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Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
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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