resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
May, 2005, Vol. 05, Issue 05
The Pinched Nerve Conundrum
By Erik Dalton, PhD
For decades, manual therapists, biomedical researchers and neuroscientists have battled over the conceptual ideology of pinched nerves. One group holds the belief that spinal misalignments cause or contribute to disease by choking "nerve energy" to body tissues.Others generally agree that the human body probably does possess some sort of universal energy system, but quickly point out that nerves do not appear as conductors of this "life-force" energy. To allow the reader to grasp both sides of this very important issue, this article will provide an overview of current theories that spur the controversy. Following an initial review of the various nerve impingement theories, let us review the two most pressing, yet basic, questions:
One age-old premise supporting the pinched nerve theory follows this logic: If a spinal segment is not in its normal position, nerve pathways between the vertebrae (intravertebral foramina) will partially close resulting in nerve impingement. As the nerve root undergoes compression, soft tissues and organs supplied by the pinched nerve suffer from decreased nerve energy flow to the affected body parts. Thus, according to this theory, alterations in joint structure and function result not only in pain but an increased susceptibility to disease from spinal obstructions impinging on these nerves.
Detractors counter that nerves do not emit a flow of energy. Since nerves are gland cells, their primary function is to produce and release a hormone that causes muscle cell inhibition or contraction. Basically, that is all they do - no more, no less; therefore, these supporters believe that nerves do not actually conduct electricity or any other form of energy.
When a nerve cell undergoes its function of hormonal secretion, changes occur in its outer cell membrane allowing electrically charged ions to move in and out of the cell in a step-by-step fashion along the full extent of the nerve. This is often referred to as "conducting an impulse" or "firing." A spinal nerve as it exits the intervertebral foraminal opening is actually a thin tube of connective tissue containing extensions of millions of nerve cells. These extensions are axons or "fibers." The latter term appears misleading for it connotes a certain firmness similar to fine electrical wires. Sadly, nothing could be further from the truth.
Axons are delicate, flimsy structures. Since they consist of elongated or drawn out parts of cells, nourishment is needed along with the cells that make up their sheaths. Vital nutrients are supplied by blood vessels embedded in what is termed a "visible-level nerve." If acute nerve compression does not directly kill the axons, they may die from compressive forces blocking blood flow within the vessels of the nerve. Nerve occlusion prevents axoplasmic flow of nutrients to be properly transported up and down the length of the nerve.
Another Snapshot of Pinched Nerves
The nerve root itself has been dismissed by most researchers as a pain-sensitive structure, although most clinicians do agree that nerve compression from herniated discs, spinal stenosis and spondylolisthesis can cause radiculopathies such as sciatica. Acute compression of a normal healthy nerve may lead to paresthesias, motor loss, sensory deficits and reflex abnormalities, but pain is absent. However, if an inflamed nerve suffering intraneural edema is compressed, pain is present. This "silent nerve root compression syndrome" hypothesizes that time is required for functional alterations, such as nerve tethering, to cause mechanical nerve fiber deformation and resulting pain.
Compression of an inflamed nerve anywhere along its extent can cause it to secrete its specific hormone. Pressure on an inflamed sensory nerve cell can cause the brain to experience pain (nociception). If an obstruction compresses a motor nerve cell, the hormone secretion can cause a muscle cell to contract (protective muscle spasm). When motor nerve cells to a skeletal muscle die from complete occlusion, the muscle becomes paralyzed as observed in extreme cases of sciatica and thoracic outlet syndrome. One of the first signs of complete nerve occlusion is muscle atrophy followed by a loss of normal neurological reflexes.
Nociceptive ... or Pinched Nerve Pain?
Over the past decade, researchers working with magnetic resonance imaging (MRIs) have demonstrated that no matter how much a normally functioning spine is compressed or twisted, there is ample room in the intervertebral foramina for free movement of the nerve. It is postulated that in a healthy spine, nerve root compression shouldn't exist even with all the intervertebral discs removed. Still, another viewpoint bears consideration.
While conditions such as intraneural edema and ischemia from prolonged nerve-root abuse certainly causes pain in a certain percentage of the population, it is also possible much of the reported pain may be due to sensory receptor overload from postural imbalances. For example, recall what happens when the typical client injures their back. As the spine is subjected to sudden asymmetrical loading, the major stress focuses at the capsule of the articular facets as the joint is moved beyond its acceptable range of motion (physiologic barrier).
Sprained capsules and ligaments cause joint mechanoreceptor hyperexcitability and protective muscle guarding. Muscles aren't designed to be restraining tissues even though the deepest transversospinalis muscles are often awarded that task. As deep intrinsic muscles are subjected to abnormal sustained loading, nociceptive stimuli warn the brain of the possibility of tissue damage.
When nociceptors fire in response to actual tissue damage from macro- or microtrauma during routine daily activities, they quickly become major myofascial and spinal pain generators. Through a process called sensitization, an aberrant hard-wiring pattern is "burned" into the central nervous system (CNS). Long-term CNS agitation from angry nociceptors causes the brain to twist and torque the body in an effort to avoid pain.
Understanding and Treating the Dysfunction
As discussed earlier, the joint receptor concepts attempt to override the idea that pain is primarily a consequence of "pinched nerves" that could ultimately be freed by removing the bony or muscular obstruction. Many neurophysiologists now believe that restoration of proper postural alignment and range of motion successfully reduces pain by stimulating mechanoreceptors in fibrous joint capsules, spinal ligaments and transversospinalis muscles. To achieve a noticeable reduction of increased excitability in the neuronal pool, the pain-generating stimulus must be interrupted until the memory burned into the nerve cells has been completely "forgotten." For many chronic pain cases, a "serial-type" deep tissue therapy works best where clients are seen twice weekly until hyperexcited receptors feeding the CNS are quieted.
Although spinal nerves travel through small intervertebral foramen openings, rarely does a bone-on-nerve dysfunction occur. Significant facet hypertrophy, disc collapse or intraneural edema must accompany the vertebral misalignment before the client experiences pain. While commonly associated with the spine, pinched nerve compressive lesions are actually rare.
What has made the "pinched nerve theory" so popular is that therapists viewing anatomy texts or cadavers can easily visualize how spinal nerves could become entrapped as they make their way through the bony little holes between vertebrae. Regrettably, nociceptors and mechanoreceptors cannot be seen.
For most of mankind, it is far easier to believe something we can see versus something invisible to the naked eye. Despite this human tendency, massage therapists must understand that spinal joints and muscles have massive nociceptive innervation that is profoundly affected by sustained compressional loading from tension, trauma and poor posture. While not clearly apparent, sensory receptors are the primary reason for client visits.
Click here for more information about Erik Dalton, PhD.
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