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Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
July, 2006, Vol. 06, Issue 07
Pain Under the Medial Arch of the Foot
By Ben Benjamin, PhD
Question: If a person experiences pain under the medial arch of the foot while walking or while rising onto the balls of the feet to reach for something, which structure is likely to be injured?
Answer: The flexor hallucis.The flexor hallucis is a very strong muscle-tendon unit that takes the lion's share of our weight while we walk, stand and rise onto the balls of our feet. The muscle is located in the calf, and its tendon begins just medial to the Achilles' tendon. The tendon passes under the medial heel and travels along the medial arch of the foot to attach distally at the great toe.
Poor alignment makes the flexor hallucis tendon more susceptible to injury. In a normally aligned foot, roughly one-third of the body's weight falls onto the great toe, with one-sixth falling onto each of the other toes. If the feet are turned out while standing and walking, even more weight falls onto the great toe - and therefore onto its flexor tendon. In such cases, strain or tendinitis of the flexor hallucis tendon is fairly common. In cases where poor alignment is placing pressure on the medial arch, there often is a callus at the medial edge of the great toe and/or the medial aspect of great toe joint.
Flexor hallucis injuries occur most commonly in the medial arch of the foot. Injuries to the flexor hallucis tendon at the back of the ankle, where the tendon is running parallel to the Achilles', are sometimes mistaken for Achilles' tendinitis. Injuries to this tendon near the anterior portion of the heel often are mistaken for plantar fasciitis. If a person feels pain not just at the medial arch, but in a wider area under the arch of the foot, this might indicate that the flexor tendons of several other toes also are strained or that a plantar fasciitis is present.
Question: What assessment test would you perform to verify this injury?
Answer: Resisted plantar flexion of the great toe.
First, hold the great toe in slight dorsiflexion (Figure 1) with your thumb and ask the person to push the toe down against you (into plantar flexion). If the injury is relatively severe, this test will be positive (causing a little pain). If the tendon is only mildly strained, you'll need to perform one or two additional tests to place more stress on the tendon.
The second test is performed in a standing position. While holding the client's hands for balance, ask the person to rise onto the balls of the feet (Figure 2). If this reproduces the person's pain, and the pain is in the medial arch, you have confirmed the presence of flexor hallucis tendon strain. If the reproduced pain is in the Achilles' area, you'll need to do further testing to determine whether it's coming from the Achilles' or the flexor hallucis. If this second test does not cause discomfort, move on to the third test.
For this final test, have the client face a wall and lean against it at approximately a 35-degree angle, while rising up onto the balls of the feet (Figure 3). If this causes no pain or discomfort in the offending area, ask the person to transfer most of his or her weight onto the big toes. This places maximum stress on the flexor hallucis tendon.
Click here for more information about Ben Benjamin, PhD.
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