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The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
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 previous articles by Erik Dalton, PhD.
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