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Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
November, 2005, Vol. 05, Issue 11
By Erik Dalton, PhD
Most of the human race suffers some form of neck and back pain during their lifetime just as common as a headache, stomach ache or knee pain. "Until it was turned into a medical condition in the early 20th century, back pain was considered an inevitable human experience," said Canadian surgeon Hamilton Hall, MD."There is no simple cure because there is usually not a clear-cut precipitating trigger associated with many forms of musculoskeletal pain," notes Hall.
Despite the liberal use of the words "back injury" across modern societies, most episodes of back pain do not have an obvious cause. "Research indicates that approximately two of every three people who experience pain in the spine are unable to identify any specific event that may have caused their problems," states Hall. Back pain simply happens!
The modern perspective that neck and back pain is a variable, intermittent illness rather than a one-time condition should not be considered a threatening event for our clients. In the vast majority of cases, recurrences of these painful conditions are not signs of advancing disease, an omen of chronic disability or even a cause for significant worry.
Some researchers draw an analogy between back pain and upper respiratory infections. Many individuals get colds or respiratory infections several times each year, yet are typically not viewed as a significant threat to their health. Colds don't require high-tech diagnostic testing, heroic treatment interventions or significant absence from work. These conditions, like most cases of neck/back pain, simply are bumps in the road.
However, some have begun to question the possibility of previously unrecognized neurobiological processes that might unravel the question: Why are some people more susceptible to pain than others? One interesting new area of pain management research that is gaining a great deal of attention proposes alternative ways that nerve impulses are transmitted and learned by the central nervous system.
For decades, it was thought that spinal cord, brain and peripheral pain transmission pathways were hardwired circuits whose job was simply to communicate pain signals from injured or diseased parts of the body to specific message centers in the brain. But based on recent scientific research, new ideas are emerging on how pain transmission actually works and how the brain has the ability to create the conscious experience of pain.
A process called sensitization has become a topic of great interest to neuroscientists studying transmission mechanisms of painful stimuli. The puzzling question is: How are pain messages actually delivered? A discussion of sensitization might help somatic practitioners better understand why a client's chronic pain can be so severe, but in some cases, seem out of proportion to the degree of injury or disease in the affected body tissues. This understanding also might help explain why specific treatments directed at pain relief often provide'only limited benefit.
The neurobiology of sensitization is extremely complex, but the basic idea behind it is fairly straightforward. When pain signals are transmitted from injured or diseased tissues, these signals can then activate (sensitize) pain circuits in the peripheral nervous system, spinal cord and brain by burning a memory pathway (See Figure).
The process of sensitization can be compared to overly adjusting the volume control on a stereo system, thereby amplifying and sometimes distorting the pain message. This results in a painful condition that is severe and out of proportion to the actual dysfunction or original injury. Sensitization has the innate ability to alter all regions of the central nervous system that process pain messages. This includes the sensing, feeling and thinking centers of the brain. Here lies one explanation why chronic pain often is associated with, not only physical disorders, but also emotional and psychological suffering as well.
Phantom Limb Pain
A perfect example of the workings of sensitization can be found in the sometimes mysterious condition called phantom limb pain. In the presence of phantom limb pain, the client might feel intense pain in an area where the body part is missing. Common examples are seen in amputated arms and legs, as well as in women experiencing abdominal pain years after undergoing a hysterectomy. The difficult-to-treat problem of phantom limb pain is consciously actualized by persistent activation (sensitization) of the pain transmission pathways from the site of amputation up to the brain.
But what about the presence of sensitization in various pain conditions where amputation or surgeries to remove diseased organs don't exist? Too often, manual therapy treatments in such cases are directed to body areas that were once actual pain-generators, (i.e., where the injured or diseased tissues once existed). Regrettably, "chasing the pain" by directing therapy to where the client currently is hurting will have little effect on the sensitized pain pathways in the spinal cord and brain. As a result, little benefit is experienced.
Having said that, the author has found that application of specific deep tissue and assisted stretching techniques to torsioned and compressed joint-related soft tissues co-activates and desensitizes noxious mechanoreceptive activity leading to a reduction in pain. Successful outcomes require the therapist concentrate treatment to areas proximal to the previously injured or amputated tissues (usually beginning in the lamina groove). Proper treatment to deep intrinsic muscles, spinal ligaments, joint capsules, and visceral structures co-activates a wider range of neuro-receptors, which enhances the desensitization process.
Click here for previous articles by Erik Dalton, PhD.
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