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News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
June, 2004, Vol. 04, Issue 06
Is That Really Frozen Shoulder?
By Whitney Lowe, LMT
It is easy to get excited about being able to help a client that comes to you with a specific pain condition. In fact, this is one of the most rewarding aspects of doing clinical massage.With only your hands you can perform therapeutic procedures that help relieve the pain and suffering that your client has been experiencing. However, in our enthusiasm to help as many people as possible we must avoid a common clinical mistake: oversimplification and overgeneralization of our client's complaints. This can lead to inaccurate identification of the problem, improper treatments, and unsubstantiated claims about clinical efficacy, which simply aren't true. These mistakes are detrimental to all of us in the long run.
One of the most frequent situations where I have seen this occur is with shoulder pain that is commonly labeled "frozen shoulder." Practitioners will show treatment methods and make claims for healing a frozen shoulder in one or two treatments. Healing a true frozen shoulder in one or two treatments is highly unlikely due to the nature of the pathology. In order to understand why this is unlikely, it is first necessary to understand a little more about frozen shoulder.
CAP Underside of the capsule that will adhere to itself in adhesive capsulitis. Figure 1: The glenohumeral joint capsule slackened on the underside when the shoulder is in a neutral position. Mediclip image (c)1998, Williams and Wilkins. All rights reserved.
The term "frozen shoulder" is a clinically inaccurate term because it doesn't specify the nature of the pathology in the shoulder, only that there is some limited motion at the glenohumeral joint. The true frozen shoulder is a pathology called adhesive capsulitis. This is a situation where a pouch of tissue on the underside of the glenohumeral joint capsule becomes adhered to itself and prevents full motion at the shoulder (Figure 1).
A person that has shoulder pain and limited abduction is often described as having a frozen shoulder; however, there are a number of problems that may actually cause shoulder pain and limited range of motion in abduction. For example, subacromial bursitis, shoulder impingement syndrome, arthritis, supraspinatus tendinosis, calcific tendinitis, or rotator cuff tears may all cause shoulder pain and limited motion in abduction, just like adhesive capsulitis. This is why the term "frozen shoulder" is so misleading. There are other conditions, such as paralysis of the trapezius or serratus anterior muscles that may also cause limitation in abduction although they are not likely to produce pain sensations, as some of these other problems will.
Adhesive capsulitis is a problem that does not resolve quickly. Due to the adhesion of joint capsule fibers, it usually takes more than one or two treatments to encourage capsular stretching and breaking of the adhesions that hold the sides of the capsule together. So, how do we determine if this is a true adhesive capsulitis, one of the other problems mentioned above, or something we might not have thought of? Luckily, there are a number of assessment procedures that can help us make that distinction.
First, and most importantly, is the client history. There are unique characteristics in the onset of adhesive capsulitis compared to some of these other conditions. It will often come on slowly for no apparent reason, or it may be associated with some other traumatic event in the shoulder. In addition to information from the history, one of the most important characteristics to evaluate is whether or not the client is demonstrating a capsular pattern of restriction for the shoulder.
The capsular pattern is a concept that was first described by the well-known British orthopedic physician, Dr. James Cyriax. The joint capsule has certain motions that it limits more than others. If there is a problem in the joint capsule, the limitation in these motions will usually follow a common pattern. For example, the capsular pattern in the glenohumeral joint is such that motion will be most limited in lateral rotation, second in abduction, and third in medial rotation. This is due to the way the capsular tissues are stretched during those motions. For instance, if there is a problem like adhesive capsulitis involving the joint capsule, the motion that will be most restricted is lateral rotation. Abduction will be the motion next most likely to have limited range, and limitation in medial rotation will be less likely. The worse the condition gets, the more limitation you will see in all those different motions.
In most of the other conditions described above, the primary problem exists because of compression or irritation of various soft tissues underneath the coracoacromial arch. Therefore, motion in abduction is painful and limited, as these structures get pinched in abduction (Figure 2).
However, if the arm is laterally rotated from a neutral position, there is not likely to be pain because there is no increase in compression or tension on these structures. Yet, if there is a capsular problem, lateral rotation should be the first motion to show restriction. Therefore, if there is pain and limitation in lateral rotation from a neutral position, this is more indicative of a capsular problem like adhesive capsulitis.
It will be important to go through other assessment strategies, such as active motion, passive motion, manual resistive tests, and any other special orthopedic tests that might help you either identify or rule out other problems. If, after performing a thorough evaluation, you are convinced that you are dealing with a true adhesive capsulitis, then your treatment strategies should reflect methods that will reduce capsular adhesions and encourage elongation of the inferior portion of the capsule. This is usually a long process, because it requires the capsule to stretch tissues that have been stuck together, and is unlikely to occur over just one or two treatments.
CAP Compression of various tissues during abduction. Figure 2: Compression of tissues on the underside of the coracoacromial arch. Mediclip image (c)1998, Williams and Wilkins. All rights reserved.
It is essential that we be as accurate as possible when evaluating these problems for several reasons. First, it is crucial you know as much about who and what you are dealing with so you can construct a beneficial treatment plan. In addition, it is essential that we are accurate in our descriptions and claims about what we are able to do in treatment. Making inaccurate or unsubstantiated claims about miracle recoveries is one sure way to decrease our credibility in the eyes of our fellow health care professionals.
Click here for more information about Whitney Lowe, LMT.
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