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News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
April, 2006, Vol. 06, Issue 04
A Reflexogenic Relationship: The Muscle/Joint Battle, Part 1
By Erik Dalton, PhD
Reflexogenic - Producing or increasing reflex actions between muscles and joints.
Myoskeletal - All soft tissues forming from the mesoderm including muscles, ligaments, joint capsules, discs, fascia and bones.
Surprisingly, the "key" that unlocked the door to this muscle/joint mystery initially was revealed in a presentation to the American Back Association by the legendary osteopath Dr. Philip Greenman when he stated, "In the presence of vertebral dysfunction, palpable fourth-layer muscle hypertonicity will always be found." The fourth-layer transversospinalis muscles include the rotatores, multifidus, levator costalis and intertransversarii (Fig. 1). These phylogenetically old laminar-groove muscles are the first structures neurologically stressed by joint blockage, and often are the very same tissues that prolong the dysfunction.
Working with the understanding contained in Greenman's statement, the massage therapist can maximize therapeutic outcomes by:
Under normal conditions, the superior vertebra of each joint smoothly flexes, extends, sidebends and rotates on its inferior neighbor. Too often, however, hypertonically short spinal muscles bind one side of a joint altering its axis of rotation and center of gravity (Fig. 2). When therapists continually palpate lumpy, stringy or wiry fourth-layer intrinsic muscles session after session, underlying joint dysfunction is present and must be addressed.
According to John Mennell, MD, all of the body's synovial joints must have at least 1/8 inch of movement not controlled by voluntary muscle contraction. The term "joint play" was coined to describe this essential principle of normal, pain-free, non-restricted vertebral movement. Deep-tissue myoskeletal techniques focus on restoring joint play and stopping the reflexogenic battle between muscles and joints.
This article offers an overview of current theories and myoskeletal strategies for preventing and correcting "catch 22" pain/spasm/pain cycles perpetuated by abnormal muscle/joint reflex actions.
Fourth-Layer Spinal Muscles
Working through the bulky paravertebral muscles and fascia, bodyworkers' sensitive fingers frequently encounter small, hard and sometimes tender knots in the deep transversospinalis muscles of the erector spinae group. These highly innervated tissues located in the medial groove adjacent to the spinous processes contribute to rotation, sidebending and extension in each spinal segment. According to Greenman, "Fourth-layer muscles are dense in spindles and function more as proprioceptors than prime movers. When dysfunctional, they alter joint mechanics locally and alter the behavior of the larger muscles of the erector spinae group." Therefore, muscles such as the multifidus and rotatores (and suboccipitals) are perceived as dynamic ligaments designed to stabilize the spine. Acting as supporting, information-gathering ligaments, they allow the brain to coordinate more gross movements of the vertebral column via longer-lever muscles that have greater leverage and mechanical advantage.
The power generated by short fourth-layer spinal muscles is easily underestimated. These highly innervated little critters readily pack enough punch to lock spinal joints open or closed with their strong torsional forces (Fig. 3). Holding a telephone with the shoulder to one ear is a perfect example in which prolonged cervicothoracic sidebending unilaterally compresses joint surfaces, creating reflex transversospinalis and erector spinae spasm. This predictable neurological firing pattern represents the beginning of many functional scoliotic cases seen in the clinic. However, specially designed deep-tissue massage techniques can be very effective in releasing hypertonic myofascia and recovering joint play to fixated facets. Regrettably, some of the tightest transversospinalis muscles are buried deep to more superficial groove muscles such as the multifidus and spinalis, making it difficult and sometimes impossible to mobilize them with fingers and thumbs (Fig. 4). So, how can massage therapists access and release short, concealed spinal muscles that bind joints and perpetuate aberrant pain and posture problems? In part two of the "Reflexogenic Relationship" series, I will demonstrate innovative soft tissue techniques for creating joint-play in fixated facets.
Editor's Note: Part two of Erik Dalton's article, along with a complete list of references, will appear in the May 2006 issue of Massage Today.
Click here for previous articles by Erik Dalton, PhD.
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