resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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."
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.
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.
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.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
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.
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.
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.
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."
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
December, 2006, Vol. 06, Issue 12
The Pelvic Floor Paradox
By Leon Chaitow, ND, DO
When I started writing this periodic column, I mentioned that every now and then, a "wow-factor" enters my life; synchronistic events and pieces of information coincide to illuminate what was previously foggy.As the fog lifts, simultaneous thoughts often occur. The first thought is, "It's obvious why I didn't see it before" coupled with "Is there evidence to support this?" As I hope you will agree at the end of this short article, "it" is obvious, and there is abundant evidence. So what is "it" and what is "the problem?"
Let's start with a clinical fact I have been aware of, but have been unable to explain. In recent years, more and more of my younger female patients have reported symptoms ranging from variable to acute pelvic pain to stress incontinence, interstitial (i.e., nonbacterial) cystitis, vestibulitis and painful intercourse (dyspareunia). Many of these patients had seen appropriate experts in genitourinary medicine and/or physical medicine, and most had been prescribed what can best be described as "toning" (Kegel-type) exercises for presumed laxity in their pelvic floor muscles, along with various forms of medication.
Now, clearly, the patients I was seeing were the ones in whom such treatment had failed. However, because the practitioners prescribing these methods continued to do so, I must assume they worked for many. But they had not worked for those distressed (mainly) young ladies consulting me, whose lives were in turmoil because of considerable and sometimes constant pain in a very intimate part of their anatomy. All too often, these women were socially incapacitated due to their incontinence; with many unable to have normal relationships. And most of these women were no older than their early 20s.
Structural evaluation often revealed very well-toned musculature. Many had a history involving athletics, gymnastics or dance, and it also was common to have a report of emphasis on Pilates toning exercises with insufficient emphasis on flexibility. Frequently, there was extreme shortness of some of the muscles attaching to the pelvis, particularly the adductors, hip flexors and the ("core stability") abdominals.
In the United Kingdom, my license as a doctor of osteopathy allows me to conduct internal examination and treatment with informed consent, but this was not part of my usual assessment protocol - until recently, that is.
Nowadays, with a clinical chaperone or member of the patient's family present, such examinations are always suggested (and sometimes declined) in such cases.
What changed my approach? Evidence that the problems in most of these unfortunate patients was not reduced tone, but increased and excessive tone, together with the wonderful work of (mainly U.S.-based) medical and manual therapy practitioners who rediscovered something demonstrated many years ago1 - that trigger points can cause all of these symptoms, and that the trigger points and the symptoms frequently can be removed manually.
Diversion to Australia
Before going more deeply into the high-tone/trigger-point connection, I want to take you to Melbourne, Australia, where a part of the complex picture began to fall into place.
The 5th World Congress on Low Back and Pelvic Pain (November 2004) was held in beautiful (magnificent might be a better word) Melbourne, where I was presenting a paper on the influence of breathing pattern disorders and motor control associated with back pain. On the same panel was the wonderful Diane Lee, PT, from Vancouver, B.C. In front of some 2,000 delegates, she was discussing and showing video clips of paradoxical behaviour of the pelvic floor in women with stress incontinence.2 Ultrasound images of the pelvic floor and bladder were shown in which, when asked to "retract" or "draw the pelvic floor upward," quite the opposite happened and the pelvic floor, along with the bladder, dropped toward the floor with the incontinence consequences.
In real life, such women would try to prevent from wetting themselves by the natural response of tightening and drawing up and in, but what if the muscles trying to tighten and draw up already were as tight as they could possibly be? Perhaps the better response would have been to learn to relax these clenched muscles (or to have them manually relaxed), and to be able to influence the pelvic floor via a relearned awareness of muscle control?
This was Diane's objective. To me, the "wow factor" was the recognition that these women were almost certainly also going to demonstrate paradoxical diaphragm behaviour and unbalanced breathing (and most do), which is one of my main areas of interest.3 It would be fair to say that, after that presentation, my area of interest moved south to incorporate that other diaphragm, the pelvic floor. My belief is that if normal diaphragm (breathing) function can be restored and the pelvic floor muscles relaxed, re-education can take place efficiently and relatively easily. A part of that process requires that active trigger points - in the lower abdomen, inner thigh and sometimes internally - be deactivated as the muscles are restored to their normal length and tone. Is there evidence for any of this?
Sometime before World War II, a physician named Thiele developed a technique in which coccygeal prostate problems were treated by means of massage of specific muscles, mainly levator ani.4 This approach (see description in the third bulleted item below) currently is used in major centers in the U.S. to treat prostate pain and the sort of pelvic floor problems discussed above.5 Examples include:
So, this story is not just about pelvic pain and incontinence, but possible irritable bowel disease and, in some instances, sacroiliac dysfunction. Is this not a remarkable conjunction of influences, often linked to hypertonicity and dysfunctional patterns such as breathing?
The Tennis Ball Trick
For many practitioners, the Thiele form of massage may be in contravention of their license. In such cases, a referral to an appropriately licensed and trained practitioner is one option. Even where this is seen to be a good clinical choice, focus on normalizing the associated pelvic muscles and breathing function offers a positive option.
Another option was offered to me by a therapist (ex-dancer) at a recent workshop. She reported she had suffered many of the symptoms outlined above, and had been instructed in Kegel exercises for her incontinence. She noted that these exercises had aggravated rather than helped her. A yoga therapist had then advised her to purchase a tennis ball and sit on it with the ball (placed on a firm surface such as a carpeted floor) strategically placed under the perineum, between anus and the vagina; and to allow the pressure onto the ball to deeply relax the pelvic floor muscles for five to 10 minutes daily. She reported that this procedure was somewhat uncomfortable at first, but that the effects were dramatic in terms of her symptoms. I have since recommended this to several patients for home use and all have reported benefit.
Don't Forget the Psychological Aspect
This is a complex story, and I don't want to leave you with the impression it can all be solved by a tennis ball, although this might offer symptomatic relief for many. It's essential to note that in many such cases of clenched pelvic floor muscles, there is a background of assault or abuse (although a great many seem to be caused by nothing more than mechanically-produced, excessive tone with a background of dance, athletics and bad Pilates). Where there is a psychosocial or psychosexual element to the condition, appropriate professional support usually is needed along with bodywork.
The information offered above should at least provide a sense of what might be happening in some patient's bodies. Those trained in neuromuscular therapy know that aspects of this work usually are a part of that training. Information on the inter-rectal NMT approach is provided in Clinical Applications of Neuromuscular Techniques, Volume 2 (pp. 384-387)11 for information only, unless the methods are within your scope of practice.
Working on relaxation of the region (adductors, etc., as a first focus!), possibly deactivating trigger points if they are readily accessible, along with breathing rehabilitation, offer practical ways forward. And the tennis ball trick might just be an answer for some.
Click here for more information about Leon Chaitow, ND, DO.
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