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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
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.
February, 2003, Vol. 03, Issue 02
The Ligamentum Nuchae
By Neal Cross, PhD, NCTMB
In a recent article published in Clinical Anatomy,1 Dean and Richard clarified some of the anatomical detail of the upper cervical connective tissue elements.I think their results are exciting for anyone utilizing craniosacral techniques and/or treating cervicogenic headache.
The ligamentum nuchae is that well-developed portion of the supraspinous ligament in the cervical region. It runs from the external occipital protuberance along the tips of the spinous processes of the cervical vertebrae, to the tip of the spinous process of the vertebra prominens (usually C7). The supraspinous ligament can be considered the superficial continuation of the interspinous ligament. This latter ligament runs between the adjacent vertebrae extending from the base to the tip of each spinous process. The ligamentum nuchae is formed primarily from the aponeurotic attachments of the adjacent and subjacent musculature. From superficial to deep, these muscles are the trapezius; rhomboideus minor; splenius capitis; and the serratus posterior superior.
Dean and Richard found direct fibrous attachments between the ligamentum nuchae and the spinal dura - between the occiput and C1, and between C1 and C2. They found attachments to the ligamentum flavum and the spinal dura between C2 and C3. These were not as prominent as the attachments at superior levels. They did not find any direct connections between the spinal dura and the rectus capitis posterior minor (RCPM), as had been previously reported.2 However, they did find a connective tissue band that ran from the deep surface of the RCPM to the posterior atlanto-occipital membrane. This thin membrane runs from the posterior margin of the foramen magnum to the upper border of the posterior arch of C1.
It is interesting to note that although most of the cranial dura are innervated by the trigeminal nerve (CNV), the infratentorial portion (the portion inferior to the cerebellar tent) is innervated by upper cervical nerves. It is tempting to speculate how working the suboccipital soft tissue elements might have a positive impact on relieving cervicogenic headaches. We may be able to effect this end by using several different techniques, including craniosacral, Swedish and counterstrain, among others.
Of further interest for consideration would be to review the anatomy of the transition of the dura from the cranium to the vertebral canal. The cranial dura is comprised of two layers: the outer or endosteal layer, and the inner or meningeal layer. These two layers are contiguous throughout most of the cranial cavities, except where they part to allow for the formation of the dural sinuses. The outer layer also ends at its attachment around the foramen magnum. However, at this latter point, the inner layer continues through the foramen magnum to become the spinal dura. The periosteum of the vertebral canal is the equivalent of the outer layer of cranial dura.
In summary, we see several cervical elements associated with the cranial dura mater by their connection to the spinal dura. The ligamentum nuchae directly attaches to the spinal dura, as does the ligamentum flavum, to a lesser degree. The upper cervical nerves serve the sensory innervation of both the cervical spinal dura and the cranial dura in the posterior cranial fossa. These same nerves supply the sensory elements of the muscles of the deep back and skin over the back. Although the trapezius is innervated by the accessory nerve, its sensory innervation derives from the upper cervical nerves.
A therapist could spend quite some time on the back of a client's neck, and achieve results well-worth the time spent.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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