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The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
January, 2008, Vol. 08, Issue 01
Leg Length Discrepancy and Low Back Pain
By Whitney Lowe, LMT
Low back pain is one of the most common reasons for people to seek care from a massage therapist. Unfortunately, despite all our advances in knowledge, most health care researchers admit that we still don't know what causes many cases of back pain. There are numerous suspected causes and biomechanical dysfunction in the lumbopelvic region is a frequent culprit. One biomechanical factor that causes low back pain is a leg length discrepancy (LLD).
Several months ago, a discussion of bodywork began on Yahoo! Groups about the role of pelvic rotation and LLD. This discussion eventually carried me into debates and conversations with a number of experts across multiple disciplines about the role of LLD and lumbopelvic pain. Thus, my perspective was significantly changed about how to assess LLD and the role it plays in various soft-tissue disorders.
There are two types of LLD, structural and functional. It is important to distinguish between the two as they are treated differently. A structural LLD also is called a true leg length discrepancy and is considered a true or structural discrepancy because the cause is an actual length difference in the lower extremity bones (femur or tibia). Also, structural LLD usually is congenital. Small discrepancies between the length of bones on each side of the body are common, but the problem occurs when the difference in length is more pronounced (usually .5 to 1 inch difference is considered within normal limits).1 Surgeries, accidents or previous fractures are other causes that produce a structural LLD.
Structural LLDs are treated with a heel lift if they are not severe; severe cases can require surgery. Before getting a heel lift, it is important to determine that there is a true structural discrepancy and not a functional one. The most accurate way to identify a structural LLD is with a lower extremity X-ray that allows a comparison of bone measurement with the other side. If X-ray evaluation is not an option, a comparison of the measurement between bony landmarks on each side with a tape measure is another option, although it is somewhat less accurate. Visual evaluation, such as that pictured in Figure 2, is commonly used to evaluate LLDs, but is the least accurate.
A functional LLD is more common than the structural-discrepancy type, however its cause can be hard to determine. Functional LLDs occur when it appears that one leg may be longer than the other, but there is no significant difference in the length of the lower extremity bones. Instead, a postural distortion has caused one lower extremity to appear longer or shorter than the other.
Figure 1 shows an example of how a functional LLD occurs from tight lumbar muscles. This is a posterior view of our client. The client has a tight left quadratus lumborum muscle that has pulled the left iliac crest in a superior direction. When you evaluate the height of each iliac crest in a standing position it appears that the left side is higher. If this client were supine, it would appear that the left leg is shorter because the pelvis and lower extremity on the left side are being pulled in a superior direction by the tight quadratus lumborum.
Some functional LLDs are harder to evaluate than others. A number of clinicians suggest that an anterior innominate rotation can produce an LLD. The innominate is one half of the pelvis and includes the ilium, ischium and pubis on one side. Each innominate can rotate independently of the other. Therefore, you can have one innominate that is anteriorly rotated and one that is more posteriorly rotated. If the client is supine, the anteriorly rotated innominate may appear to push the femur in a distal direction. When you evaluate the two legs using a method such as a visual leg length comparison (Figure 2), the leg on the side of the anteriorly rotated innominate could appear longer.
The problem with this evaluation method occurs when the person stands up. When the individual places weight on the lower extremity it affects innominate rotation. The innominate rotation can't push the femur inferiorly when the person is standing because the lower extremity is bearing weight (you would have to push the lower extremity into the ground). So what happens to the innominate rotation? Some people say it stays as an anterior rotation and others say weight bearing causes a reverse (posterior) rotation of the innominate. However, there is very little biomechanical research on this issue to clarify what actually occurs.
Bearing weight does not change a functional LLD that is caused by a tight quadratus lumborum (Figure 1). When the individual stands upright, the pelvis still will appear high on the side of the apparent short leg. This apparent LLD remains because it is caused by the innominate on that side being pulled superiorly and not because a lower extremity is being pushed down in an inferior direction.
After consulting numerous resources and conversing with experts on this issue, it is clear that there is no consensus on what happens with functional LLDs caused by innominate rotation when the individual is weight bearing. Yet there is agreement that most functional LLDs that cause back pain are created by soft-tissue dysfunction and can be corrected by manual methods such as massage. Several good recommendations are provided in Erik Dalton's article on the "Short Leg Syndrome" in the November 2007 issue of
LLD, whether structural or functional, is an important contributor to lumbopelvic pain. What is still not clear is exactly how the mechanics of the sacroiliac joint, lumbar spine and hip directly cause specific pathological problems with an LLD. If there is a simple mechanical cause of pain there should be a strong correlation between the assessment of LLD and specific symptoms of lumbopelvic pain. Unfortunately, there is a poor relationship between evaluation methods for pelvic position and specific pain complaints.2,3 Additional research is highly needed to help us understand the complex biomechanics of this region and exactly what role innominate position or leg length play in lumbopelvic pain.
Click here for more information about Whitney Lowe, LMT.
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