resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
May, 2006, Vol. 06, Issue 05
A Reflexogenic Relationship: The Muscle/Joint Battle, Part 2
By Erik Dalton, PhD
Editor's Note: Part 1 of "A Reflexogenic Relationship: The Muscle/Joint Battle" appeared in the April 2006 issue of Massage Today. To access the online version, visit www.massagetoday.com/archives/2006/04/07.html.
Myoskeletal Muscle Manipulation Through Joint Mobilization
A confounding situation arises as the therapist's fingers attempt to pry between joint surfaces to contact the short rotators, intertransversarii, and intertransverse muscles.Although these tiny, one-joint rotators/side-benders typically are the tightest in the presence of joint dysfunction, application of direct localized pressure sometimes is impossible, given the limited space between articular surfaces. Here's when the myoskeletal technique comes in handy. The therapist utilizes sustained manual pressure on the superior fixated vertebra as the joint is taken through a specific range of motion. Basically, bones are used as levers to create a Golgi tendon organ (GTO) release in all fourth-layer muscles, causing the joint blockage. The question then arises as to the nature of the fixated joint: Is it locked, open or closed? And which side of the spine is stuck?
Using the myoskeletal approach, the therapist's fingers and thumbs wade through the paraspinal laminar groove tissues, scanning for lumpy, wiry and knotty transversospinalis muscles. Once the hypertonic little muscles are found, what information is revealed about the nature of the dysfunctional joint? Not much! By Greenman's definition, it's obvious that joint dysfunction exists, but what type? Is one side of the joint jammed closed and unable to open during forward bending, or is a superior facet not closing on the vertebra below during backward bending?
In Figure 5, the therapist's thumbs apply sustained pressure to the bony knot where the fibrosis was found, as the side-lying client flexes and extends the spine through the affected area using a chin-tucking enhancer. If the bony knot pushes back into the thumbs as flexion is introduced, the joint on the ipsilateral side is not opening. The joint's axis of rotation is forced to revolve around the fixated facets, causing the superior transverse process to push back against the therapist's thumbs. The thumbs hold a gentle, sustained headward pressure on the superior transverse process as the client flexes the chin toward his chest. This produces a GTO release in the deep groove muscles and stretches the fibrosed spinal ligaments and joint capsule, allowing the fixated facets to open. In the myoskeletal method, bones are only applied as levers to release adhesive spinal soft tissues that cannot be liberated directly with traditional deep-tissue techniques.
During the fourth-layer assessment, if the bony knot does not push back into the palpating thumbs or fingers as the client flexes through the area, the joint is not closing on the contralateral side. To free the hypertonic tissues preventing closure of the superior facets on their inferior neighbor, the client assumes a prone position. The therapist's fingers, thumbs or elbow slowly glide down each side of the lamina groove as the client rhythmically raises and lowers his head. In Figure 6, the therapist uses the elbow to traverse down the groove while the client extends and lowers his neck and upper thoracic spine. If a bony knot is palpated, the joint is not closing on the contralateral side. Gentle, sustained pressure (with client-enhancing movement) releases fibrotic groove muscles, joint capsules, and spinal ligaments, allowing the superior facets joints to glide inferiorly and close on the vertebra below.
Scope of Practice
As with all treatment protocols, exceptions occur that can render the myoskeletal method ineffective. Damaged joints often create stubborn fixations that cannot be released by working muscles alone. Vertebrae that have undergone adherent cartilage degradation, apophyseal joint swelling and facet "nipping" due to prolonged microtrauma, typically will not regain lost motion simply by releasing the fibrotic muscles, joint capsules and spinal ligaments. True adhesive joint-fixation problems point to a more serious condition. However, massage therapists who regularly work in conjunction with chiropractors and manipulative osteopaths can enhance therapeutic outcomes by "prepping" the affected area, so that high-velocity thrusting maneuvers are more effective. Manual therapists must develop a good complementary health care referral base so prompt referrals can occur if soft-tissue approaches do not alleviate all the client's pain and/or posture problems.
Combining muscle and joint modalities increases therapeutic efficiency and encourages referrals as therapists resolve stubborn, long-standing pain/spasm/pain cycles. By incorporating holistic-minded reflexogenic routines, today's touch therapist can help solve America's epidemic musculoskeletal pain crisis. Therapeutic outcomes are enhanced as assessment and treatment routines are expanded to include all soft tissues forming from the mesoderm, including muscles, fascia, joint capsules, spinal ligaments, nerve dura, and intervertebral discs.
Although myoskeletal therapy delves deep into body structures, the intent is still slow and sustained soft-tissue work combined with specific client-initiated enhancers, such as chin-tucking, eye movements, deep breathing, pelvic tilting, etc. The client's experience following a myoskeletal session should be one of invigoration, pain relief, increased range of motion and postural improvement. Bones are assessed and treated as soft tissues in the myoskeletal system, with pressure often applied directly to myofascia overlying transverse processes. It's of the utmost importance to stress that bones only are used as levers to release hard-to-access, fourth-layer muscles, ligaments and fibrotic joint capsules (much like frozen shoulder work). Therapists always must remember that joints should never be taken into a nonphysiologic range of motion, which remains outside the scope of practice for most massage and bodywork practitioners.
Click here for previous articles by Erik Dalton, PhD.
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