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Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
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.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
February, 2005, Vol. 05, Issue 02
Syndesmosis Ankle Sprains
By Whitney Lowe, LMT
Ankle sprains are the most commonly occurring lower extremity soft-tissue injury. An estimated 85 percent of all ankle injuries involve ligament sprains. Of the various ligaments around the ankle, the majority of injuries occur to the ligaments on the lateral side of the ankle, primarily the anterior talofibular (Figure 1).If injuries are more severe, they may also include damage to the calcaneofibular ligament.
While the lateral ankle sprain is the most common ankle ligament injury, it is not the only one. Failure to recognize other types of ligamentous injury, such as a syndesmosis sprain, may lead to inappropriate treatment and prolonged disability.
Due to the number of joints in the ankle region numerous ligaments are needed to maintain joint stability. Most of the joints in the foot and ankle have significant movement capability; however, that same degree of mobility is not present in a syndesmosis joint. A syndesmosis is a fibrous joint with very little mobility where two bones are directly connected by ligaments or some other connective tissue membrane. The syndesmosis in the ankle where ligament sprains may occur is the distal tibiofibular syndesmosis. It is the tough fibrous connection that holds the distal ends of the tibia and fibula together.
The distal tibiofibular syndesmosis is composed of several ligaments and connective tissues. They include the lower margin of the interosseous membrane, interosseous ligament, anterior tibiofibular ligament (Figure 1), and the posterior tibiofibular and transverse tibiofibular ligaments (Figure 2). Because the syndesmosis ligaments are more proximal than the other ligaments commonly injured in an ankle sprain, the syndesmosis injury is often called a "high ankle sprain."
Injuries to the ankle syndesmosis are most likely to result from excessive rotation of the ankle (adduction or abduction of the foot), extremes of dorsiflexion, or combinations of dorsiflexion with adduction or abduction. The type of injury that produces syndesmosis sprain commonly occurs in sports played on turf with cleated shoes. For example, suppose an athlete has a cleated shoe that digs into the turf and keeps the ankle relatively immobile. If that person falls forward (causing dorsiflexion of the foot) at the same time that s/he is attempting to turn to the side (causing rotational stress in the ankle), injury to the syndesmosis is likely.
The common lateral ankle ligament injuries are usually not difficult to identify because the injured ligaments are superficial, making their palpation much easier; however, in the syndesmosis joint, palpation of the injured ligaments is not easy because other soft tissues obscure the ligaments. Therefore, several special orthopedic tests are used to help identify the syndesmosis sprain.
In addition to other important factors from the history, visual examination, and range-of-motion evaluations, the squeeze test and external rotation stress test may be used to evaluate syndesmotic injury. In the squeeze test, the distal tibia and fibula are gently squeezed together proximal to the syndesmosis joint.
If the client's pain is reproduced with this maneuver, damage to the syndesmosis ligaments is likely. In the external rotation stress test, the practitioner uses one hand to stabilize the tibia and fibula while the other hand gently externally rotates (abducts) the foot. The foot is in a neutral position or slightly dorsiflexed when the rotational movement is started. If this movement reproduces the client's primary pain, there is a good chance that the distal tibiofibular syndesmosis is involved in the injury.
It is important to recognize an injury to the ankle syndesmosis because an incorrectly identified problem may lead to errors in treatment or prolonged disability. If your client has sustained an ankle injury, identify the primary tissues injured so appropriate treatment can be provided. Refer the client if the injury appears more serious. Syndesmosis sprains may become chronic instability problems in the ankle if they are not properly evaluated and treated.
Click here for more information about Whitney Lowe, LMT.
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