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Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
April, 2008, Vol. 08, Issue 04
The Progression of Cervical Stenosis Toward Cervical Spondylotic Myelopathy
By Dale G. Alexander, LMT, MA, PhD
Have you ever wondered whether there might be a neurological connection between chronic upper and lower extremity difficulties? There is one neural tract that has received little attention, yet clearly tends to be part of a long sine wave of progression toward reducing the quality of our lives. It is the neural reflex arc related to C5-6 outlined in the illustration.1 This relationship can be a co-conspirator in sciatic syndromes along with the same-sided upper extremity, shoulder and cervical difficulties. In addition to the progression of gallbladder dysfunction described in my previous article series, I have observed that the progression of cervical stenosis is implicated in many of the chronic problems our clients present to us.
The problem begins with a narrowing of the central cervical canal where, most commonly, the vertebral bodies of C4, 5, 6 or 7 may compress the canal, encroaching upon one or both of the foraminal openings for the exiting spinal nerves and eventually pressing on the spinal cord itself. This progressive compression is called stenosis.
The simple picture is to visualize the bony spine pinching the spinal cord more and more tightly over a period of years.2 Congenital predisposition (a narrow central canal at birth), accreted trauma or a major trauma often advances this progression to show itself earlier in life or in the severity of its expression.
Stenosis can occur anywhere along the length of the spinal cord but is most frequently identified in the cervical region.3 The segmental levels of L4-5, L1-2 and T8-9 are other areas where my clients report medically identified stenosis. An MRI scan can show the degree of central canal or foraminal compression and any spinal cord pinching. A CT scan often is used to determine the extent of bone remodeling, disc deterioration/herniation or the presence and types of osteophytes and spurs. Together these two tests usually are considered definitive in making a medical diagnosis, although additional testing sometimes is used for surgical planning.4
I distinctly remember a female client in her early 50s who came to me some 20 years ago and announced she had been diagnosed with cervical stenosis. Initially I freaked, as my understanding of this problem was minimal and is part of my motivation to write this article.
Yet, as I opened my awareness and began working with the layers of connective tissue and muscles of her neck and shoulders, I felt guided by her body's innate sense of what to draw from my library of skills at the time. She felt better and I learned a lot. And during the past decade, I have experienced an increasing number of clients whose chronic problems lead back to this C4-5-6-7 neurological relationship as a significant slice of the body's homeostatic pie.
Each of you has developed your own library of skills. Trust that your clients will evoke from you the best you have to offer. It is not technique but "intention" that opens the door to using your perception and kinesthetic instincts as therapeutic aides. Extend your awareness to the inside of their body. Centering yourself with them in embodiment, occupancy, congruence and presence invites their body to guide you.5
What I hope you will hold in your awareness at the end of this article, and any that follow, is the prevalence of progressive cervical stenosis and your consideration of it as a likely contributor to your clients' chronic somatic complaints. I also hope you will consider its possible contribution to diminished sensory and motor function of either the upper or lower extremities, and that you will develop a sense of when to refer clients on to physicians.
As in previous articles, I will make some speculative leaps into the underlying functional physiology of this degenerative progression. The distillation of information I wish to share will be broad brushstrokes because this diamond has so many facets and thus will be incomplete. But it will be a beginning.
The progression of cervical stenosis is quite similar to the gradual onset of gallbladder dysfunction in its progression toward disease, as it tends to fly under the radar of medical detection until more classic symptoms begin to point in its direction. Multiple sources suggest that in the early stages of cervical stenosis, it most often is asymptomatic.3,4 One reference suggested "symptoms are believed to develop when the spinal cord has been reduced by at least 30 percent."4
One of the principal factors to the narrowing of the central canal is spondylosis or osteoarthritis, with its accompanying disc thinning, bone remodeling, osteophyte and/or spur formation. This progression, coupled with the effects of congenital and/or accreted traumatic influences such as whiplash episodes or events involving cranial compression upon the neck, eventually can converge to further narrow the central canal and one or both of the foraminal openings for the exiting spinal nerves. Once sensory or motor function is affected, the term myelopathy is used. So, cervical stenosis progresses to cervical spondylotic myelopathy (CSM).
Myelopathy is distinguished from radiculopathy in that the pain or numbness patterns do not necessarily follow the commonly accepted map of the sensory nerve dermatomes. The pain and numbness of myelopathy tend to be more general. For example, broad areas of the neck, shoulder, arm, hip or leg are affected. And radiculopathy can coexist with myelopathy.3,4 For a quick review of the body's sensory dermatomes, please refer to Netter's Plates, pp. 150, 455 and 511.6
Quite often, the sensory or motor symptoms that do emerge during the progression from mild to moderate myelopathy do so insidiously. Among these may include:
The insidious part of these clinical indicators is that they come and go. Clients and their physicians often dismiss them as insignificant because they do go away. Instead of ignoring or denying these signs, we need to be part of our clients' early detection team.
Often, this collection of somatic complaints is filed away under the general heading of the aging process. The assumption that if something goes away on its own, there is no underlying pathological progression is one of my least favorite notions equaled only by the "oft-repeated saw" that children eventually will "grow out of" their somatic aches and pains and functional difficulties. And sometimes, a cigar is just a cigar. Either and both can be accurate given the mathematical curve of our genetic diversity. The important flag for our consideration is that when clients of ages 50 and older seek us out for assistance with their chronic problems, the progression of cervical stenosis is a possible and more probable part of the symptomatic puzzle.
When CMS is full blown, all of the above symptoms become exaggerated, more persistent and may include muscular atrophy of one shoulder, arm and/or hand and/or the emergence of an ataxic gait pattern. An ataxic gait pattern can have many expressions, yet typically is characterized by taking a step by lifting the advancing leg too high and then slapping it down to the ground. There often is an uneven spacing of steps and tottering or swaying also may occur. I personally observed one of my clients demonstrate the following: The affected leg is rigid and is swung from the hip in a semi-circle by the movements of the trunk. Then the patient leans to the affected side, and the arm on that side is held in a rigid, semi-flexed position.7 With obvious haste, I encouraged the client to seek a referral to a neurosurgeon even though they were able to walk out of my office with an improved gait pattern following our session. It is crucial that we recognize our role in referring clients.
It is estimated that approximately 80 percent of our aging population has some degree of clinical progression toward cervical spondylotic myelopathy.8 Mutiple sources note that "it is the most prevalent spinal cord dysfunction of people over 55 in North America."3,4 I find it interesting that in a parallel fashion, it has been speculated that 70 percent of the U.S. population over the age of 70 will experience gallstones and that these stones are estimated to take, on average, 11 to 25 years to become clinically obvious.9,10
Thus, my first speculative leap into functional physiology is to propose that gallbladder dysfunction and cervical stenosis may have an overlapping progression, as they share a common neurological junction at C5-6 related to the phrenic nerves, the brachial plexuses and C5-6 reflex arc's relationship to the same-sided sciatic nerve distribution.1,11 My clinical experiences do not imply any cause-and-effect relationship in a predictable sequence, but simply reflect the repetitive nature of what I have observed in my client population.
A female client who came to me following surgery for cervical myelopathy reported that most of her pre-surgical symptoms, principally left neck, right shoulder/scapular and same-sided hip pain, still bothered her, with the exception that her right shoulder and arm muscles had ceased their progressive atrophy and that she had been able to rebuild some of her strength and the general use of her right shoulder, arm and hand.
Over the next year, she committed to an extended series of treatment sessions. Her somatic complaints reduced considerably and her fine motor control improved. However, digestive complaints began to emerge. I encouraged her to return to her physician, requesting that they explore these symptoms. Long story short, her gallbladder was removed.
Her cervical myelopathy surgery was successful, as it did stop the progressive atrophy of her shoulder, arm and hand muscles. However, her cervical and shoulder pain, radicular arm and hand dysfunction and same-sided hip tightness continued unabated until she began treatment with me. Following the removal of her gallbladder, all of the above symptoms have diminished to more tolerable levels and she continues to receive periodic care.
Let us reprise: My intention in this first article is first, to highlight that there exists a little-recognized neurological relationship between the cervical reflex arc of C5-6 and lower extremity difficulties; second, to theorize that cervical stenosis progressing toward cervical spondylotic myelopathy may underlie many of the chronic somatic complaints that our clients bring to us either as a singular symptomatic etiology or in combination with other subtle progressions such as gallbladder dysfunction/disease; and third, to offer a listing of early indications of this progression so we may refer our clients for appropriate medical testing.
Additionally, I would speculate that as the population over the age of 50 continues to rise dramatically in our country over the next decade, we will have ample opportunity to be of assistance with clients experiencing this progression. I believe our profession will not only make a significant difference to improving the quality of life for our clients, but also can serve to educate our clients about the prevalence of this progression and encourage them to seek early detection through appropriate medical testing.
A caveat of perspective: Twenty years ago an MRI scan cost approximately $10,000, whereas today it runs approximately $1,600-$2,400 via insurance policies and can be done for $400-$700 in certain centers when direct personal payment is made. Encouraging our clients to seek such a diagnostic test may assist them in making important lifestyle choices and/or medical decisions.
In my next article, we will delve further into the many facets associated with cervical stenosis and its potential progression toward cervical spondylitic myelopathy.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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