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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.
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.
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.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
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.
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.
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.
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.
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?
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.
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."
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
January, 2003, Vol. 03, Issue 01
The Perils of Perfect Posture, Part I
By Erik Dalton, PhD
Throughout history, human posture has been scrutinized for symbolic values ranging from socioeconomic status to psychological babble. In schools, teachers often reprimanded students to sit up straight.Young girls innocently walked with books balanced perfectly on the top of their heads during "charm school" classes. Aesthetically, even the dancer has come to represent the epitome of graceful posture and balance, with the ethereal vision of the lithe ballerina artlessly stretching to the sky. Meanwhile, the rest of us may never forget the words of well-intentioned parents, "Now, stand up straight or people will think you have something to hide." Society's undying commitment to its tradition for proper postural codes remains alive today, in circles that not only envelop the military private, but also the young debutante in white.
But as we begin to casually observe the people around us, the question must arise: Is perfect posture really a reasonable goal for the average American living in a flexion-addicted society?
Clinical evidence overwhelmingly supports the fact that prolonged sitting or sleeping in flexed positions neurologically shortens and tightens the body's hip flexors, particularly the iliopsoas muscles. As the antagonist gluteus maximus muscles gradually become reciprocally inhibited and weak, a primary muscle imbalance pattern ensues. Could more harm fall upon someone in this condition? Simply put, yes. As he rises from his chair, the shortened iliopsoas and rectus femoris muscles drag the hips and lumbar spine forward. Thus, the unsettling "before" snapshot: A swayback posture and protruding belly ... paving the way to a disappointing first impression.
However, prolonged slumped sitting can also promote an even greater pain-generating problem. While slouching or leaning forward, such as when we tirelessly perform computer or couch potato work, our swayback curve gradually begins to reverse itself by overstretching the posterior low back ligaments and joint capsules. Gravity loudly demands its pound of flesh, and this newly formed "reversed lordosis" gets an extra boost in its battle with the flexion-addicted swayback.
As we repeatedly stand, sit and slouch throughout a typical 8- to 10- hour workday, our low back curve is forced to repetitively translate anteriorly to posteriorly. The inevitable strain from local lumbar hypermobility soon begins to ravage the vulnerable sensory receptors in the body's joints, ligaments and intervertebral discs. Noxious afferent stimuli bombards the central nervous system causing the brain to react by triggering layers of muscle spasm to protect the unstable spine from further insult. Digging out the deep spasm and fascial contractures is usually a sad waste of time and energy unless the underlying joint dysfunction is first appropriately treated. Approaches to restore optimal posture and relieve chronic pain should include specific techniques designed to co-activate hyperactive sensory receptors such as mechanoreceptors, nociceptors and chemoreceptors in joints and ligaments, while activating muscle spindles to tonify inhibited weak tissues.
Ligaments, Muscles and Strain Patterns
While the overstretched ligaments valiantly strive to maintain spinal stability, the unrelenting force of gravity pounds the posterior facet joints and flattens the lumbar discs. The brain then begins its selective recruitment of specific muscles to provide ancillary support to the unstable spine. The problem worsens since contractile tissues designed to move bones are now required to work as spinal stabilizers. Sustained isometric muscular contraction neurologically weakens the lumbar myofascia due to the sudden influx of lactic acid and other toxic waste products. As the shortened tissue tugs unevenly on the spine, the joints' axis of rotation is altered. Predictable strain patterns and postural compensations reverberate throughout the thorax, neck and head. Forward head postures and slumped shoulders are two favorite dance partners of the pained swaybacks in this rapidly growing social circle of "flexaholics."
Postural muscles, such as the iliopsoas, quadratus lumborum, rectus femoris, and hamstrings, are structurally designed to resist fatigue in the presence of prolonged gravitational exposure. So why are distorted postures and chronic pain problems dominating our practices? The easy answer: overuse, underuse and just plain old abuse.
These three primary culprits create muscle imbalances that reduce the body's capacity to resist stress. As with everything in life, the body exists on a plane of give and take. Therefore, when postural muscles tighten, the antagonist groups are overstretched and weakened, allowing asymmetric patterns to develop. Soon the anti-gravity function of the body's myofascial system sends an alarm to deeper structures, such as spinal ligaments, joint capsules and intervertebral discs, to brace for the overbearing compressional loads. The homeostatic threshold has been violated.
The body must now prepare to battle the devastating, self-perpetuating pain/spasm/pain cycle manual therapists confront each workday.
If considering the medley of countless occupations that require the typical 12-pound head to be held in a bent forward position, with arms positioned in front of the body, why is it any shock that neck, shoulder and arm pain run rampant in today's society? Consider the typical profiles of individuals fitting this definition. This endless list runs the gamut from dentists, car mechanics, stockbrokers, hairdressers, etc. - even bodyworkers.
Long hours of passive sitting at the computer, or leaning over therapy tables, create stretch weakness in the rhomboids and lower trapezius. This repetitive physical practice contributes to forward dragging of the shoulder girdle due to the pectorals propensity for domination. Tight latissimus dorsi and subscapularis muscles unite with the clavicular head of pectoralis major to internally rotate the humerus. With the scapulae protracted and the arms internally rotated, the neck reluctantly moves forward on the shoulders often forming the unattractive "dowager's hump". Unfortunately, as the spinal facet joints slide open, the cervical curve loses its lordosis and transforms to a typical straight cervical curve. To prevent the person from only looking at the ground, the brain recruits the suboccipitals and other capital extensor muscles to cock the head back into hyperextension. As the occiput hyperextends and slides forward on the atlas vertebra, the posterior occipital atlantal membrane is squashed along with local neural and vascular structures.
Sadly, tonic reflexes and dural attachments originating at the O-A joint dictate postural muscle tone throughout the entire trunk. Stubborn head, neck, brachial, and scapular pain refuses to leave when in an agitated state. These painful and chronic conditions frustratingly persevere until the therapist chooses to systematically balance the shoulder girdle on the rib cage, the neck on the shoulders, and the head on the neck.
To better understand the consequences of forward head postures and slumped shoulders, try these two experiments:
Most people experience a 25 percent to 50 percent decrease in range of motion while in the forward head position. This exercise helps illustrate the physical limitations of people suffering forward head postures and demonstrates the negative impact these sensitive neck structures must endure during normal activities, such as driving, shopping, dancing, etc., Spondylosis, degenerative disc disease and osteoporosis are but a few names that describe what physically transpires when this structural alignment problem is not corrected in a timely manner. The farther the head slides forward on the sagittal plane, the more devastating the long-term effects. The posterior longitudinal ligament likes to tear away from the discs and vertebral bodies from C4 to C6 causing internal pressure to fill the cracks with calcium or bone spurs (osteophytes) - the resounding reason why bone spurs originating from forward head postures have become the most common cause of chronic neck pain.
Both exercises lead to a compromising conclusion: Always begin upper-quadrant postural alignment by balancing the shoulder girdle on the rib cage, neck on the shoulders, and the head on the neck, before tackling specific extremity pain problems, such as supraspinatus tendonitis or thoracic outlet syndrome.
Supraspinatus tendonitis pain is generally the result of forward head postures and slumped shoulders ... not the cause. When the humerus internally rotates from a slumped posture, the supraspinatus attachment at the greater tubercle of the humerus also rolls forward. Then when called upon to lift a heavy suitcase, the supraspinatus tendon cries for help as the shoulders are retracted. Pain shoots down the arm as the tendon flips back over the humeral head, and soon the fibers begin to tear.
Click here for previous articles by Erik Dalton, PhD.
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