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How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
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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