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"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
Don't Trust What Your Patients Say
When a patient presents to the office for care, they typically have a specific complaint – lower back pain, whiplash, sinus congestion, sciatica, etc. They are often not interested or engaged in what they consider "unrelated" personal health history.
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
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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