resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
September, 2006, Vol. 06, Issue 09
By Erik Dalton, PhD
Many of today's medical texts tell us the coccyx fuses into one rigid segment by adulthood in most people. However, several well-designed studies have shown that a normal coccyx should have two or three movable parts that gently curve forward and slightly flex as we sit.Two medical papers (Postacchini and Massobrio1 and Kim and Suk2) found that test subjects with fused coccyxes that didn't flex upon sitting were more likely to experience tailbone pain than those with a normal coccyx. Postacchini and Massobrio performed radiographic studies of 171 coccyxes, and found less than 10 percent were fused into one piece...most had two or three, and a few had four segments. The primary conditions they found to be associated with coccyx pain were: coccyx angled sharply forward; coccyx side-bending more to one side than the other; and coccyx completely rigid (all segments fused together and fused to the sacrum).
Although none of the abnormalities listed above always cause pain, clients seem more likely to experience coccyx problems when one or more of these conditions exist. Over the years, I have noticed clients with particularly long coccyxes also seem more likely to report local tenderness and pain. Although not reported in the literature, it seems obvious that a long coccyx would be more likely to suffer damage than a shorter one.
Why some hurt and others don't is unclear. In the case of a misaligned coccyx, it might be that the pain is caused by the coccyx pulling on muscles, ligaments or overstretching the filamen terminale (end of the dural tube). Connective tissues called the filum durae spinalis enclose the end of the spinal cord and attach it to the deep dorsal sacrococcygeal ligament. A major source of hip and back pain occurs as fibrotic sacrococcygeal ligaments anteriorly flex (hook) the coccyx and compress/overstretch the sensitive filum terminale (Fig.1). In the case of a rigid coccyx, it might be that the tissues under the inferior segments might create a pad of irritated tissue (like a bunion) that can rub the dura raw. But the most common pain-generator helped by manual therapists is neuroreceptor pain from a misaligned sacrococcygeal joint.
Coccydynia (Coccyx Pain)
When sitting, the coccyx shifts forward and acts as a shock absorber. However, falling on the tailbone or events such as childbirth can lead to coccygeal pain, known as coccydynia. In most cases, the pain is caused by an unstable coccyx, resulting in chronic inflammation of the sacrococcygeal joint. Coccydynia also can be attributed to a malformed or dislocated coccyx and the growth of bony spurs on the coccyx. Resulting pain often is resolved by performing specific soft tissue techniques to release the levator ani muscle, anococcygeal, sacrotuberal and sacrospinal ligaments, as well as the gluteus maximus muscles.
Another common etiology is childbirth. The coccyx is considered by some to be in the way during childbirth. At the end of the third trimester, certain hormonal changes enable the synchondrosis between the sacrum and the coccyx to soften and become more mobile. This increased mobility of three to five coccygeal segments allows for more flexion and extension, which might permanently change the resting tension of the surrounding ligaments and muscles. Unlike fractures, which can remodel, injuries to the sacrococcygeal junction often become inflamed as the joint is repeatedly forced out of its normal position. Physical examination should include direct palpation of the coccyx for tenderness. In true coccydynia, the coccygeal region usually is markedly tender. If the client reports coccygeal pain but is not tender upon palpation, the therapist should refer out for an orthopedic workup to rule out lumbar disk disease.
Ida Rolf, PhD, referring to the coccyx as the "seat of the soul," insisted on correcting hooked and side-bent coccyxes during her famous session six of the Rolfing® series. When this tiny group of bones "hooks" anteriorly or bends to one side (typically the left), the dural tube tightens. In reported cases, a hooked coccyx actually has shut down the entire CNS by hindering cerebrospinal fluid flow. A hooked coccyx also can lead to loss of psychological integrity. Reported cases cite severe emotional disturbances in people whose coccyx has been removed or broken off, leaving no anchor for the dura mater. The coccyx has been implicated in clients presenting with functional scoliotic patterns. Through its connection with the sphenoid, excessive dural tension stresses the eleventh cranial accessory nerve, which, in turn, shortens the SCMs and upper trapezius muscles. A modified version of Dr. Rolf's coccyx technique is demonstrated in Fig. 2.
Coccyx pain often is caused by falling backwards or by childbirth, although in many cases, the exact etiology is unknown. There are various treatment modalities available, and the great majority of sufferers can be helped. Due to the vertebra's direct attachment to the dural membrane through the filum terminale, coccyx work can cause a client to become very emotional. Prior to treating coccyx dysfunction, always ask the client's permission to perform this technique due to possible physical and emotional hypersensitivity in the area. Before performing any type of coccyx work, take time to clearly explain your therapeutic intent and the desired outcome. All coccyx alignment techniques should be performed through underwear or draping.
Click here for previous articles by Erik Dalton, PhD.
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