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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!
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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.
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.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
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.
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.
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.
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.
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.
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."
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.
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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