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Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
February, 2005, Vol. 05, Issue 02
We Get Letters and E-Mail
By Editorial Staff
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be edited for space and clarity, and published in a future issue or online.Please send all correspondence by e-mail to r regular mail to:
Editor's note: The following letter is in response to Cliff Korn's article "Thought on Being Part of Medicince" in the October issue (www.massagetoday.com/archives/2004/10/09.html).
"Instead of cramming to know it all, let's focus on turning out stunning graduates with solid basic skills"
Mr. Korn states that he finds it "important that we do both" (relaxation and clinical massage), then proceeds to put his expectations on the entire profession by assuming that "our public shares his expectations! Quite presumptuous!
Who exactly is "our public?" I've been a successful massage therapist for 14 years, practicing relaxation massage exclusively. My public has never had any problem with this, and it has not affected my ability to build a practice wherever I've lived. I feel relaxation massage is medical massage at its finest: preventative medicine, as stress accounts for over 70 percent of visits to doctors!
Since Mr. Korn is so fond of us being a part of medicine, let me ask how many patients expect to see one doctor for "orthopedic issues, stress-related issues, sports-injury prevention, etc." Family doctors are General Practitioners and as the title implies they practice general medicine, referring patients to specialists as necessary for treatment of more specific ailments. This is how I practice my profession as well, referring my clients to bodywork specialists when I feel they would benefit from a different approach.
I simply have no interest in practicing clinical massage but I am a huge proponent of its benefits and never hesitate to refer my clients to qualified rehab therapists. Nor do I hesitate to refer clients to energy workers, Shiatsu practitioners, nutritionists, aromatherapists, body movement therapists, etc. The list is endless as massage embodies the essence of holistic health! How can we hope to be experts in all such modalities? Impossible!
The fact is that true clinical massage requires a great deal of advanced training and hands-on practice to honor the ethic "do no harm," as we must do if it truly is "all about the clients." It is impossible to include this training/practice in a 500-hour entry-level program. And there's the rub!
Must we expand entry-level programs to accomodate this neurotic need to be a "part of medicine?" Many programs are moving up to 750-1,000 hours in order to include more clinical approaches. In my opinion this is a dangerous move. A little knowledge is indeed a dangerous thing and that's exactly what we have in students graduating from such programs. They have not yet mastered basic strokes, but they are expected to understand assessment and corrective techniques that take years of study and practice to grasp. Instead of cramming to know it all, let's focus on turning out stunning graduates with solid basic skills who may choose their own courses for further study!
Gail Frei, LMT
Editor's note: The following letters are in response to Bruce Klein's letter in the November issue (We Get Letters and E-mail, www.massagetoday.com/archives/2004/11/18.html).
"It's well known among spinal surgeons that cerebral spinal fluid does indeed pulse"
I am a massage therapist, exclusively practicing CranioSacral Therapy (CST). I also teach several courses for the Upledger Institute. Before becoming a massage therapist, however, I was a scientist. I have a PhD in theoretical physics from Rice University, and I did research in physics at the Massachusetts Institute of Technology for a number of years. I would like to address the question of why no movement of the cerebral spinal fluid (CSF) is discernable on an MRI and why serial CT scans are possible even if cranial bones move.
Leaving aside the question of whether placing the body in a very high magnetic field or bombarding it with X-rays will disrupt subtle physiological processes, how much fluid movement actually occurs and would one expect to be able to detect it if it were present? The amount of fluid movement within each cycle of the craniosacral rhythm (CSR) is very easily estimated. The average adult human has approximately 600ml of CSF in their system at any given time. That CSF is replaced on average 3 to 4 times per day. That means the brain produces about 600ml of CSF every 6 to 8 hours. The CSR has a frequency of 6 to 12 cycles per minute, or a period of 5 to 10 seconds per cycle. This corresponds to somewhere between 2,000 and 4,000 cycles of the CSR in a 6-hour period. Thus, the amount of CSF produced in a single cycle is somewhere between 0.15 and 0.3ml, much too small of a change to be detected by an MRI. There is movement of the CSF through the brain, but it is very slow. Any given cycle only moves the CSF a small amount, but cumulatively there is enough movement to replace the fluid several times per day.
Even though the fluid production in any one cycle is minute, the pressure changes that occur due to that fluid production are easily palpable. Dr. Upledger (et al.) has published several papers demonstrating rhythmic movement of cranial bones (citations for these papers are available from the Upledger Institute). He showed that cranial bones move rhythmically with average amplitude of about 0.010" or about the thickness of a piece of paper. A movement of this magnitude is easily palpable to the human hand. While I am not familiar with the resolution of a typical CT scanner, it would have to be of the order of 0.010" or less in order to detect the CSR. Even if it were able to detect it, such a small movement would cause only an imperceptible blurring of the image and would in no way prevent one from taking serial scans of a human head.
As a scientist, it does not surprise me at all that the CSR does not show up on MRIs or CT scans, nor does it surprise me that we can easily palpate the CSR - the human hand is a much more sensitive detection instrument than any imaging machine that is available today. What does surprise me is the continuing controversy over the existence of a rhythmic movement in the body that is easily palpable, even by laymen, and whose existence was clearly demonstrated by experiment many years ago.
Tim Hutton, LMP, CST-D
I would like to respond to Bruce Klein's letter challenging cranial movement. First, it's well known among spinal surgeons that cerebral spinal fluid (CSF) does indeed pulse. I observed a laminectomy (removal of the back half of the vertebrae, fully exposing the spinal cord in its coverings) on one of my patients. The CSF pulse was plainly visible - indeed, the neurosurgeon pointed it out. Second, saying that the cranial bones don't move shows that Dr. Klein is not current on his anatomy. Older anatomy texts claim that the bones are fused and don't move. Not so in those of more recent vintage. Actually, only the English anatomy tradition, which we by culture follow, once claimed that the skull bones don't move. The Italian anatomists have always acknowledged that they do.
As to why CSF-flow and cranial bone movement doesn't show in MRIs and CTs: The flow and the bone movements are dramatically slow compared to blood. Other tissues move during MRI exams - the lungs, esophagus, etc. - yet they visualize perfectly well. Cranial suture movement would probably show if one was specifically looking for it and had comparable images taken the few seconds apart between maximum and minimum displacement. But the easiest way to understand cranial-bone pulsing movement is to take the time to feel it for yourself; it's not all that hard to do.
Edward Rowland, MA, DC
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