial tract). The IT band runs from the anterolateral surface of the pelvis to a tubercle (Gerdy's tubercle) on the anterolateral aspect of the tibial condyle. Therefore, sometimes following an inversion ankle sprain the IT band is forced inferiorly, and this forces the pelvis to be pulled down forcibly on the affected side. The end result will be an "uneven" pelvic base to support the torso and rest of the body.
As massage therapists, we need to be aware of relationships among body parts that may impact the work we do on our clients following specific injuries. In many instances, soft tissues well-removed from the site of original insult are affected.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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