resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
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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