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The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
August, 2006, Vol. 06, Issue 08
Types of Tendon Injury
By Whitney Lowe, LMT
The primary function of a tendon is to transmit the contraction force of its associated muscle to the bone. Consequently, the tendon needs to have sufficient tensile strength. Tendons have various shapes, such as the sheet-like aponeurosis of the latissimus dorsi or the long, pencil-like structure of the biceps brachii.They are constructed with parallel collagen fibers running the length of the tendon. The longitudinal arrangement of the collagen fibers gives the tendon its tensile strength.
Tendons are a fundamental part of the contractile unit. The tensile strength in a tendon can be more than twice that of its associated muscle.1 As a result, they are rarely torn. Even in muscles where complete ruptures occur, such as the biceps brachii or triceps surae group, the rupture usually is at the musculotendinous junction or in the muscle fibers. The musculotendinous junction is the weak point in the entire contractile unit because it's where the two different tissue types (muscle and tendon) meet.
In some cases, the muscle fibers remain intact and the tendon tears or pulls away from its attachment site on the bone (another instance where different tissue types meet). This is known as an avulsion. More often, tendons are damaged with internal structural pathologies such as tendinosis and tenosynovitis. These conditions generally result from repetitive overuse as opposed to an acute injury.
The most common pathological problem involving tendons used to be referred to as tendinitis but is now more correctly known as tendinosis, which means abnormal condition of the tendon. Tendinitis implies an inflammatory condition and it previously was believed that chronic overuse lead to tendon fiber tearing and inflammation. We now know this does not occur in most overuse tendon pathologies. True tendinitis, or tendon fiber tearing with inflammation, occurs but it's a rare condition.2
Recent investigation of tendon overuse dysfunction shows most overuse tendon pathologies are devoid of inflammatory cells and instead involve a breakdown in the collagen matrix.3,4 Because of the lack of inflammatory activity in these conditions, the term tendinosis is encouraged. The term tendinosis does not specify the pathological process, only that the tendon is dysfunctional. High levels or prolonged periods of tensile stress on the tendon can lead to collagen breakdown. While any tendon can develop tendinosis, tendons in the extremities are more susceptible. Another result of chronic load on the tendon is alteration in the tendon's vascularity (blood flow). An increase in vascularity is indicated in some studies, while other research shows decreased vascularity. Either problem contributes to chronic tendon pathology.
Even though there is significant research and evidence showing it's the pathology of tendinosis occurring, physician diagnosis and rehabilitation practitioners often call this injury tendinitis. Rehabilitation, in many cases, continues to focus on anti-inflammatory treatment strategies, rather than collagen rebuilding. In some cases, the use of anti-inflammatory medication, such as corticosteroid injections or oral anti-inflammatory medications, can be detrimental for healing collagen degeneration.5 Overuse tendon disorders can take a long time to heal due to the slow rebuilding of collagen. If tendon fiber tearing (tendinitis) were the primary problem, the tissue would heal rather quickly as it moves through the various stages of the inflammation and tissue repair process. Collagen rebuilding is a slow process and tendinosis can become chronic or recurrent.
Another chronic overuse tendon problem is tenosynovitis, which is an inflammation and/or irritation between a tendon and its surrounding synovial sheath. This condition affects only those tendons enclosed within a synovial sheath. The synovial sheath is also called the epitenon. The synovial sheath surrounds tendons in the distal extremities and a few other locations, such as the biceps brachii long head tendon as it travels through the bicipital groove. The sheath reduces friction between the tendon and the retinaculum (or, infrequently, a ligament) that binds the tendon close to the joint. The tendon must be able to glide freely within the sheath.
Chronic overloading or excess friction leads to adhesion between the tendon and its sheath. The adhesions cause a roughening of the surface between the tendon and its sheath, and a subsequent inflammatory reaction results. The rough tendon surface routinely produces crepitus (grating sensations) when the muscle-tendon unit and affected joint are moved through their range of motion. The symptoms of tendinosis and tenosynovitis are similar, but one can help distinguish between the two by determining if the tendon has a synovial sheath. If it does, tenosynovitis is possible. If there is no sheath, tendinosis is probably the cause.
An avulsion is an acute tendon injury resulting from high tensile loads, in which a tendon is forcibly torn away from its attachment site on the bone. In a majority of tensile stress injuries of the musculotendinous unit, fiber tearing occurs at the musculotendinous junction producing a strain. In some other cases these fibers remains intact and the tendon pulls away from its bony attachment site.
Avulsion injuries occur in regions where a large muscle attaches at a relatively small site on the bone, such as the hamstring attachment.
Click here for more information about Whitney Lowe, LMT.
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