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Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
May, 2003, Vol. 03, Issue 05
Adhesive Capsulitis: Freezing, Frozen, Thawing Shoulders
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
My last column on reflex sympathetic dystrophy syndrome (RSDS) seemed to hit a chord. It seems many of us work with clients who live with chronic pain - clients who feel they have limited options in the mainstream medical community.While massage is unlikely to be a curative for this frustrating and potentially debilitating disorder, it is clear we have some benefits to offer. The following is an excerpt from a letter I received from Cynthia van der Smissen, RMT, who achieved some success in treating a client with this condition:
As the title promised, this month's column is about another painful and frustrating condition, but one that has a much brighter outlook than RSDS: adhesive capsulitis, sometimes called "frozen shoulder."
Adhesive Capsulitis: What Is It?
Adhesive capsulitis is the currently accepted term for one of several disorders grouped under the umbrella heading "frozen shoulder." This group includes any combination of shoulder conditions that contribute to reduced range of motion (ROM) at the glenohumeral joint, including arthritis; bone spurs; bursitis; rotator-cuff tears; and impingement syndrome. These problems occasionally lead to secondary adhesive capsulitis, but require different types of intervention for complete resolution.
Adhesive capsulitis is an idiopathic (of unknown cause or origin) problem with a peculiar and unique presentation. It typically has a long, slow, painful onset ("freezing"), followed by a period during which pain is reduced, but function is severely restricted ("frozen"), and finally, a period during which all pain subsides and function is fully or nearly fully restored ("thawing"). The entire process can take anywhere from a few months to well over a year.
Adhesive capsulitis can afflict anyone at any age, but it is seen most frequently among women in their 50s. Some researchers suggest that it affects as much as 2 percent to 3 percent of the population at some point, and somewhere between 10 percent and 15 percent of those patients may have it bilaterally.
Etiology, Signs and Symptoms
Because the shoulder joint has less supporting connective tissue than most joints in the body, it has unparalleled mobility and a huge normal range of motion. Even the capsular ligament that links the humeral head to the glenoid fossa is looser than most joint capsules. This increases mobility, but it leaves the shoulder vulnerable to a number of injuries other joints typically don't face, because they're better protected.
Stage I: Freezing
When the process of adhesive capsulitis starts, the joint capsule begins to adhere to the humeral head. Sometimes, this process is secondary to another injury that limits shoulder use, but it also can occur without any discernable trauma or trigger. This time frame, during which the adhesions between the humerus and the capsular ligament progress and worsen, is the first of three stages, sometimes referred to as the "freezing" stage. The first stage of frozen shoulder can last for two to four months, and is acutely painful in both active and passive movements of the shoulder. Typically, range of motion is lost in medial rotation first, but may progress to all directions.
Stage II: Frozen
The second or "frozen" stage of adhesive capsulitis lasts anywhere from four months to a year. During this time, the joint capsule thickens and essentially glues itself to the humeral head - particularly the anterior portion. Although range of motion is severely limited during this time, much of the pain usually subsides.
Stage III: Thawing
Perhaps the most mysterious thing about adhesive capsulitis is that after many months of severely limited movement in the shoulder, and progressive formation of connective tissue adhesions between the joint capsule and humeral head, the condition begins to resolve spontaneously. The joint capsule becomes free, pain is eradicated and movement is restored. This process may take a long time; a year or more is not unusual. If completely untreated, it is likely that range of motion at the shoulder joint may not be fully re-established, but the percentage of lost function (again, this is usually in internal rotation) is often not significant enough to warrant further interference. The goal of many treatment options is to ensure that when the adhesions begin to melt, the fullest possible range of motion is recovered.
At this time, no single factor has been identified as a direct cause of adhesive capsulitis. Certain statistical relationships have been traced, however, that raise interesting questions. People with diabetes have a higher risk of developing this problem than the general population. The same is true for people with chronic fatigue syndrome; people recovering from heart attacks or strokes; and people with hypo- or hyperthyroidism. Adhesive capsulitis has been investigated as an autoimmune disorder; however, while some immune cell abnormalities occasionally have been observed, this does not seem to be a universal situation. If there is a single reliable causative factor for adhesive capsulitis, it has yet to be identified.
Generally, adhesive capsulitis is diagnosed based on patient history and clinical tests. The end-feel of the joint is firm, but not as hard as joints with a bony end-feel. Its pattern of progression is predictable enough that it can be identified without a specific blood marker or diagnostic test. X-rays and MRIs may be conducted to rule out other possible scenarios (bone spurs, osteoarthritis, tumors, tuberculosis, etc.), but they are not diagnostic for frozen shoulder. Arthrograms (tests in which a contrast medium is injected into the joint space), give useful information; not only do they show where adhesions may have developed, they also reveal how much fluid the affected joint can accommodate. A healthy shoulder will accept 20-30 mL of dye for an arthrogram; a shoulder with adhesive capsulitis will only be able to take in 5-10mL.
The results of various treatment options for adhesive capsulitis are not exactly cause for celebration. Studies of various interventions show that while they may be successful at restoring full, or nearly full, range of motion, they may not shorten the process. Indeed, overly aggressive physical therapy and exercise, while being painful, also increase inflammation and prolong the freezing or frozen stages. Interventions for adhesive capsulitis typically start with NSAIDs or other anti-inflammatories, then progress to home exercises, physical therapy and perhaps surgery. Cortisone injections may be prescribed to limit inflammation, and allow for the possibility of manipulation under anesthesia to detach adhesive material. This treatment can improve range of motion if successful, but the possible complications are serious: fracture of the humerus; rupture of the joint capsule or subscapularis muscle; and neurovascular or cartilage injury. Surgery to mechanically separate adhesions also can improve ROM, but carries the risks associated with surgery, and significant postsurgical pain.
Can Massage Help?
As always, this is where things get interesting. Nothing in the literature suggests massage can directly affect any of the tissues in which pathological changes are taking place. After all, we can't friction the inside of a joint capsule to reduce adhesions. Furthermore, passive stretching, while important to reduce the risk of permanent loss of ROM, is painful and may exacerbate symptoms if overdone.
So, if you have a client in any stage of adhesive capsulitis, what are your options? A few readers sent me some interesting suggestions. All of them deal with the secondary restrictive effects of adhesive capsulitis, but that makes sense, since muscular restriction reinforces joint restriction, leading to the vicious "use it or lose it" cycle of immobilization.
Kathleen Beruman of Bar Harbor, Maine, wrote the following about working with a client diagnosed with adhesive capsulitis and chronic fatigue syndrome:
Terry Solomon of Los Angeles, Calif. contributed these suggestions:
While neither of these stories can function as a fully performed research project, they do point out the fact that just because the "common wisdom" about frozen shoulder predicts pain and limitation for one year or more, doesn't necessarily mean that's what a client has to endure. Thoughtful, educated, sensitive, imaginative massage therapists are finding ways to "break the rules" with intractable disorders all the time. If you're one of them, I hope you'll share your story with the rest of us.
The topic for my next column is again your choice. Would you like to read about severe acute respiratory syndrome (SARS) - the "new flu" that is spreading rapidly in Asia and somewhat more slowly in the U.S.; various types of depression; or something entirely different? Let me know what's on your table, so we can share it with everyone.
Until then, blessings,
Ruth Werner, LMP, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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