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Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
September, 2006, Vol. 06, Issue 09
Maintaining Core Integrity During Pregnancy and Postpartum Recovery
By Elaine Stillerman, LMT
Postural shifting during pregnancy creates uncomfortable strains on the pregnant woman's musculoskeletal system, particularly her weight-bearing joints, and is one of the most common reasons women seek prenatal massage.
As the fetus gets bigger, the uterus expands from the pelvis to the abdominal region.To accommodate this growth, the abdominal muscles stretch, weaken and separate, creating the diastasis recti abdominis, or the separation of the two bellies of rectus muscle along the linea alba. The separation is not painful or harmful to the mother or baby and usually is located above and below the umbilicus where the abdomen is stretched the most, but can run the entire length of the linea alba. This loss of core integrity, coupled with the bulk and weight of the uterus, encourages an anterior pelvic tilt and increased lumbar compression. With the help of the hormone relaxin, a hormone synthesized in the ovaries and stored in the placenta which relaxes the elastic ligaments of the pelvic bones, the hips widen and the ribs expand as much as 2 to 3 inches anterio-lateral. Relaxin also softens the connective tissue to provide room for the growing uterus and making the joints more flexible. In order to maintain an erect posture, she leans backwards, further compressing the lumbar spine and musculature. Her shoulders laterally rotate and her cervical spine compensates by protracting her neck (thereby compressing the cervical vertebrae and contributing to hand weakness and carpal tunnel syndrome). To support a pregnant woman's weight and maintain balance below the pregnant pelvis, the hips laterally rotate, the knees hyperextend and the medial arches might collapse.
While it's not possible to stop this process from occurring, it is possible to minimize this maladaptive posture by strengthening the core muscles during pregnancy and restoring some of the weakened structural integrity. When the abdominal muscles stay as intact as possible, many of the common discomforts of pregnancy and postpartum recovery, particularly those associated with back problems, can be reduced or eliminated. The gravida will experience more lumbar stability during pregnancy and be able to recruit strengthened abdominal muscles during birth.
A large majority of the pregnant population, as much as 80 percent to 90 percent, will develop a diastasis by their final trimester. Other non-pregnancy causes of this muscle separation are obesity and chronic, obstructive lung disease. Unless pregnant and postpartum women learn to exercise and use their abdominal muscles correctly, these complaints might plague their pregnancies and extended recoveries. Traditional crunches and sit-ups actually do more harm than good by increasing the separation of the rectus bellies. The missing link to abdominal strength and core integrity during pregnancy, postpartum recovery (as well as everyday life for everyone), is to recruit the deepest of the abdominal muscles, the tranverse abdominis.
There are four pairs of abdominal muscles: the rectus abdominis, the external/internal obliques and the transverse abdominis. The rectus has its origin at the costal cartilages of the fifth, sixth and seventh ribs and the xiphoid process of the sternum. Fibers run longitudinally along the anterior abdominal wall and insert at the pubic crest and symphasis. Its posterior lamina fuses with the aponeurosis of the transverse abdominis to form the dorsal layer of the rectus sheath. Muscle bellies on either side are connected by the linea alba. Its action is to flex the vertebral column (forward bending).
The second and third layers are the external and internal obliques. The anterior fibers of the external obliques originate at the external surfaces of the fifth through eighth ribs and the lateral fibers originate at ribs 9 through 12. Its fibers run inferomedially and attach anteriorly as an aponeurotic sheath at the linea alba, inguinal ligament, anterior superior spine and pubic tubercle. The lateral fibers attach into the external lip of the anterior half of the iliac crest. Bilateral action flexes the vertebral column and unilaterally they rotate the vertebral column. The lower fibers of the internal obliques, which run horizontally at the level of the anterior inferior iliac spine (AIIS), obliquely upward superior to the AIIS and obliquely downward inferior to the AIIS, originate at the lateral 2/3 of the inguinal ligament and iliac crest. They insert with the transverse abdominis into the pubic crest and linea alba. Its fibers also attach anteriorly as an aponeurotic sheath. The lower anterior fibers compress and support the lower abdominal viscera in conjunction with the transverse. The lateral fibers originate in the middle third of the intermediate line of the iliac crest and thoracolumbar fascia. Insertion is at the inferior borders of ribs 10 through 12 and linea alba. Bilaterally, these muscles flex the vertebral column while unilaterally they rotate the vertebral column.
The deepest, most intrinsic abdominal muscle is the tranverse abdominis. It originates at the inner surfaces of the cartilages of the lower six ribs, the transverse processes of the first four or five lumbar vertebrae, thoracodorsal fascia, anterior internal lip of the iliac crest and lower third of the inguinal ligament. Its fibers run horizontally and attach anteriorly as an aponeurotic sheath at the linea alba, pubic crest and pectin of the pubic bone. Its action is to flatten the abdominal wall, compress the abdominal viscera and stabilize the lumbar spinal segment. When the transverse is contracted (pulled in), all of the overlying muscles contract at the site of their mutual connection, the linea alba, thereby minimizing the diastasis.
Flexion and rotation are major roles of the abdominal muscles. They also play an important role in postural stability and intra-abdominal pressure. An increase in intra-abdominal pressure is necessary for defecation, urination, childbirth and forced exhalation. It wasn't until recently that the intra-abdominal pressure could be tested on all four muscle groups. In 1992, a study showed the activity of the transverse abdominis was associated with increased intra-abdominal pressure. This discovery led researchers to believe that when the transverse abdominis is recruited, it provides considerable trunk stabilization.
In order to experience this stabilization and core integrity yourself, try this simple experiment: walk around the room with your body relaxed. Continue walking at the same pace and breathe normally as you tighten your transverse by bringing your navel to your spine. Keep breathing. How do you feel now? Taller? Stronger? Another way to experience the power of core integrity is to sit comfortably in a chair with your feet on the floor. Bring your arms above your head as if you were doing a dumbbell shoulder press. Lower and raise your arms repeatedly a few more times. For the next few "presses," breathe normally and tighten your transverse. Breathe normally. Do you notice how much stronger you feel?
With a strong, integrated core, a good deal of the postural problems and lumbar instability associated with pregnancy and postpartum recovery can be avoided. After the baby is born, the diastasis does not self-heal and repeated lifting of the (growing) baby and household chores can lead to long-term referred backaches. A new mother should remember to recruit her transverse abdominis whenever she lifts her child or does any type of physical activity.
How do you know if your pregnant client has a diastasis? There is a very simple way to test for it. Have your client lie on her back on the massage table with her knees bent. Stand at the side of the massage table facing your client and place your fingertips (usually three fingers) across her linea alba just above her pubic bone. Have her take a deep breath. As she exhales, have her tuck her chin to her chest and lift her head and shoulders off the table. This will cause her abdomen to protrude (she is actually doing a crunch). As she holds this position, gently (and quickly) glide your fingers across the linea alba from her pubic bone all the way up to her xyphoid process. If the space between the bellies of the rectus abdominus is wider than half a finger's width, she has a diastasis. The number of fingers that fit into the separation indicates how wide it is. Your client can also test herself. With her fingers placed below her ribs, she lifts her head as described above, and follows the linea alba down to the pubic bone.
A recent study done by students at the Columbia University School of Physical Therapy hypothesized that pregnant women who did not exercise had a 90 percent incidence of diastasis recti as compared with 12.5 percent in the exercising group who used their transverse abdominis during exercise. The non-exercising women also had larger separations than their exercising counterparts. Since pregnant women are advised to avoid supine positioning after the first trimester, another advantage of transverse abdominal work is that many of the exercises can be performed in a comfortable sitting position. This also is beneficial for older clients or for anyone who has difficulty lying down to exercise.
In order to help your pregnant and postpartum clients, as well as those clients with chronic backaches, don't overlook the importance of proper abdominal exercises - those that emphasize the use of the transverse abdominis - to stabilize the lumbar spine and minimize backaches.
Click here for previous articles by Elaine Stillerman, LMT.
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