resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
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.
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.
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.
December, 2006, Vol. 06, Issue 12
The Phrenic Circuit, Part Two
By Dale G. Alexander, LMT, MA, PhD
The Phrenic Circuit provides us with a template to conceive of how the body discharges its tensions by endeavoring to distribute them as widely as possible. These tensions originate internally within the sacs and tubes of organ systems of the body and are eventually expressed, externally, via the musculoskeletal system.1 In part one, it was proposed that most chronic problems related to the cranium, neck, upper back, shoulders, arms, elbows and hands consistently have shown an association to the relationships of the phrenic nerves.2 This article will offer additional anatomical and perceptual relationships for your consideration.
Incorporating some of the feedback from the first article, allow me to note that none of these ideas or relationships should be construed to be provable facts at this time.I apply what produces results for my clients. I am not lobbying for the use of any specific touch technique. Rather, it's my clear intention to invite the reader "inside" the body and to introduce them to the power of perception and intention as part of the process in transformational healing. My writings emerge from a distillation of multidisciplinary theories of philosophical, perceptual, energetic, physiological and anatomical relationships. Additional feedback to the first article reflected that practitioners who actually applied the notions described therein were rewarded with an additional capacity to assist their clients.
I would propose that we all release ourselves from operating "within" or attempting "to prove" absolute cause and effect relationships. Rather, let us embrace the associational and relational correlations that have shown themselves to be repeatedly helpful. Last year's Nobel science award went to two dedicated physicians who had been rebuffed by the medical establishment for more than 30 years in their proposed notion that the bacteria, Helicobacter pylori, is highly correlated to the formation of gastric and duodenum ulcers.
In my experience, chronic problems most often involve multiple sources feeding into a recurring somatic complaint. Obviously physical trauma or repetitive wear and tear of physical activity are slices of the pie. However, when one examines human consciousness in its relationship to anatomy and physiology, many additional slices of the pie have shown themselves to be relevant.
These articles are an exploration of discovering the treasure within each of our clients. What has made the biggest difference for me, as a practitioner, is to place my perception and intention inside of the human body "feeling with my eyes and seeing with my hands" and to expand my perception to include the dimensions of sacred and energetic relationships. I also endeavor to bring to the table simple human common sense.
Let's briefly review. The phrenic nerves originate within the spinal cord from C3 to 4-5. This overlaps the origin of the brachial plexus nerves from C4-T2. This relationship within the spinal cord suggests a "shared circuitry." It's my postulation that the body uses this overlapping within its neural net to distribute the sensory tensions of all the organs and musculoskeletal structures that have even remote connections to this portion of the spinal cord.
"Everything is connected to everything," were the words of a chiropractor who was invited as a guest speaker in my original advanced training with Bill Williams, PhD and Ellen Gregory, PhD, at their Soma Neuromuscular Integration Institute in 1980.3 This phrase made an imprint which resonates even to this day.
Last year's flooding of Hurricane Wilma in the Florida Keys made this even more viscerally clear to me. Just as water finds its way into, around, under or over whatever it can, it has been my experience in working with chronic problems that the electrochemical and electro-magnetic energy of the body can use any portion of the human neural net in its attempt to distribute strain and re-establish some kind of homeostasis. And the punch line is that there appears to exist fairly specific energetic and neural relationships the body uses more frequently. These are the treasure maps for us to follow and improve upon in our collective intention to assist our clients. It has been my clinical experience that the relationships of the Phrenic Circuit are one of these treasure maps.
Let us dive deeper into a review of the basic anatomy. The phrenic nerves are the sole "motor supply" to the diaphragm muscle. There is a separate right and left phrenic nerve, each with its own excursion through the thoracic cavity vitalizing respectively the right and left hemi-diaphragms. Along their descent through the thorax, the phrenic nerves supply sensory branches to the pericardial sac of the heart, the mediastinal/pleural sacs of the lungs and to the subclavius muscles. Once below the diaphragm muscle, they communicate with the celiac plexus through a common phrenic ganglion. Other sensory relationships routinely identified and inferred include the peritoneal sac, the gallbladder, the capsule and the hepatic and falciform ligaments of the liver, the pancreas, both sides of the esophagus and the adrenals.4 Once tied into the celiac plexuses, all the organs below the diaphragm potentially can use this sensory channel to express their tensions. Old-time anatomists commonly described the celiac ganglion and plexus as the "solar plexus" and as an abdominal brain. The point here is that the sensory supply to the phrenic nerves is an extremely open system, not a closed neural loop, and one that intimately shares the spinal cord circuitry of the brachial plexus that provides the neurocirculatory supply for the upper extremities. The Phrenic Circuit does not create anything physiologically, rather it's the conduit for the expression for deeper tensions to be expressed.
I propose that the Phrenic Circuit functions similar to the "canary in the coal mine." This is a phrase from the turn of the century when coal miners would take canaries in cages down into the mineshafts with them, to create an early warning system when their safety was in jeopardy from a buildup of carbon monoxide or natural gas leakage. When the canaries stopped singing, it was a warning to the miners to vacate the underground shaft.
In a similar fashion, the internal organs of the body seek to let us know when their stress levels have reached a threshold of importance. It's like the student who gyrates and excitedly waves their hand in the back of the class endeavoring to be recognized. The inside is signaling through to the outside that something needs attention. The inside is where our consciousness lives and grows, or doesn't, where the biological tenaciousness of the "mind" refuses to operate in present time.5
In the early stages, "that something important," usually relates to our emotional or energetic experience in relation to someone or to a future or past event. We call this "stress." However, the "canary" also can be signaling that dysfunction or disease has begun to progress toward pathology. This suggests that when a symptom of the head, neck, shoulders, arms or hands "just won't go away," it's appropriate for us to refer our clients for a medical checkup.
Currently, most of my clients have been to physicians before contacting me. For a general massage therapist, I would recommend a three session rule. If you have been unable to assist within three sessions at least a 50 percent reduction in their somatic intensity and the profile of their complaints remains unchanged, then send them on to a physician. The following description of "referral patterns" might offer additional guidance.
Let's examine the left and right-sided relationships reflected through the theorized Phrenic Circuit. According to Dr. William Silen's compilation of the experience of surgeons in Cope's Early Diagnosis of the Acute Abdoment, "the significance of constant or intermittent pain in the region of the fourth cervical nerve (the principle root of the phrenic nerves) is still sometimes either not understood or seriously neglected. Pain on top of the right shoulder may be the only signal that an inarticulate liver abscess, threatening to perforate the diaphragm, may be able to produce."6 Dr. Silen enumerates a host of acute and potentially life-threatening ailments we do not routinely see in our offices but that, I propose, often use the Phrenic Circuit in their attempts to be noticed in the early and middle stages of their development.
According to Dr. Jean-Pierre Barral, DO, the developer of the Visceral Manipulation Approach, the gallbladder, liver and the right lung reflect their tensions via the right upper extremity whereas the stomach, pancreas, spleen, heart and left lung reflect their tensions into the left upper extremity. In addition, his many years of clinical experience correlate to the left side of the neck most consistently to gallbladder difficulties and the right side of the neck to liver problems.7
It has been my own clinical experience that early warning signals of diverticulitis attacks often use these upper extremity and cervical referral patterns as well, with the ascending colon referring into the right shoulder while the descending colon usually refers into the left. I also have experienced kidney problems to use this circuitry, especially long-standing sub-clinical kidney infections and clients on the verge of a kidney stone becoming lodged in one of the ureters. However, most commonly in my experience, either kidney will refer its chronic tensions into the low back, the inguinal region and/or into the same-sided hip and most frequently the knee. Additionally, there are presenting anomalies that switch sides. Duodenal ulcers might do this or abdominal adhesions might refer via the pancreatic sensory supply through the phrenic/brachial plexus overlap to the left shoulder or from the transverse colon that is a literal connector between both sides.
I experienced the adhesion example with a female client who exhibited a confusing switching back and forth between the right and left shoulder and neck symptoms, only to discover after an exploratory laparoscopic surgery that she had a 2 centimeter adhesion between the duodenum and the abdominal wall that was referring through both sides of the circuit. Her presenting problem was a constant state of anxiety.
Another case study might further serve to illuminate these relationships. About 17 years ago, while still studying with Dr. Barral, I was working with a client whose right shoulder began to freeze, i.e., progressively began to lose range of motion until he had only about 20 degrees of abduction remaining.
He lost functional use of his right arm for most activities of daily living including his ability to work with his computer. Not good, as he was, and still is, a publisher. He had been diagnosed as having a frozen shoulder and his orthopedist recommended he have his shoulder surgically broken to re-mobilize it. This was a regular client who would see me about twice a month, so I had a perspective from his somatic onset and followed it through to its resolution. I had consistently been using connective tissue, muscle energy, and CranioSacral techniques to mobilize the range of motion of his shoulder along with the visceral touch techniques I learned from Dr. Barral, to mobilize his gall- bladder, liver and to assist in clearing his common bile duct. Nothing worked, but all I had learned about the progression of gallbladder difficulties pointed to it as a bigger slice of the pie.
I begged my client to see his physician and have an ultrasound done of his gallbladder. I have no problem pleading with my clients to seek medical consultation. The test showed he had two rather large gallstones, so big they were unlikely to ever find their way into the common bile duct. His physician told him that removing them was the best course of action but that he could live with them as they were. He selected to live with them. Within a month of his ultrasound and discussion with his physician, we were able to fully re-mobilize his shoulder.
From the beginning of his problem until the eventual resolution and restoration of his shoulder motion, took approximately six months. Obviously, I had yet to create the three-session rule mentioned earlier, however, here was evidence that the body can get used to just about anything. This same case study will be cited and explored further in my next article. The resolution of a presenting somatic complaint does not mean living with something will not affect a client's quality of life or won't possibly contribute to the progression of emerging pathology.
Now, let's explore the dimension of "sidedness" from another perspective. According to Lansing Gresham's The Body's Map of Consciousness, the left side of the human body for both genders reflects our composite of experiences with females while the right side of our bodies reflects our composite of experiences with males.8 One of the most defining elements of our human experience is our gender, how we feel about our own and how we feel about the other. For example, when a male client presents with chronic right-sided complaints, I become curious as to how he feels about himself as a male and the nature of his relationships with his father, brothers or other males in his life. This also includes the absence of male family members through divorce/custody battles, geographic dislocation or death. In contrast, when a female presents with a chronic history of right-sided complaints, I expand to consider not only the possibility of conflicts/trauma associated with males in her life, but also her feelings and the degree of permission she has for assertive expression of her wants and needs. And, of course, for both sexes there often is the wound of not being the gender expected or wanted by one or both parents.
Carl Jung articulated the notion that within females and males there exist conjointly an "anima" and an "animus," both a receptive and a nurturing side and the capacity for confidence in expressing one's competence, skills and abilities.9 We all are challenged to integrate these elements within the process of identity formation throughout the course of our lives, as are our clients.
During sessions with clients, it's my willingness to perceive anything is possible without any preconceptions that allows a quality of touch through which a client might access my library of knowledge and experience. It involves perceptually accessing a space of "not knowing" where clarity through touch might emerge "from within the client," signaling to me the many possible variables relevant to them.
As human beings we are complex. As we turn the facets of the diamond there are many reflections. This article can only serve but to introduce you to some of them. The next time one of your clients speaks to you about chronic problem(s) with their right or left upper extremity or neck, please consider that one of the streams feeding into the Phrenic Circuit might be a contributing factor, that some aspect of the person's sense of self is seeking expression and acknowledgement. Also, please consider exploring the references listed below.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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