resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
September, 2007, Vol. 07, Issue 09
Achilles Tendon Disorder
By Whitney Lowe, LMT
Massage therapists see many clients with active lifestyles. Running, jumping, dancing, climbing, or any number of other activities can put serious stress on the Achilles tendon (AT). AT disorders also can contribute to biomechanical disorders in the foot and lower extremity.That is why it is important for the massage practitioner to understand more about the structure, function and pathology of this very important tendon.
The AT is the strongest tendon in the body and needs this strength because of the high force loads required during motions such as walking, running or landing from a jump. AT disorders can occur at any age, but there is an increased frequency in older populations. The increased age of the active baby boomer generation in this country suggests we likely are to see more of this condition in years to come. The tendon is susceptible to a variety of pathologies, such as paratendinitis (also spelled paratendonitis), tendinosis and tendinitis. Some of these different terms can be confusing, so I'll distinguish them below.
Structure, Function and Pathology
The AT connects the gastrocnemius and soleus muscles to the calcaneus. The tendon is surrounded by a thin membrane called the paratenon, which helps facilitate blood supply throughout the tendon. There is a region of the AT near the distal insertion, called the avascular zone that has a very poor blood supply (Figure 1). This region frequently is the site of inflammation and degenerative changes within the tendon.
The term tendinitis is used for overuse tendon pathologies throughout the body. Yet, most of these conditions do not involve inflammation so they truly aren't tendinitis (the suffix -itis indicates inflammation). Yet the AT is one tendon that commonly does have inflammatory activity in the tendon and the paratenon. Consequently, the terms tendinitis and paratendinitis usually are accurate when referring to the AT.
Achilles tendinitis is classified as insertional or non-insertional. Insertional tendinitis involves pathology at the insertion of the AT into the calcaneus. It is prevalent in older individuals and those who engage in activities without proper conditioning. Poor healing of minor tendon damage occurs at the calcaneal tendon insertion due to the lack of blood supply in the avascular region.1
The second category of overuse AT disorders is non-insertional tendonitis - those that don't affect the insertion of the tendon into the calcaneus, but cause problems in other areas of the tendon. Non-insertional tendinitis typically affects athletes and those engaged in vigorous physical activity. The pathologies under the umbrella of non-insertional tendinitis include paratendonitis (inflammation of the paratenon), tendinosis (collagen degeneration within the tendon) and tendinitis (inflammation of the tendon).
Tendinosis is degeneration of the collagen matrix within the tendon, which leads to pain and loss of function. It commonly is categorized as non-insertional tendinitis, even though it is not an inflammatory disorder. The degenerative changes of tendinosis are caused by age, repetitive microtrauma or other factors that lead to collagen breakdown. The collagen degeneration frequently precedes inflammatory conditions such as tendinitis.
Non-insertional tendinitis can be acute or chronic and primarily affects the avascular zone near the base of the tendon. There is tenderness throughout the tendon and fibrous thickening near the distal end, which is apparent when the tendon is compared to the unaffected side (assuming the other side is not affected). In many cases, tendinitis and paratendinitis occur together and both the tendon and paratenon are inflamed. If not treated properly, tendinitis can lead to either partial or complete tendon ruptures.2
Recent studies show a link between certain medications and the onset of AT degeneration and ruptures. Especially implicated are medications in the fluoroquinolone family of antibiotics, such as ciprofloxacin (brand named Cipro).3-5 These medications cause tendon pathology in large tendons of the body, even in the absence of vigorous repeated activity. In addition, systemic disorders such as hyperthyroidism, renal insufficiency, gout or rheumatoid arthritis also can contribute to tendinitis in the AT.6,7
AT disorders are best controlled through rest and activity modification. Rest means stopping offending activities, not immobilization. Lack of movement might lead to the development of fibrous adhesions. Cold applications and anti-inflammatory medication may be used to address inflammatory activity if present. As soon as stretching is tolerable, it is helpful to stretch the AT several times per day.
Massage applications to the calf muscles reduce tension and decrease tensile forces on the tendon. Deep friction, as tolerated in the problem area, is beneficial in stimulating fibroblast proliferation in the tendon to repair the damaged collagen matrix. Cold applications prior to the deep friction reduce the intensity of the discomfort, and reapplying cold after treatment reduces the accelerated metabolic response to the friction. Heel lifts inside the shoe may be recommended to help reduce tension on the tendon. Corticosteroid injections formerly were used with greater frequency and are not recommended now because of long-term detrimental effects on the tendon, such as tendon rupture.8 Massage therapists applying these concepts of evaluation and treatment will be much more effective in helping their clients address this frequent cause of foot and lower leg pain.
Click here for more information about Whitney Lowe, LMT.
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