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The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
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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