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A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
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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