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Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
July, 2008, Vol. 08, Issue 07
The Progression of Cervical Stenosis Toward Cervical Spondylotic Myelopathy(CMS)
By Dale G. Alexander, LMT, MA, PhD
In my previous article you were invited to consider the following points regarding the potential for cervical stenosis to progress toward cervical spondylotic myelopathy (CMS):
This article expands on the clinical indications with which we need to become more familiar, the theories that exist describing why and how this progression may occur, and some hands-on suggestions for what I have found to be effective in assisting clients exhibiting the early and moderate stages of the progression of CMS.
However, at a certain point in this pathological progression, surgery does appear to be the best remedy. I have worked with two clients who needed surgery for advanced CMS, with positive results. I was unable to stem the tide for both of them. My best efforts and all the research I have done failed to prevent its progression. Many other clients have now identified this progression and are proactively adjusting their lives with common sense and grace to maintain their quality of life. They have been my teachers.
Let's begin by further elaborating the many possible somatic indications that might highlight this progression. The number-one tipoff to my sensibilities is when a client presents with a history of same-sided somatic complaints of the neck, and upper- and lower-extremity pain or dysfunction, including sciatica. The possible somatic combinations are quite varied. When the pain or dysfunction is on the same side, this is my clinical flag. Another subtle clue a client might not volunteer is occasional or frequent urgency or difficulty with urination.
Just today, a client (an orthopedist specializing in knees, shoulders, and sports medicine) who underwent surgery for CMS recounted that his fellow spinal surgeons have suggested to him that when an individual experiences an inability to stop their urinary stream, this is one of the reliable indicators the progression of CMS has become clinically significant.2 The following paragraphs offer three different sets of symptomatic indicators that might trigger your perceptions as to the varied functional expressions of this progression.
One medical journal article offers the following concise description of CMS: "Patients will generally report neck stiffness, a unilateral or bilateral deep aching of the neck, arm or shoulder and possibly stiffness or clumsiness while walking. CMS usually develops insidiously. Other common complaints include crepitus in the neck with movement, occasional stabbing pain into the arm, elbow, wrist, or fingers or report a dull achy feeling into the arm with intermittent numbness or tingling into the hands. The hallmark symptom of CMS is weakness or stiffness in the legs. Patients with CMS also might present unsteadiness of gait. Weakness or clumsiness of the hands in conjunction with the legs also is characteristic of CMS. Loss of sphincter control or frank incontinence is rare, however, some patients complain of slight hesitancy on urination."3
Another medical article references the following additional symptoms:
Myelopathy is distinguished from the many forms of radicular pain in that the discomfort is more generalized and doesn't necessarily follow the established, generally accepted sensory and motor maps for dermatomes (skin) and myotomes (muscles).
Finally, another medical article references the typical symptoms in yet a different fashion:
Alhough CMS is painless in more than 50 percent of patients, when pain is present, it might be described as a stabbing, burning sensation or a persistent dull ache radiating throughout the arms to the forearms. At times, the pain will extend into the fingers, associated with "pins and needles" paresthesias. Patients often comment about dropping objects accidentally or having trouble fastening their clothes. If prolonged, there might be associated muscle wasting and overt loss of sensation to vibration, pinprick sensation, pain and thermal sensation. As the impairment to spinal cord function progresses, both legs weaken and become progressively spastic. Bowel and bladder control subsequently may be altered. In advanced cases, gait will become progressively more difficult without aid by a cane or walker.5
The above descriptions reflect some of my own somatic complaints. You may find they describe some of yours as well. Let's be real. A fair number of us within our profession are going to be part of that 80 percent of the population who experience somatic complaints of this progression. Some of these indications began popping up for me in my mid-30s, whereas now, at age 55, I experience them more often. To the best of my memory, the occasional clumsiness in my general balance was the first indication to attract my attention at about age 35. Admittedly, my accumulated trauma history is well beyond the average and yes, I have scheduled a cervical MRI.
Obviously, these identical somatic complaints might be indications of other forms of pathological progressions. I have listed these in the Appendix for your further consideration. More acute presentations of CMS often include visual disturbances and bilateral pain symptoms, similar to the early and moderate stages of multiple sclerosis.2
We all know our role as massage therapists is not to diagnose anything, but rather to encourage our clients to seek medical attention that might provide them with the timely opportunity to make appropriate lifestyle or medical choices. We are part of our clients' early detection and prevention team. Aging occurs within all of us and injury strikes some of us. Not everyone is dealt an equal hand in the genetic shuffle of the cards. Early detection and prevention are our best hedges to maintain quality of life.
According to Rene Calliet, MD, cervical spondylotic myelopathy (CMS) was distinguished from myelopathy in 1956, based on the presence of acute disk prolapse. The principal pathology is encroachment of bony protrusion(s) into the spinal canal, the intervertebral foramen or foraminae, or both. The resulting encroachment might apply direct pressure to the spinal cord itself and/or to one or both of the exiting spinal nerves.6
Let's now review the general theories offered to explain how the progression of CMS might occur. Most common among the references I have gathered is the notion of a congenitally narrow spinal canal. Such a diminished diameter for the spinal cord accentuates the probability of eventual stenosis and myelopathy, and hastens its clinical expression.
The second most offered theory, which builds on the first, is that nearly all of us eventually develop some degree of arthritis (spondylosis) between our cervical vertebrae, most commonly between the C4-7 levels of the spinal cord. Such spondylosis often is accompanied by varying degrees of osteophyte/spur formation, disc thinning and desiccation, disc protrusions/herniations, vertebral remodeling, and compression of the foraminal openings through which the spinal nerves deliver their electrochemical vitalization to their somatic and visceral end organs.
The third most cited reason for this central compression of the spinal cord is related to traumatic cranial/cervical events with their resulting vertebral subluxations and scar-tissue formation. The effects of wear and tear of repetitive head/neck movements also are cited as contributing to and hastening the clinical expression of symptoms.
Additionally, the thickening of the ligaments surrounding the spinal canal, including the pleating of the ligamentum flavum and the ossification of the anterior or posterior ligaments, is proposed as a contributor to spinal cord compression. The latter notion of ossification of the posterior longitudinal ligament has a particular designation of OPLL and more often is appreciated in the non-Asian population.5,6
Vascular insufficiency and edema also are considered part of the degenerative progression, usually thought to be associated with this fibrosis of ligaments, as they might affect the anterior and posterior spinal arteries that supply the spinal cord.7
All of these notions have obvious merit and make sense logically, yet, in my opinion, there seem to be missing pieces of the puzzle. It is a "both/and" rather than an "either/or." Not a right or wrong. The body is both complex and quite simple, simultaneously. In my experience, there rarely is a singular causative agent in chronic somatic profiles. Rather, there are multiple streams flowing into a river of unrelenting somatic expression. My next article will propose some additional streams I believe also contribute to the progression of CMS.
Clinically, what has made the most sense to me is that most of our internal visceral organs are anatomically suspended forward and down from the spine and cranium. I owe a debt of gratitude to Dr. Jean Pierre Barral, DO, the developer of visceral manipulation, and to Jon Zahourek, the developer of the manikin style of anatomy study, for illuminating this elegantly simple aspect of human anatomy.8,9
Thus, what I have consistently observed is that relieving the forward and downward pull of the head and neck upon the trunk can assist clients. This might be accomplished by releasing the tensions associated with the suspension of the viscera themselves and by attending to the musculoskeletal flexor muscles, especially those whose attachments span from the posterior aspect of the body to an anterior mooring.
I would encourage you, by whatever style of bodywork and massage is your training base, to release the tension and enhance the fascial ease of the SCMs, the scalenes, the longus colli, the muscles of the jaw, the subclavius muscles, the pectoralis minor muscles, both sides of the diaphragm muscle, the rectus abdominus, the iliopsoas muscles, the piriformis muscles and the rectus femoris muscles, and to enhance the range of motion of your clients' ankles.
Releasing any existing tension of muscular contracture and enhancing the fascial ease of these flexor muscles will reduce the forward and downward pressure on the neck, and will soften the need for the extensor musculature of the posterior neck and upper back to develop varying states of contracture or spasm. Additionally, I recommend attending to the ease of the body's transverse diaphragms at C0-1/2, C7, T1-2, T12-L1 and L4-5/S1. It is through these transverse diaphragms that lymphatic and circulatory flow most often is impeded.10 Also, apply your experience and knowledge of enhancing blood flow to the cervical vertebrae. This is a significant approach through which we might offer some assistance. It is not about technique, per se, but rather where we place our attention and intention, mediated by the quality of our touch. Place your attention and intention inside the body. Work from the "inside-out."
Appendix: Conditions That Mimic Cervical Spondylotic Myelopathy on Presentation2
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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