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Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
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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