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An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
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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