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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.
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.
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
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.
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.
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.
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.
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.
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.
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.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
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.
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.
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?
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.
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.
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."
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.
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.
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.
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
May, 2003, Vol. 03, Issue 05
Applications of CranioSacral Therapy in Newborns and Infants, Part I
By John Upledger, DO, OMM
CranioSacral Therapy has proven effective in identifying a number of disorders affecting children, including dyslexia, hyperkinetic behavior and motor-control problems.It's also good at alleviating such conditions when they're caused by restrictions in the dura mater membranes of the craniosacral system. I believe the few minutes necessary to conduct a craniosacral system evaluation in the delivery room, or shortly after birth, is a worthwhile investment in any child's future health and well-being.
In 1977, we did a great deal of clinical work at Michigan State University (MSU) to discover how the newly discovered craniosacral system affected patients. For research purposes, I had to develop a standardized evaluation tool. By that time, I had done enough hands-on work that it was fairly simple to come up with the 19-step protocol, which was used by four different examiners to see whether or not the findings were in agreement. The examiners were unaware of each other's findings until each statistician had completed his work. Using this protocol, we examined 25 nursery-school children and found an 85- percent agreement among the four examiners, which took their individual subjective findings out of the realm of chance. Clearly, we were dealing with a craniosacral system that could be evaluated reliably using only the hands of a trained examiner. Based on this study, I considered the evaluation protocol a valid research tool.
I went on to use this protocol on 203 grade-school children. An independent statistician-psychologist correlated my results with the childrens' academic and behavioral performances, and with the medical/obstetrical history of each mother and child. Statistical data analysis revealed that the process was capable of identifying children suffering from dyslexia, hyperkinetic behavior, seizures and motor-control problems. It also could identify babies delivered by Caesarean section or forceps, and those who had suffered oxygen deprivation at the time of delivery.
Based on those results, we opened a clinic at MSU for brain-dysfunctional children. We also received funding to research relationships between autism and craniosacral system dysfunction. The clinic opened in late 1977, and the autistic research was carried out from September 1978 through June 1981. All of this work led to the following impressions and conclusions regarding the effects of craniosacral system dysfunctions on central nervous system (CNS) function.
Maternal Illness or Toxicity During Pregnancy
Maternal illness or toxicity during pregnancy usually results in a generalized tightness of the fetal dura mater, which makes the membrane less able to comply with the rhythmic volume changes of cerebrospinal fluid flowing within the craniosacral system. Frequently, this is a consequence of a maternal viral infection during the last six months of pregnancy. (Maternal bacterial infection is a less likely cause.) We've also seen cases in which tight membranes seemed related to the mother's respiratory difficulties, such as asthma, or to toxin problems, whether from a single experience or ongoing exposure. The toxins could be taken in as food, drink, medicines or street drugs, or inhaled as air pollutants or airborne allergies.
Usually, such a generalized tight-membrane syndrome manifests as gross dysfunction of the child's central nervous system: Sensory and motor deficits, while extremely variable, are obvious. Most often, CranioSacral Therapy greatly affects or completely corrects these problems. The treatment is particularly effective when applied during the first few weeks of an infant's life. If allowed to persist, the noncompliant-membrane syndrome may be severe enough to become a strong contributing factor to the development of autism. Other problems, such as maternal injury, emotional upset or fetal malposition in the pelvis over a prolonged period, are more likely to produce specific clinical symptoms related to craniosacral system dysfunctions that can be discovered quite easily. Proper application of CranioSacral Therapy - the earlier the better - usually is quite effective.
Craniosacral System Dysfunctions Related to the Delivery Process
Delivery of the newborn involves passage of the child through a convoluted birth canal. I believe vaginal delivery represents a child's first CranioSacral treatment, spinal mobilization, myoneural system treatment and sensory-stimulation session. In my opinion, all of these serve to prepare the infant for the rapid transition from life inside the womb to the outside world. Nature seldom makes design errors, and I certainly don't believe the birth canal is one of them.
The bones of the vault of the fetal/newborn skull are hard places in the membrane. There is ample room between their edges for overriding and changing of the head's shape so it can pass through the birth canal. This passage represents a "manipulation" of the skull bones by the birth-canal walls; it ensures their proper mobility, so that after delivery, the bones are able to comply with the motion of the craniosacral system.
Cases of skull-bone overriding usually self-correct as the child's head expands and reshapes after exiting the birth canal. Should this not occur within minutes, a CranioSacral therapist can correct these situations easily. Left uncorrected, override problems can contribute to seizure tendencies. We often find a persistent override between the parietal and frontal bones in spastic conditions such as cerebral palsy. When corrected, these conditions usually improve or disappear entirely.
The squeezing of the child's head during delivery also may act as a circular wringer that encourages the permeation of cerebrospinal fluid into and throughout the brain tissue, down the spinal canal and throughout the subdural spaces. This squeezing motion helps the venous blood drain from the skull vault, so that as soon as the head is delivered from the birth canal, fresh arterial blood can enter the vault and further activate the circulatory systems of the brain. It also offers the first scalp massage.
Most infants are delivered face-down, with the mother in the supine position and the child's occiput coming out under her pubic bones. Many well-meaning delivery attendants feel a need to speed up the process. Obstetrical lore contends that when the head comes out, we must hasten to complete the delivery, since the birth canal may be squeezing the umbilical cord against the infant's body. This cord compression is thought to potentially occlude blood flow to the infant, which may result in brain damage due to hypoxia. In other words, the attendant's good intention translates into grasping the child's head and pulling; in doing so, the head can be hyperextended, which may create a "jamming" of the skull's occipital bone forward into the V-shaped receiving-joint surfaces, located on the superior surface of the 1st cervical vertebra (atlas).
When there is danger of injury, the soft tissues of the body contract or splint. If splinting occurs with the child's occiput jammed in this forward position, it will stay that way. In that case, the contracture of soft tissues at the juncture of the skull base and the top of the neck may compromise areas of the jugular foramena on the right side, the left side or both. If the jamming is more severe, it may compromise the foramen magnum.
The jugular foramena allow several important structures to pass out of the skull, including the jugular veins that drain most of the venous blood from the head into the neck. The foramena also afford passage to the IXth, Xth and XIth cranial nerves. The glossopharyngeal (IXth) and vagus (Xth) cranial nerves work jointly to help control swallowing, airway function, and the larynx, pharynx and esophagus. The glossopharyngeal nerve also works along with the hypoglossal (XIIth) cranial nerve to control the tongue and oropharynx. Additionally, the vagus nerve helps maintain a normal heart rate and is involved in stomach and bowel function. When dysfunctional, the vagus nerve can contribute to a sense of dizziness.
The hypoglossal (XIIth) nerve exits from the skull through the hypoglossal canals, located beside and beneath the joint surfaces of the occiput as it articulates with the atlas. Consequently, jamming can easily result in tongue control problems, such as tongue thrust. The spinal accessory (XIth) cranial nerve innervates some of the major muscles of the neck; when dysfunctional, it may create spasm of the sternocleidomastoideus and/or the portion of the trapezius muscle in the neck. This may continue after birth due to ongoing compression/irritation of the nerve as it exits the jugular foramen, which may then produce a torticollis.
We call this type of craniosacral system dysfunction "occipital base compression." If both sides of the occipital base are severely compressed, it's common to see colic; food regurgitation; esophageal reflux; respiratory difficulties; rapid heart rate; and compromised bowel function (constipation or diarrhea). There also may be spasm of the neck muscles. If left uncorrected, the situation may result in hyperactive child syndrome and attention deficit disorder. When the occipital base jamming is less severe, or only on the right or left side, any combination of these symptoms may be present.
Fortunately, occipital base compression can usually be corrected by a skilled CranioSacral therapist in a matter of minutes, if the child is treated during the first weeks of life. Treatment is most effective when performed during the first few days of life - or even in the delivery room, after the umbilical cord has been cut and the child has been suctioned and wiped clean. The sooner the child is seen, the less treatment normally is required.
If neck-muscle spasm is allowed to persist, it can cause temporal bone dysfunction in the craniosacral system. This has been shown to be a strong contributing factor in children with dyslexia and other reading problems. Interestingly, correcting these dysfunctions in school-age children often allows them to catch up to normal reading levels in a matter of weeks, unless psychological and/or emotional scars are in the way. If they are, psychoemotional therapeutic modalities must be incorporated into the treatment program.
Click here for previous articles by John Upledger, DO, OMM.
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