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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.
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?
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.
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.
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.
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.
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.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
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.
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.
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.
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.
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).
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.
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?'
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
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.
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.
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.
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.
August, 2003, Vol. 03, Issue 08
Depression and the Stress Response System: Part I of III
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
Last time, we talked about adhesive capsulitis, and some of you shared wonderful information about this disorder. Conventional wisdom suggests that this disorder is lengthy, painful and debilitating, but that doesn't mean every person will suffer.Many massage therapists are having great success with their clients' "intractable" shoulder pain and restrictions!
My next three columns will focus on depression. This first piece will focus on the definition and etiology of this disorder, with emphasis on the Stress Response System and its influence on mood. The second section will address five common types of depression, including major depressive disorder; dysthymia; bipolar disease; seasonal affective disorder; and post-partum depression. I will conclude the series with a discussion of treatment options, and a look at the interaction between massage, the disease process and the medications commonly prescribed for it.
What is Depression?
Depression is a term used to classify a group of disorders that causes debilitating changes to one's emotional state. I found a wonderful description of depression in one of my favorite books about stress and disease, Why Zebras Don't Get Ulcers, by Robert Sapolsky. He classifies depression as "a genetic-neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets."1
Depression is a central nervous system (CNS) disorder that involves a genetic predisposition, chemical changes, and often a triggering event, that results in a person losing the ability to enjoy life. It is more than a temporary spell of "the blues"; it can be a long-lasting, self-propagating and debilitating disease. Statistics on the incidence of depression are hard to gather. Most estimates suggest that between 10 percent and 20 percent of the U.S. population experiences an episode of depression every year, amounting to 11 to 19 million people. Women seem to be more susceptible to depression, as well as more likely to seek help. Incidences of diagnosed depression among women are twice as frequent as they are among men.
Etiology of Depression: What Happens?
No one really knows how depression starts. Several distinctive features have been noted in the brains and endocrine systems of depressed individuals, but whether these features cause the problem or are caused by the problem, is still a mystery. Nonetheless, as we learn more about the chemical changes associated with depression, we also learn new ways to treat it:
Many contributing factors collide to initiate a depressive episode. Some of them are controllable; many are not. Whether or not someone will end up feeling depressed depends on his or her own personal chemistry, genetics, and something much harder to quantify: personality.
Depression and the Stress Response System
The Stress Response System (SRS) is the link between the CNS and the endocrine system that allows humans to respond to short-term and long-term stressors. It is controlled by the hypothalamus-pituitary-adrenal axis (HPA): the communication between the hypothalamus, the pituitary gland and the adrenal glands. A healthy SRS allows reactions that are appropriately gauged to the circumstances: big reactions to big threats; small reactions to small threats.
When the SRS works well, the chemical changes it brings about are transitory and quickly neutralized, once the threat has passed. A person with a healthy SRS will have a rapidly beating heart; dilated pupils; dry-mouth; heightened blood sugar; and increased blood pressure when he or she narrowly dodges a drifting car on the highway, but won't blow a gasket when his or her 10-year-old leaves the bike in the driveway again.
Sometimes the SRS doesn't work well. The chemical messages issued first from the hypothalamus, then by the pituitary gland, are slow to leave the brain and reach the adrenals. This takes longer to have an effect on the body, which slows reactions and decreases the ability to respond quickly to threat. The stress reaction is tenacious, and its after effects can linger longer than for someone with a healthy SRS.
Furthermore, people who have a sluggish SRS also tend to have more stress responses, more often, to less threatening stimuli; those responses have longer lasting effects on the body. This type of person fumes in a long checkout line, frets in heavy traffic and explodes when the dog gets into the garbage. This person may have a sluggish, but overreactive stress response and a tendency to develop depression.
What Determines the Health of the SRS?
Studies on animals reveal one reason for a sluggish stress response: lack of tactile stimulation, or touch. Under stimulated animals have consistently slower, longer lasting and more frequent stress responses than animals that have been regularly handled. Consider what this means for the average under-touched person in our society. Touch deprivation and depression might especially affect those who live in isolation, away from the tactile and emotional stimulation of a partner or extended community. Ironically, depression tends to cause people to isolate themselves even further from their communities, which can exacerbate and elongate their problems.
There is some good news: The health of the SRS can be improved with an abundance of healthy, nurturing touch. Next time, we'll look at different types of depression, along with their distinctive signs and symptoms.
If you work with depressive clients, I'd like to hear from you about: the type of depression your clients have; if they take medication; the type of bodywork you do with them; the length of time you have worked together; and the results you are seeing. I will take your input and incorporate it into the next two articles, so get busy!
Many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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