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Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
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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