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Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
January, 2003, Vol. 03, Issue 01
The Facilitated Segment
By John Upledger, DO, OMM
The concept of the facilitated segment is highly relevant to neuromusculoskeletal and psychoemotional problems. The word "facilitated" usually has a positive connotation, implying that some process is made easier or more efficient.In the case of the facilitated segment, however, it means that the stimulus threshold in a particular spinal cord segment has been reduced. This means that the facilitated segment of the spinal cord is highly excitable, and that a smaller stimulus will trigger excessive impulse firing in the segment.
Depending on the tissues involved, this hypersensitivity may be detrimental to the body as a whole. For example, if the segment that innervates the stomach becomes facilitated, the stomach becomes hypersensitive. Mildly irritating foods may cause disproportionately large pains or stomach dysfunctions. A person who suffers from this problem may be said to have a nervous stomach, food allergies or intolerances. If the situation continues, gastritis or ulceration may follow.
The concept of the facilitated segment originated in the work of Dr. I.M. Korr and his associates, beginning in the 1940s at the Kirksville College of Osteopathy and Surgery. The word "segment" means "one of the parts into which something separates or divides." In the phrase "facilitated segment," the word can be somewhat misleading. It suggests that the spinal cord is naturally divided into pieces or segments. To some extent this is true, but bear in mind that the spinal cord is a longitudinal structure, both functionally and structurally. It connects the brain with the nerve roots, which branch out to form the peripheral nervous system.
The spinal cord can be compared to a freeway, and the spinal nerve roots to on- and off-ramps. The spinal cord is a continuous structure, but the nerve roots branch off at regular intervals, and can be viewed as delimiting "segments" of the spinal cord. In this sense, a spinal segment can be defined as a level of the spinal cord at which two dorsal nerve roots (sensory) enter, and two ventral nerve roots (motor) exit. In a facilitated segment, these roots are overly sensitive, or hair-triggered. The hyperactive ventral motor root from the segment passes through the intervertebral foramen and joins the sympathetic nerve chain, which thereby comes under constant bombardment. This keeps the sympathetic nervous system in a state of chronic overactivity, ultimately resulting in damage to the target organs and the patient's health. If the trophic-nerve-function hypothesis is true, this process may also result in protein deprivation in the target organs.
A facilitated segment produces a palpable change in tissue texture. The local paravertebral muscles and connective tissues develop a "shoddy" feel, and joints in the area are less mobile. The tissues are tender to the touch and often painfully irritable. I believe that the term "fibrositis" can be applied to the connective tissues in this situation. Sympathetic system dysfunction at the level of the facilitated segment also produces changes in skin texture, sweat gland activity, and capillary blood supply to the skin.
Dr. Korr compares the facilitated segment to a neuronal lens, in that it seems to gather nerve impulses. It does not pass on its sensory input; rather, it accumulates and hoards not only those stimuli that come into it directly, but also those that attempt to pass through to other segments. Experimental electromyographic work done by Dr. Korr and his associates has demonstrated that stimulus of the nervous system almost anywhere will result in increased electrical activity of the muscles serviced by nerve roots derived from a facilitated segment.
Facilitated segments seem to occur at areas of focus for postural stress, sites of trauma, and segmental levels related to visceral problems. Once established, a facilitated segment can continue for years, even contributing to death. A facilitated segment at T4, for instance, may cause decreased vitality of the heart, leading to a blockage of coronary arteries and myocardial infarction. A facilitated segment also tends to perpetuate itself; that is, the hyperactivity of the motor root causes the related sympathetic ganglion to become hyperactive, leading to dysfunction and deterioration of the target organs. A variety of sensory stimuli related to the dysfunction are sent back to the spinal segment, further increasing its level of facilitation, and so on.
Different types of problems are associated with facilitated segments at specific levels, e.g., T9/10 (gall bladder), T12/L1 (kidney), L5 (urogenital), etc. Once a segment becomes facilitated, all of the associated target structures (connective tissue, muscle, bone, blood vessels, skin, sweat glands and internal organs) will be adversely affected.
Therapeutically, any approach that interrupts the self-perpetuating activity of the facilitated segment is helpful. The sensory input to the segment must be reduced. Effective approaches, therefore, include those that: relax the muscles (massage, soft-tissue manipulation); mobilize the area, reducing stasis and edema (structural manipulative therapy); (3) reduce postural stress (Rolfing, Alexander Technique); and reduce the number of signals from higher centers of the central nervous system (relaxation techniques, biofeedback, hypnotherapy, psychotherapy, tranquilizers).
CranioSacral Therapy is particularly helpful with facilitated segments, in that it reduces autonomic tone (sympathetic activity); reduces general stress and anxiety; enhances endocrine function; assists in postural balancing; and improves fluid exchange. It's also extremely helpful when used to mobilize the dural tube within the spinal canal, because restrictions of the dural tube, or its sleeves, contribute to segmental facilitation.
To locate these areas of restricted mobility, the therapist tests the mobility of the dural tube and releases restrictions as they're found, using gentle traction techniques. These releases are mandatory - if a peripheral restriction is released, but the dural tube restriction and facilitated spinal cord segment are not, the peripheral problem usually reoccurs.
Once the peripheral body and the dural tube have been treated for restrictions, the therapist can focus on the cranium and sacrum. During this time the therapist also helps correct both primary and secondary dysfunctions of the skull bones, facial bones, hard palate and sacrococcygeal complex. All related sutures and joints are gently mobilized. The therapist then focuses on correcting abnormal dural membrane restrictions, irregularities in cerebrospinal fluid activities, and dysfunctional energy patterns and fluctuations related to the craniosacral system.
It is at this stage that the patient often moves from a phase of having obstacles removed to one of self-healing, with the therapist simply facilitating the process. In essence, the patient moves out of the realm of fighting disease and into one of enhancing health. That's why CranioSacral Therapy is also a preventive-medicine modality - it mobilizes natural defenses, rather than focusing on the etiologic agents of diseases.
Click here for previous articles by John Upledger, DO, OMM.
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