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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
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.
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.
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
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.
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."
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
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.
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.
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.
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.
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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