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Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
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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