resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
January, 2006, Vol. 06, Issue 01
The Potential Impact of Orthodontia on Whole-Body Health
By John Upledger, DO, OMM
While the craniosacral system is comprised of the membranes and fluid that surround the brain and spinal cord, its numerous osseous relations can impact the body in far-reaching ways. For instance, I was a professor of biomechanics at Michigan State University in 1976, when I first witnessed the effects of orthodontia on the spinal alignment of the vertebral bones.
The patient was a 16-year-old girl who had begun to develop scoliosis about two years earlier.Her father, an English professor at the university, told me her orthopedic surgeon wanted to implant corrective rods for the scoliosis, which had been measured at 38 degrees in the thoracic curve. At his request, I began to see his daughter weekly.
Over a period of six weeks, we were able to reduce the curve to 18 degrees using a combination of CranioSacral Therapy, Myofascial Release, osteopathic spinal manipulation and Therapeutic Imagery. At that point, I continued to try to help improve her condition. After four or five unsuccessful attempts, however, I realized that each time I balanced her occipital bone it was off balance the following week.
Clearly, I had not located the underlying cause of the occipital bone problem. The occipital bone had to be relieved of its abnormal transverse tilt and its restriction to motion, which were both compromising craniosacral system function. The sphenoid bone remained transversely tilted in the opposite direction from the occiput.
Ultimately, I discovered the hard palate was preventing the sphenoid bone from maintaining the corrections. Could it be that the orthodontic braces the patient had been wearing for about three years were contributing to her scoliosis? The answer proved to be "yes." At my request, the orthodontist removed the braces from the patient's mouth. Subsequently, her scoliotic curve was able to correct to less than five degrees and there was no recurrence of scoliosis over the next five years. I continued to see her every six months or so until she married and left home.
Please allow me to explain the biomechanics of how such an event could occur in a 16-year-old girl. The paired maxillary bones are influenced via the pterygoid wings of the sphenoid bone with which they articulate bilaterally. The maxillary bones move in concert with the sphenoid bone via these articulations. Actually, the distance between the second upper molars on each side fluctuates about two millimeters at a rate of 8-12 cycles per minute in accordance with the craniosacral rhythm. The sphenoid bone is one of the prime movers of the craniosacral system. When the bone's mobility is restricted, the craniosacral system tries very hard to compensate for the dysfunction, but it's seldom fully successful.
When an orthodontic appliance is put on the upper teeth and it crosses the midline between the two anteromedially located incisors, the motion of the maxillary bones induced by the sphenoid bone is inhibited and sometimes totally restricted. When they are first applied, the braces also might entrap one of the maxilla in an external position and the other in an internal position. In CranioSacral Therapy, the motions of the maxillae in response to the sphenoid bone are called internal and external rotations, because the maxillae appear to rotate about individual axes generally directed in anterior-posterior directions.
The distance across the hard palate is measured using the biting surfaces of the second molars as reference points. The usual mean distance variation between these teeth in response to internal and external rotations of the maxillae is two millimeters. In the case of my scoliosis patient, the braces locked the left maxilla in external rotation while locking the right maxilla in internal rotation. The abnormal positional locking of the maxillae caused the sphenoid bone to eventually yield to these abnormal forces after attempting to correct the problem and then adapt to it. Having ultimately failed in these attempts, the sphenoid was forced into a transversely oriented tilt, with its left side tilted in a superior direction and its right side in an inferior direction.
Next, the occiput had to compensate for the sphenoid tilt. In order to do this, the occiput had to tilt in the opposite direction, right side superior and left side inferior. This occipital tilt placed an increased traction on the right side of the dural tube as it ran through the sinal/vertebral canal. It also allowed less tension or increased slack on the left side of the dural tube.
We have found over and over again that the sacrum mimics the occiput unless there is a significant restriction of the dural tube somewhere between the occiput and the sacrum. In the case of our patient, the sacrum was mimicking the occiput. The right upper pole of the sacrum was higher; the left was abnormally lower. Hence, the sacral base, which is the upper transverse boundary of the sacrum, presented a tilted foundation for the spinal column to rest upon. Because of this un-level sacral base with the right side high and the left side low, the 5th lumbar vertebra had to angle off to the left, creating a "leaning-tower" dynamic. In order to correct this, the remaining lumbar vertebrae formed a scoliotic curve so the thoracolumbar junction crossed the midline center of gravity.
Now we had the upper lumbar coming diagonally across the midline center of gravity from the left, thus sending the lower thoracic vertebra off diagonally to the right. This curve needed to come back to the midline center of gravity at about the cervico-thoracic juncture in order to maintain body balance. The compensatory lumbar and thoracic spinal curves form the classic "S" curve of scoliosis. In the neck, we also might have a compensatory curve that involves most of the cervical spinal vertebrae. Clearly, the balance for the neck is skewed as the upper thoracic vertebral column comes to the midline center of gravity.
Sometimes this whole compensation in the neck occurs from a sharp displacement of the two lower cervical vertebrae atop the 1st thoracic vertebrae. This acute compensation at the lower cervical vertebrae often is painful and frequently results in brachialgia or dysfunction of the arms and hands, all due to nerve-root compression. It seems reasonable to me that the powerful nerve reflexes that strive to keep the eyes horizontal with the horizon might require this compensation at the cervicothoracic junction.
This is but one example of how orthodontia can affect the craniosacral-neuromusculoskeletal relationship to impact the whole body. To learn more, read "Surviving Orthodontics: A Bodyworker's Exploration into Orthodontics and CranioSacral Therapy," by Nancy Burke, CMT, CST. You can find it at www.upledger.com/news/9803.htm.
Click here for previous articles by John Upledger, DO, OMM.
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