resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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.
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.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
March, 2003, Vol. 03, Issue 03
The Perils of Perfect Posture, Part II
By Erik Dalton, PhD
Editor's note: Part I of this article appeared in the January 2003 issue.
Postural Harm to the Viscera
Prolonged sitting can contribute to a significant loss of cervical and lumbar curve, while increasing thoracic kyphosis.Just like the newborn, the result is one big C-curve, with all the facet joints sliding open - beginning at the sacrum and curving all the way up to the occiput. With the shoulders drawn forward and the chest flattened, the abdomen protrudes below the belly button, resulting in altered breathing patterns. Tension increases on the pericardium and its neurovascular contents, because the diaphragm is now lowered. Individuals who suffer from this condition may seek help from their physician for complaints of heart palpitations or respiratory infections, while ignoring the real cause - a potential alteration of visceral position and function.
Exploring Perfect Posture
To fully understand why aberrant postural patterns create chronic head, neck, back and hip pain, perfect posture must be clearly defined. Simply put, perfect posture is a condition in which body mass is evenly distributed. Muscles are not actively working toward appeasement of pain. Ligamentous tension must be perfectly balanced against compressive and tensegrity forces, so the typical activities of standing and walking require minimal energy expenditure. Because locomotion requires the controlled loss and regaining of balance, movement of any body part with respect to the rest of the body shifts its centerline of gravity, causing an inevitable change in overall balance.
Wasting Precious Energy
Ideally, during standing, postural muscles should be in a state of normal tonus and not actively contracting. However, as the body is subjected to micro or macrotraumas during the normal routines of life, postural balance becomes less than perfect. When this happens, active muscle contraction is required to redistribute body mass and effectively hold it in place. At this point, the muscles are working against gravity requiring them to perform the ligament's job of stabilizing the joints.
Muscle contraction requires energy; therefore, postural imbalances result in an enormous energy drain, proportional to the magnitude of the postural imbalance. Of course, this becomes lost energy unavailable for its original purposes. Energy drains have a dramatic effect on the limbic system - the highest cortical level controlling muscle tone. As whole-body tension builds, clients begin to report strange symptoms resembling fibromyalgia, chronic fatigue syndrome and digestive or hormonal disorders.
Faulty posture becomes magnified in clients who participate in athletic competitions. For example, short leg syndromes from a tilted pelvis can create a dramatic loss in time, strength, coordination and endurance in both amateur and professional athletes. In addition to energy loss, the body's joints are often subjected to abnormal mechanical stresses. When the spinal musculature is involved in lateral curvatures due to compensations from a tilted or side-shifted pelvis, shortening of the ligaments and muscles on one side and lengthening on the other occurs. Alterations in joint function, caused by capsular restriction or loss of joint play, inhibit or facilitate the muscles that cross the misaligned joint.
If proprioceptive impulses from sensory receptors located in joint capsules, ligaments, tendons, muscles, fascia and intervertebral discs become agitated from pelvic misalignment, compensations resound up and down the spine. Even the slightest alteration in the normal balance of the various spinal segments leads to some degree of soft tissue change. Nature inherently attempts to automatically restore equilibrium, by contracting and shortening certain muscles and inhibiting and weakening others.
When a joint's axis of rotation changes, one side of the joint capsule and its supporting muscles and ligaments become overstretched and weak. Meanwhile, sensitive mechanoreceptors imbedded in the articular cartilages and discs on the compressed side send a barrage of mechanical distress signals to the spinal cord.
Facet joints are possibly the most innervated structures in the spine. Their cartilages despise prolonged compression and soon become swollen, inflamed, and eventually degraded. As chemical inflammatory agents accumulate, chemoreceptors are stimulated and join the mechanoreceptors in flooding the neuronal pool with warning bells of possible tissue damage. This stimulates the pain-producing nociceptors that cause the brain to tighten and shorten specific muscles to avoid further pain - the embodiment of our" crooked" clients in acute pain. The brain twists and torques the body in an attempt to alleviate the pain. Regrettably, the cerebellum has the ability to memorize these aberrant patterns and re-learn them as normal. This condition, when the deformed posture long outlasts the painful stimuli, is called neuroplasticity, reflex entrainment or spinal learning.
In the presence of joint blockage caused by capsular tightness and compression, normal articular reflexes may become so disrupted that when the tightened area of the joint capsule is overstretched, reflex inhibition of the overstretched muscle prevents further capsular elongation.
"Feet-shufflers," occasionally seen in malls and supermarkets, represent the perfect exaggerated embodiment of how a dysfunctional hip capsule can disrupt the firing order of muscles that cross a joint. During the walking cycle, the feet-shuffler's push-off leg can't extend backward, due to adhesions in the anterior part of the hip capsule. Therefore, he or she uses the hip flexors to throw the feet forward to walk. Therapists usually attribute this condition to tight hip flexors that won't allow the back leg to follow through in extension. However, during therapy treatment, attempts to increase hip extension by actively or passively stretching the hip flexors can cause an immediate firing of the joint and ligament mechanoreceptors creating a sort of stretch reflex. The adhesive capsule fools the joint receptors into believing the hip has already reached its end range of motion. A condition called arthrogenic muscular weakness inhibits the hip's prime mover, the gluteus maximus, and facilitates the already tight/short iliopsoas. This appears to be a local genetic protective device to prevent excessive hip extension and further jamming of the joints' compressed cartilage.
Regrettably, anterior hip capsule adhesions are a widespread and overlooked source of flexion addiction in our society. Some may conclude that this insidious hip condition is the reason for so many hip replacements being performed in this country each year. Athletes who complain of loss of speed in their competitive trials may also suffer from a lack of full hip extension in one or both hips. Hip flexor work alone just won't solve the problem. One helpful routine is to first dig-out, plunger and stretch the adhesive hip capsule, then tonify the weak gluteus maximus with fast-paced, spindle-stimulating maneuvers. To finalize this procedure, use techniques ranging from assisted stretching, myofascial release, trigger point therapy or muscle energy to lengthen the tight iliopsoas.
The mysterious yet potentially stressful force of gravity affects each of us here on planet Earth. Our body's somatic system is intrinsically involved in its reaction to a shift in the center of gravity. Muscle and ligamentous tension is maintained by negative feedback from sensory receptors located in joint capsules and intervertebral discs. When the normal function of any part of the somatic system becomes overstressed, the vicious cycle of pain and dysfunction begins. Our job as bodyworkers is to maintain normal mobility of all components of the somatic system, to help minimize gravitational strain and any consequences from postural imbalance.
Emerging from an industrial society to one rich in technology, we now live in a world in which our external environment greatly impacts the healthful functioning of our bodies. As therapists working with a flexion-addicted population, we must garner a greater understanding and respect for the goal of perfect posture and its relationship to chronic pain, so we can teach our clients how to lead healthier, happier and more productive lives. May we all be graceful dancers, stretching artlessly to the sky.
Click here for previous articles by Erik Dalton, PhD.
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