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Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
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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