resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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!
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."
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 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.
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.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
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.
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.
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.
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.
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."
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.
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.
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.
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.
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...
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.
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.
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.
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.
March, 2006, Vol. 06, Issue 03
Spondylolisthesis: An Elusive Cause of Low Back Pain
By Whitney Lowe, LMTLow back pain (LBP) is one of the most prevalent orthopedic problems in the world. Yet, the cause of much LBP is poorly understood, which sometimes leads to improper treatment. Many times LBP is caused by muscular tightness or myofascial trigger point activity, and is effectively treated with massage. However, serious structural problems can exist in the spine. These conditions need to be referred to a physician for proper evaluation. Spondylolisthesis is just such a problem.
The term spondylolisthesis is derived from the Greek spondylo, meaning "spine," and listhesis, "to slide down an incline." Spondylolisthesis results from a stress fracture in a region of the vertebra called the pars interarticularis (Figure 1). Left untreated, the stress fracture might fully separate, causing one vertebra to slip forward in relation to another (Figure 2). The slippage is most common at the articulation between L5 and S1 junction due to the downward pull of gravity and the anterior and inferior sloping of the L5-S1 junction. If only a stress fracture exists without the vertebral sliding, the condition is called spondylolysis. Because the stress fracture occurs before the forward slippage of the vertebral body, spondylolysis generally is a precursor to spondylolisthesis.
The compressive forces that aggravate the condition are magnified if the individual has an exaggerated lumbar lordosis. When the lumbar lordosis is increased, the posterior vertebral arch bears a greater percentage of the upper body weight.
In addition, the exaggerated lordosis tilts the lower lumbar vertebrae even farther in an anterior and inferior direction, making forward slippage more likely.
Individuals engaged in certain sports or occupations are particularly susceptible to spondylolisthesis, especially if it involves repetitive flexion and extension of the spine. It is common in gymnastics, rowing, diving, swimming (especially the butterfly), tennis, wrestling, weightlifting and football. An increased incidence also has been identified in loggers and soldiers carrying heavy backpacks.1, 2 The condition is prevalent in adolescents due to the extremes of physical exertion in athletics and bones that are not fully formed.3 Females are affected more often than males, possibly due to strength differences in bone structure.
Hamstring tightness is evident in many individuals with spondylolisthesis. The hamstrings tighten in an effort to posteriorly rotate the pelvis. The posterior pelvic rotation decreases the potential for forward slippage of the lower lumbar vertebra and helps stabilize the lumbar region.1
The most common symptom in spondylolisthesis is dull, aching pain in the lower lumbar or upper sacral region. Pain also extends into the buttocks or posterior thigh in some cases. The client generally reports some repetitive flexion or extension activity prior to the onset of symptoms. Consider the client's report of recent activities that might produce aggravating stress on the posterior vertebral arch, especially if there is a corresponding exaggerated lumbar lordosis.
There usually is tenderness in the soft tissues in the lower lumbar and upper sacral region. However, the tenderness usually is not the primary pain-producing sensation of the stress fracture or vertebral slippage. Attempting to palpate tissues in this region also can produce pain because there is anterior pressure being applied to the vertebral structures. The anterior pressure might push the vertebra further into the position of slippage and aggravate the pain. In addition to tenderness, hypertonicity in the lumbar erector spinae, quadratus, lumborum, gluteals and hamstring muscles is likely.
In spondylolisthesis, pain increases with lumbar extension. Flexion decreases the pain, as this motion pushes the vertebra back toward the normal position. Pain might be aggravated during either lateral flexion or rotation, although there is not a clearly established pattern of this pain. Hip flexion with the knee in extension generally is limited due to hamstring tightness.
A special test called the one-leg lumbar extension test might help isolate spondylolysis or spondylolisthesis. To perform this test, the client is standing on one leg and balancing. While in this position, the client attempts to bend backward, thus extending the spine (Figure 3). The test is repeated on the opposite side. If back pain is felt during the spinal extension, there is a strong likelihood of a stress fracture in the pars interarticularis. If the stress fracture is only on one side, standing on the ipsilateral leg produces more pain.
If spondylolisthesis is suspected, the client should be referred to a physician for appropriate evaluation. Forward slippage of the vertebra has to be confirmed by X-ray and is not testable with physical examination alone. Soft-tissue therapies like massage can be helpful in reducing overall muscular hypertonicity associated with spondylolisthesis, but it's important to consult with the client's physician about appropriate treatment goals. For example, working on the hamstrings to relax their hypertonicity actually could be detrimental to the condition because the hamstring tightness is helping reduce forward vertebral slippage. Awareness of conditions such as spondylolisthesis highlights the importance of proper assessment so an appropriate referral and/or treatment approach can be developed.
Click here for more information about Whitney Lowe, LMT.
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