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How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
June, 2006, Vol. 06, Issue 06
The Phrenic Circuit
By Dale G. Alexander, LMT, MA, PhD
Let's return to some basics in anatomy and physiology that support the notion that placing your awareness and working from the "inside-out" facilitates the healing process for our clients.Appreciating the influence of the phrenic nerves has assisted me to serve my clients with chronic problems. The very nature of chronic illness and pain requires that the body somehow distribute both the internal physiological pressures within it and the external musculoskeletal strain placed upon it.
My clinical experience has consistently demonstrated that the diaphragm muscle and its phrenic nerves together are one of the body's primary circuits for distributing strain. The phrenic nerves are the sole motor nerves of the diaphragm muscle; a direct efferent supply from the neck to the diaphragm. Its afferent system however is extensive as it receives sensory supply from all of the following sources; the peritoneal sac, the gall bladder, the capsule of the liver, the pancreas, the pericardial sac of the heart, the pleurae of the lungs and from the subclavius muscles1. Wow! That's a lot of current to handle.
Distribution of strain and allocation of resources are crucial components of physical healing. The notion of compensation within the musculoskeletal system when one has experienced an injury is a simple way to conceive of what is meant by distribution of strain. But it's only the tip of the iceberg. Allocation of resources refers to the body's remarkable genius to commandeer energetic and nutritional sources to support general physiology during times of increased demand. The body does all of this and more but, often at a price which lowers the quality of our lives.
What few have made sense of is that the pain in your client's neck actually might be emanating from their gut tube, heart or lungs, and might even be a major contributing source of their pain or the numbness in their shoulder, arms, elbow, wrist or fingers that just won't go away. How does that happen, you might ask? The phrenic nerves exit the spinal cord from C3, C4 and C5. This overlaps and shares the circuitry within the spinal cord of the brachial plexus C4 - T2, the origin of the neurocirculatory supply to the upper extremities.
Imagine water filling up within a sink, which, if not diverted back into the drain pipe, overflows the container. Thus, tensions within the organs of the "phrenic circuit" build to a tipping point and spill over into the relationships of the brachial plexus and are expressed as symptoms in the neck, upper back, and/or upper extremities. How many times have you used, or heard the phrase, "I've had it up to here" as an expression of feeling stressed, exasperated or overwhelmed? Often, people actually raise their hand to the level of their chin, which interestingly is approximately the level of the 4th cervical vertebra.
Let's remember, I previously have described the stereotypical effects of stress as the "cringing of the body's sacs and a shortening and narrowing of its tubes."2 Three of the four major sacs within the body feed direct sensory supply into this phrenic circuit.
Imagine what happens to body posture when the large sac within your abdomen cringes. Feel it within your own body. Next, add the cringing of the sacs of the heart and lungs, a shortening of the esophagus (the major tube between the head and the abdomen), and now, add the tightening of the diaphragm and a shortening of one or both of the iliopsoas muscles. Where do you feel the strain? Obviously, in the back and/or the neck. The head and neck literally are being pulled forward and down. The entire extensor reflex system is activated from the occiput to the sacrum. Little wonder our clients present so often with neck and upper, middle or lower back pain.
Make the connection within your own body. Tensions from within are distributed, expressed, and discharged into the musculoskeletal system from the "inside out." More specifically, these tensions are shared across as broad an area as possible for as long as possible until the pressure builds to where this distribution of strain affects the allocation of resources to the point that physical, energetic or psychological symptoms emerge and become chronic.
Psychologically, the physical symptoms you can now relate to the phrenic circuit are strongly correlated with anxiety and depression. The "mind" generates predictions which stimulate our emotions, which leads to the cringing of the sacs and the shortening of our tubes. Sadly, the mind is organized to predict negative outcomes under the guise of protecting us.3
Over time, we become tied up into knots, anxious about what might happen, then becoming depressed that we can't make any significant changes for ourselves. The cycle repeats itself over and over in so many of our clients' lives.
It is my consistent clinical experience that phrenic relationships are associated in most upper extremity dysfunction and pain syndromes. It's only a matter of degree. This includes cervical dysfunction and pain, frozen shoulder, encapsulitis, chronic rotator cuff problems and radicular symptoms (pain and numbness) into the arm, elbow, wrist, hand and fingers. These reflect the build-up of the tensions within the phrenic circuit and the body's attempt to distribute the strain.
What is the source of our stress?
Please refer to the articles co-authored with Lansing Gresham, "Move Your Mind and Engage Your Brain" (see the February 2006 issue of Massage Today, www.massagetoday.com/archives/2006/02/01.html) and "Your Mind Is the Source of Your Stress" (see the April 2006 issue of Massage Today, www.massagetoday.com/archives/2006/04/02.html). In this article, I have endeavored to introduce the anatomical relationships that consistently have assisted me to serve my clients. More in-depth anatomical descriptions of the relationships of the phrenic circuit will follow.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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