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Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
April, 2006, Vol. 06, Issue 04
By Whitney Lowe, LMT
The glenohumeral joint is a highly complex articulation. It has the greatest range of motion of any joint in the body. However, its increased motion occurs at the expense of stability, requiring the soft tissues to play a more critical role in maintaining joint integrity.As a result of increased mechanical demands, numerous soft-tissue injuries occur in the shoulder. In fact, shoulder pain is the third most common musculoskeletal disorder, following low back and cervical pain.1
Chronic injuries are common in the shoulder, and develop from the movement requirements in repetitive upper-extremity activities such as sports (e.g., tennis, swimming) and assorted occupations. Also problematic are activities requiring that the shoulder be held in an elevated position for prolonged periods. One of the adverse effects of repetitive motion or holding the shoulder in a static position for long periods is shoulder impingement. Shoulder impingement involves compression of soft tissues between the head of the humerus and the underside of the acromion process or coracoacromial ligament. Impingement might lead to tendinosis, rotator cuff tears, calcific tendinitis, bone spurs or subacromial bursitis.
There is a region in the shoulder composed of the acromion process, coracoacromial ligament, and coracoid process known as the coracoacromial arch (Figure 1). Several tissues are susceptible to compression under the arch: the upper margin of the glenohumeral joint capsule, coracohumeral ligament, supraspinatus muscle-tendon unit, tendon from the long head of the biceps brachii, and the subacromial bursa. Any of these tissues might be compressed against the acromion process or coracoacromial ligament.
Impingement might result purely from the structure of the coracoacromial arch, but commonly results from a combination of architecture and repetitive motions, especially those involving flexion and internal rotation of the humerus. In some cases, bone spurs or osteophytes develop on the underside of the acromion process and serve to further decrease the subacromial space and impinge tissues.
There are three progressive stages of impingement syndrome.2 Stage 1 is more common in patients 25 years old or younger. It is characterized by acute inflammation, edema and hemorrhage in the affected tissues. Repeated overhead use of the upper extremity usually is involved. Stage 2 occurs more often in patients between the ages of 25 and 40. There is a progressive degeneration in the rotator cuff structures that involves fibrosis and tendinitis. Stage 3 usually affects patients older than age 40. Tears of the supraspinatus and long head of the biceps tendon might occur. In addition, bone spurs and osteophytes might develop along the underside of the acromion and further contribute to subacromial impingement.
A further classification of impingement pathologies divides them into primary or secondary. Primary impingement is predominantly caused by the architecture of the subacromial region.3 Primary impingement is directly related to the variations in shape of the acromion process. There are three variations in the shape of the acromion process (Figure 2),4 which are described as Types 1, 2, and 3. A Type 1 acromion has a flat undersurface; Type 2 has a curved undersurface; and Type 3 is referred to as a hooked acromion. The hooked acromion is associated with a greater incidence of impingement syndrome.5
It is mostly a result of dysfunctional shoulder biomechanics, and is exacerbated by excessive motion or long periods of compression. Several biomechanical factors can contribute to secondary impingement, including rotator cuff muscle weakness, joint capsule restrictions and dysfunctional coordination of scapulothoracic muscles.6
Shoulder impingement is a challenging problem to treat because many of the affected tissues lie underneath the acromion process. However, in many cases, such as secondary impingement problems, repetitive motion and altered shoulder biomechanics aggravate the condition. In these cases, massage is a highly effective treatment to address the muscular dysfunction that leads to the biomechanical stress. Identifying which tissues underneath the acromion are affected is essential for constructing an effective treatment plan. A future installment of this column will investigate how to determine which of the different tissues are affected.
Click here for more information about Whitney Lowe, LMT.
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