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Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
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 more information about Erik Dalton, PhD.
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