resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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?'
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.
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.
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.
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.
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).
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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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