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A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
December, 2006, Vol. 06, Issue 12
Tarsal Tunnel Syndrome
By Whitney Lowe, LMT
Most people are aware of carpal tunnel syndrome as a common nerve entrapment problem in the wrist and hand. There is a similar type of nerve entrapment in the ankle, which is not as common.Entrapment of the tibial nerve as it passes through a tunnel on the medial side of the ankle is called tarsal tunnel syndrome.
Nerve entrapment syndromes don't occur with as much frequency in the lower extremity as they do in the upper extremity. As a result, tarsal tunnel syndrome (TTS) is considered by some to be a rare condition, leading to it being frequently overlooked as a source of foot pain.1 The location of pain on the plantar surface of the foot produced by TTS also might cause it to be mistaken for plantar fasciitis. TTS also can be mistaken for proximal nerve compression pathologies, such as herniated discs in the lumbar region.
As the tibial nerve exits the deep posterior compartment, it passes around the medial side of the ankle on its way to termination in the toes. Near the medial malleolus, it divides into three branches. Just after it divides into these three branches, they all pass under a fascial band on the medial side of the ankle called the flexor retinaculum (Figure 1). The retinaculum is connected superiorly to the medial malleolus and inferiorly to the medial side of the calcaneus. The space under the retinaculum is the tarsal tunnel. There are several other structures that pass through the tunnel, including the tendons of tibialis posterior, flexor digitorum longus and flexor hallucis longus, and the posterior tibial artery and vein.
Tarsal tunnel syndrome results when the tibial nerve or its branches are exposed to compressive or tensile stress within the tarsal tunnel. Nerve compression occurs from pressure outside the tunnel such as a direct blow to the medial side of the ankle or from force within the tunnel from synovial ganglions or bony prominences.2,3
A swelling of synovial tendon sheaths (tenosynovitis) also could compress the tibial nerve.
Tensile forces on the tarsal tunnel nerves also cause symptoms. Neural tension results from either a sudden or chronic stretch of the nerve. Sudden nerve stretch happens in acute injuries while chronic stretching results from postural distortions such as a calcaneal valgus foot alignment.
Peripheral neuropathies like TTS can be linked to systemic disorders such as diabetes, muscular sclerosis, rheumatoid arthritis and hyperthyroidism.4 Note that some medications might cause sensitivity in the distal lower extremity nerves that could be mistaken for compression pathologies in the tarsal tunnel.
Identifying the Condition
A client with TTS reports sharp, shooting pain sensations around the medial ankle and along the plantar surface of the foot. In addition to pain, there might be paresthesia, numbness or motor weakness in the muscles of the foot. Symptoms ordinarily are worse after long periods of standing or walking, but also might be aggravated during the night if the nerve is in a compromised position for prolonged periods. Ask about recent trauma involving sudden compressive or tensile loads on the nerve, as recent injuries might be responsible for the symptoms. It's important to ask about systemic disorders that might cause TTS, or be related to it.
There are no clear visible signs of tarsal tunnel syndrome, but certain postural disorders such as calcaneal varus or valgus can aggravate the condition. Although uncommon, if TTS is severe or has been present for a long time some atrophy of the muscles innervated by the divisions of the tibial nerve might be apparent. Placing pressure directly on the tarsal tunnel is one of the most valuable ways of identifying this condition and is sometimes called the tarsal compression test. If the pressure reproduces the client's primary pain or other neurological sensations, it's a good indication of tarsal tunnel syndrome.
A special orthopedic test called the dorsiflexion-eversion test also is used to identify the condition. In this test, the client is in a supine position. The ankle is passively moved into maximum dorsiflexion and eversion while the toes are held in hyperextension (Figure 2). The position is held for five to 10 seconds. If symptoms develop, it's a positive sign of TTS.
Identifying nerve compression pathologies like TTS is important so proper treatment can be administered. If the client reports foot pain, there might be a tendency to use additional pressure around the ankle or foot in an effort to "work it out." This would be a mistake with a nerve compression pathology like TTS. Accurate identification will guide the most appropriate treatment.
Click here for more information about Whitney Lowe, LMT.
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