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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.
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.
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.
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.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
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).
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
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.
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.
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.
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.
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%.
May, 2008, Vol. 08, Issue 05
The Controversy of Cranial Bone Movement
By Lisa Johnson Zee; guest author for John Upledger, DO, OMM
Editor's note: Dr. Upledger has asked guest author Lisa Johnson Zee to share her thoughts on cranial bone movement in this month's column.
In anatomy and physiology, I learned that cranial bones fuse in early adulthood or childhood.1 Gray's Anatomy supports the theory that the sutures grow together, creating a solid mass of bone called the calvarium. The fused skull functions as a helmet in which volume or pressure changes in blood, cerebrospinal fluid (CSF) or brain tissue cause corresponding pressure changes in other systems to prevent an increase of intracranial pressure.
However, there is a sizable body of literature that documents a small, rhythmic movement of the cranial bones. The bulk of these studies come from the cranial osteopathy medical field. The following is a synopsis of some of these studies.
Tettambel used force transducers to measure movement between the frontal bone and bilateral mastoid processes of the temporal bone in 30 subjects.2 She recorded three rhythms including the cardiac and respiratory rhythms. She hypothesized that the third pulse, which averaged eight cycles per minute, was the craniosacral rhythm.
Frymann studied the rhythmic changes in the circumference of the head using a U-shaped frame with a differential transducer.3 Changes in the diameter of the skull were measured by the displacement of metal rods. This study is unique because it measured movement in live human subjects. Frymann found a pulsating rhythm between six and eight cycles per minute separate from cardiac and respiratory rates. The amount of displacement was measured between 10 and 30 microns.
Another study by Adams, et al., looked at parietal bone mobility in cats.4 These researchers fastened strain gauges to feline parietal bones to measure movement when injections of artificial CSF were given. The bones moved significantly, varying from 17 to 70 microns. External lateral head compression caused a measurable widening of the sagittal suture with an inward rotation of the parietal bones.
Researchers at the University of Michigan College of Osteopathic Medicine have looked at cranial bone mobility in adult primates.5 Michael and Retzlaff used a direct screw attachment on the right parietal bone and measured movement with a pressure transducer. They also measured blood pressure, heart rate and respiration rate. The parietal bones moved spontaneously in two distinct rhythms, one corresponding to the respiration rate and a second, slower rate of five to seven cycles per minute.
These four studies indicate cranial bones may show a slow, steady, cyclical movement. A relatively new theory for Western medical science, it represents a dramatic shift. Bringing controversial ideas into the status quo of scientific thought is not easy, but the body of literature supporting cranial movement is growing. Although inconclusive, it deserves to be approached with an open mind.
In CranioSacral Therapy (CST), the rhythm of CSF can be palpated at all parts of the body due to the passive action of fascial connective tissue. The rhythm occurs in two distinct phases: flexion (outward movement) and extension (inward movement). In physical therapy terms, flexion is a decreasing measurement of degrees in the angle of the joint. The sphenobasilar joint is where the posterior sphenoid articulates with a ridge on the occipital bone.
When Dr. William Garner Sutherland, the "father of osteopathy," palpated the movement of these bones, he noticed this joint does indeed flex or reduce angle size on the inferior side. The flexion of this angle is accompanied by subtle outward movement in the body, which Sutherland called flexion. Therefore, in CST, the cranium, along with the rest of the body, is in flexion when it widens and in extension when it narrows.
Anatomy of Suture Closure
To discover more about cranial bone motion, let's examine the nature of cranial sutures. If the sutures remain flexible throughout adulthood, some degree of motion is possible when driven by pressure changes in the craniosacral system. If the tissues fuse and become immobile, rhythmic motion is unlikely.
Several studies have examined the nature of the cranial sutures. Retzlaff, et al.,used light and scanning microscopy to examine tissue samples of adult primate sutures.6 They found connective tissue, blood vessels and nerve fibers present in the sutural space. They described a five-layered pattern of fibers and cells containing collagenous bundles. Tissue was reported to be arranged in a wavy pattern. The researchers hypothesized the purpose of the tissue might be to control the elongation of the collagen bundles. They reported no evidence of fusion in the adult primate sutures.
In a separate study, Upledger and Retzlaff examined the sagittal suture in primate skulls.7 They found not only connective tissue, but also a vascular network and neuronal plexuses and receptors in sutural tissue. In one specimen, they were able to trace a single dendrite through the dural membrane into the brain, terminating in the third ventricle containing CSF. Further study of this neural tract may bring answers to how the homeostatic feedback mechanism in the brain's CSF hydraulic system functions.
In the 1920s, Todd and Lyon published two articles examining a timeline of sutural closure in the male human skull.8 These researchers hypothesized that cranial sutures fuse at some point in the human lifetime. They started with 427 specimens, but rejected 81 due to abnormal suture closure or "delayed union." Furthermore, some of the skulls were termed lapsed union, which meant failure of the suture to close due to a concentration of bone along the edge of the articulatory surface. For reasons unclear, they counted these skulls as fused, which biased results toward earlier suture closure. The data they found is as follows:
The authors concluded that the sutures tend to close along this timeline. However, there is a high degree of variability reported. This study also was conducted some 80 years ago. Standards of protocol in scientific research have changed.
Researchers have studied one suture in-depth using different human specimens. Kokich examined one suture in the facial area - the frontozygomatic suture.9 Of his 61 specimens, he found none demonstrated closure until after age 80, and some weren't completely fused even after age 90. He noted that bony interdigitations formed along the suture with advancing age, but did not affect the patency of sutural movement. Kokich, like Retzlaff and Upledger, found clear evidence of collagen fibers within the suture. He stated that frontozygomatic suture remains a functioning "articulation" until late in life.
A conclusive statement about whether and when sutural fusion occurs cannot be made from existing research.10 Clearly the subject remains open for debate. Having palpated the craniosacral rhythm with my own hands, I believe cranial sutures maintain flexibility that might best be called articulation. This flexibility allows the bones to move passively as they are driven by the craniosacral system.
Click here for previous articles by John Upledger, DO, OMM.
Lisa Johnson Zee is a clinical supervisor and instructor in the Communication Disorders and Sciences Program at Southern Illinois University Carbondale. She is certified in CranioSacral Therapy Techniques through The Upledger Institute. Her other interests include complementary and alternative medicine, traumatic brain injury and bilingual Spanish/English therapy.
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