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What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
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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