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Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
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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