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What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. 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.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
August, 2002, Vol. 02, Issue 08
TMJ: Primary Problem, or Tip of the Iceberg?
By John Upledger, DO, OMM
The diagnosis of temporomandibular joint (TMJ) syndrome came into its own in the 1980s, and still remains popular today. A myriad of mechanical devices have been placed in people's mouths to alleviate the painful symptoms of TMJ dysfunction.The success rate of the singular use of such devices, however, leaves much to be desired. All too often, symptomatic relief is only partially achieved, and leaving treatment dependent upon the ongoing use of the intraoral devices. In other words, when the "splint" comes out, the symptoms return.
My own experience with TMJ dysfunction leads me to believe that the condition is often a secondary or tertiary manifestation of another problem somewhere in the body. Underlying problems that contribute to TMJ dysfunction and secondary symptoms are frequently found in the craniosacral, nervous, musculoskeletal, myofascial and masticatory systems.
TMJ syndrome may also be secondary to - or receiving significant contributions from - previous or current traumatic injuries anywhere in the body, and/or from stress. In addition, there may be systemic disease processes in the background, along with allergic and/or nutritional factors that can significantly contribute to the presenting TMJ syndrome.
I have assigned the majority of contributing factors of TMJ dysfunction and the resulting syndrome to the following major categories: craniosacral system dysfunction; stress; neurogenic problems and dysfunctions; posttraumatic problems and residua; structural/somatic problems and dysfunctions; degenerative problems and diseases; and dental problems. I'll discuss several of these categories, including suggestions for the efficacious use of different treatment modalities.
Craniosacral System Dysfunction: The craniosacral system is composed of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. It extends from the bones of the skull, face and mouth - which make up the cranium - down to the sacrum or tailbone area.
The bones of the skull most directly involved with the temporomandibular joints are the temporal bones and the mandible. In the case of TMJ dysfunction, the temporals are the most likely offenders directly related to craniosacral system dysfunctions.
The temporomandibular joints are located two-to-four centimeters anterior to each temporal bone's axis of rotation. Because of that articulating relationship, they are commonly involved in TMJ problems. Since the joint surfaces of the temporal bones are located in eccentric positions, when the temporal bone or bones are restricted into asymmetrical positions in relationship to one another, they provide malaligned joint surfaces for the temporomandibular joints on both sides. This malalignment results in mandibular imbalance and undue wear and stress upon the joints.
Temporal bone dysfunction can result from almost any problem within the craniosacral system, be it osseous or membranous. Only a thorough evaluation of the craniosacral system and the whole-body contributions to craniosacral system dysfunction will yield the primary cause of the problem. This can be accomplished through CranioSacral Therapy, a gentle method of releasing restrictions in the craniosacral system.
Remember, temporal bones can also be forced into abnormal positions when the muscles and ligaments that attach to them present with abnormal strains and tensions. CranioSacral Therapy aims at releasing temporal bones to restore normal function, regardless of the primary cause of the TMJ dysfunction.
The mandible, the other bone that contributes directly to the temporomandibular joints, is a single bone with one joint on each end. Therefore, you cannot distort one joint without causing a problem with the joint at the other end of the mandible. CranioSacral Therapy uses techniques to release and balance the joints at both ends of the mandible. It also releases undue muscle and ligament tensions upon this lower jawbone.
The hard palate is at the mercy of the sphenoid bone with which it articulates at both sides and, via the vomer, in the middle. Since the sphenoid is a major player in the craniosacral system, it is also important to evaluate the system's effect on the function of the hard palate. Distortions in sphenoid function or position often cause hard palate malalignment, which results in malocclusion of the teeth and secondary temporomandibular joint problems.
Within the domain of CranioSacral Therapy, we also have the balancing of all of the muscles of mastication. This means that bruxism, disc position and TMJ compression are all addressed effectively.
Stress: Stress can be caused by a number of factors. Physiological stress might be imposed by problems such as gallstones, kidney dysfunction or arteriosclerotic heart disease. Stress also can be induced by poor posture secondary to a shortened leg, for example. Psychoemotional stress, yet another category, is due to life frustrations, neuroses, or harbored destructive emotions like chronic anger. Environmental conditions - breathing polluted air or working in a noisy environment - produce stress as well.
No matter what the cause or type, stress exacts a toll from the body, as vital energy is required to cope with these conditions. While it's well-known that chronic stress may cause a range of health problems, stress has not been thoroughly considered as the root of TMJ problems (surprisingly). Teeth or jaw clenching is a natural response to increased stress, which compresses the temporomandibular joints and, in turn, causes the joint surfaces to be placed in jeopardy.
When excess stress is a factor in TMJ dysfunction, we must consider the use of stress management techniques. Among these modalities are therapeutic massage for relaxation and release, CranioSacral Therapy to reduce sympathetic nerve tone; SomatoEmotional Release to alleviate traumatic tissue memories and psychoemotional problems; hypnotherapy and/or biofeedback to develop conscious control of muscular hypertonus; and psychotherapy or counseling. Depending on the patient and the availability of therapeutic modalities, any or all of these techniques should be considered along with similar ones.
Dental Problems: I hesitate to discuss how dentists should treat TMJ syndrome. I only know that when direct orthodontic, occlusal and/or surgical interventions are put into play before the craniosacral system is functioning at its optimal level, the dental work must often be redone. Why? Because the involved structures change in response to the craniosacral work and other types of bodywork.
In CranioSacral Therapy, we specifically mobilize teeth in their sockets and encourage them to find their natural position in the mouth. When this happens, it changes the occlusion more toward what nature intended.
Dentists should not be excluded from being a part of the therapeutic team; however, they must recognize that occlusions, temporomandibular joint vitality, bruxism and compressive forces related to the masticatory system will most likely be changing as a result of the non-dental work. Therefore, the interventions imposed by dentists should be temporary and complementary to the holistic approach.
These examples show that TMJ syndrome may be the primary problem, or it may be just the tip of the iceberg. The condition is a part of the whole person, and the whole person must be evaluated to solve it.
Click here for previous articles by John Upledger, DO, OMM.
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