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Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
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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