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A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
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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