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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."
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
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.
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.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
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.
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.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
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 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.
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.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
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.
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!
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
June, 2005, Vol. 05, Issue 06
The Soft Touch
By Keith Eric Grant, PhD, NCTMB
In our technically oriented culture, we have become accustomed to relying on our instrument readouts and conscious reasoning. We can, in our wanderings, for example, routinely and accurately determine time and position from our communicating electronics. Vital signs of medical patients, once done periodically by a human, can now be continually taken by electronic sensors and monitored for changes by computers.
What we tend to forget is that our human bodies are covered with a network of tactile sensors numbering 6 million to 10 million in all,5 making us superb sensors in our own right. Equally forgotten is that our ability to integrate the ongoing stream of information from these sensors is beyond the capabilities of today's computers or of our conscious minds. Profound statements of our sensing and processing abilities come from a decade ago by dance/anatomy teachers Andrea Olsen and Caryn McHose8 and very recently by sensory scientist Martin Grunwald:5
"The somatosensory cortex of the cerebrum has a precise map representing sensory information from all parts of the body, and works in conjunction with the cerebellum of the brainstem to maintain a continuous, cumulative picture of the body's position in space. The cerebellum, in particular, is responsible for constant coordination and correction of posture, movement and muscle tone. Even more fascinating, it holds the image of where you just were, where you are now, and it projects where you will go next."8
"Our sense of touch also enables us to take the measure of our body's size and position. The parietal-cortex apparently combines millions of individual data points from the touch sensors in muscles, joints, tendons, and skin to create an internal picture of ourselves. Normally, people are very good at estimating how tall, heavy and broad they are, allowing them to duck sufficiently for a low doorway or turn sideways to slip through a narrow passageway."5
The subconscious "computational" processing that creates our body image from our sensors extends our responses to stimuli beyond direct reaction. The basis for meridian theory, for example, might lie as much in our processing of input as in our physical bodies. Grunwald and his group hypothesize that body image afflictions, such as anorexia nervosa, may lie partly within faulty integration of sensory information. Their research indicates that other touch-based (i.e., haptic) processing, such as drawing simple shapes from touch, may also be adversely affected by the underling dysfunction. Other paths of current research tie our sensory and neurological systems to our immune systems.9 The brain and immune system continuously signal each other, often along the same pathways, which may explain how sensory input and state of mind influences health.
Sensory research has also recently uncovered why being cuddled feels so good - human skin has a special network of nerves that stimulate a pleasurable response to stroking.10 Normal touch is transmitted to the brain through a network of fast-conducting nerves called myelinated fibers, which carry signals at 60 meters per second. But there is a second slow-conducting nerve network of unmyelinated fibers, called C-tactile (CT), the role of which was unknown. The CT network carries signals at just one meter per second. By examining the response of a woman who had lost the normal sense of touch, scientists were recently able to look at her responses to the C-tactile system. MRI scans of her brain revealed that brushing strokes activated insular region of the cerebral cortex associated with emotional response. The researchers concluded that the CT system may be important for emotional, hormonal and behavioral responses to tactile stimulation.
As sensory images, understanding anatomy via names and insertions is only one path, and perhaps not the optimal one. Olsen and McHose8 take the experiential path to learning about anatomy via touch and position, literally making use of sensory input rather than rote memorization. In her book, The Anatomy of Movement, Blandine Calais-Germain provides a dancer's dynamic view toward understanding muscles.2
The focus throughout the book is on anatomy not for its own sake as items to be memorized and recited, but in its functional relationship to the actual movements of the body in dance, exercise and other physical disciplines. I delight in teaching that a muscle, ever so gently activated against a resistance, suddenly takes on sharp form to our touch. The activated muscle, whether subscapularis or psoas, suddenly becomes "visible" to our searching fingers.
As sensory beings, we learn to understand the body by palpation - the soft touch of awareness and wonder.3 Our fingers and hands, via practice, learn to seek and find asymmetries and differences in range of motion and tissue texture.4 The benefits of practice don't come from mechanical practice of technique, but from performance with awareness of both the effort and of the actual results. The adjustment comes in first doing and then making a correction to our inner picture or body-sense and running through the process again. Practice should be done enough to solidify it yet stop before physical and mental fatigue undermines the efforts by decreasing attention, increasing response times, and recruiting less optimum patterns of muscle activation.
Ultimately, practice with attention takes one from inability, to perform a pattern of skilled actions, to slow conscious control of performance, to mixed conscious control of learning with use of already learned patterns, to unconscious performance in response to environmental stimuli and conscious wish. Learning of new movement and body usage patterns can temporarily disrupt similar existing patterns. It's as if the body experiences a short-term period of confusion about which pattern to use in a given situation. Teaching sports or deep tissue massage to existing practitioners of Swedish massage, for example, can result in feeling that well-known patterns feel a new uncertainness. The situation sorts itself out, resulting in both patterns being available for use. Research indicates that consolidation and integration of practice continues hours later during sleep.1
The greatest determinants of good work that I have seen are an attitude of humility, respect for the client to react individualistically rather than as the textbook predicted, and cumulative attention to sensory input and client responses. An initial sensory feeling of "groping in the dark" rather rapidly becomes knowledgeable palpation as we observe sensation, client response, and effects. Those who have learned from their clients and can organize what they have learned, have the potential to become teachers who can shorten the path for the attentive student.
Often the greatest learning comes not from what is written or recorded, but simply from watching a master worker move and interact with a client. Hours and facts memorized out of their context of use are the poorest training outcomes I've yet to find for the process of teaching others. That's something to sleep on, the approach with a soft touch.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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