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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.
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.
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.
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.
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 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.
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.
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.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
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.
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.
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.
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).
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.
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).
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
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.
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.
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.
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%.
September, 2008, Vol. 08, Issue 09
Early Hours and Shortened Muscles
By Keith Eric Grant, PhD, NCTMB
Getting up too early is a vice habitual in horned owls, stars, geese and freight trains. Some hunters acquire it from geese and some coffee pots from hunters. It is strange that of all the multitude of creatures who must rise in the morning at some time, only these few should have discovered the most pleasant and least useful time for doing it.Orion must have been the original mentor of the too-early company, for it is he who signals for too-early rising. It is time when Orion has passed west of the zenith about as far as one should lead a teal.6
- Aldo Leopold
Back in my college days, I managed to fulfill my biology requirement while escaping hours looking through a microscope by taking a couple of university-sponsored field trips: one to Death Valley, Calif., and the other to Sequoia National Park. During the day, we students would follow professors around listening to them talk about the local mammals, insects and minerals. In the evening hours, among other activities, were some readings from different naturalists. Thus, I became acquainted with Aldo Leopold's A Sand County Almanac and his paragraphs on getting up "too early." Although Leopold was a few decades too early to note it, the quiet, semi-dark hours of the early morning also is a time many runners, including myself, prefer. Runner and writer Joe Henderson expresses well the draw and the disadvantages of rolling out of bed for a run:
After some hours of sleeping and not using our muscles, they often are shortened and unprepared for full exertion or full range of motion. The exertions of the previous several days find their revenge in those first minutes of active wakefulness. This leads us to warming up, cooling down and stretching, which often is an anything but simple discussion. The complexity is exemplified by a "debate" on passive stretching and injury prevention that was hosted in the Journal of Bodywork and Movement Therapies a few years ago.3 Having a dozen authors and an editor involved is, in itself, an indication of the ranges of opinion. A thorough review of stretching is beyond the scope of a short column. For this, I'll refer you to the works of Brad Appleton2 and Michael Alter.1
Some of the complexity around stretching can be at least narrowed, I believe, by looking at contexts and immediate goals. The goal upon getting out of bed for a run, for example, is not to extend one's long-term flexibility but to regain the short-term range of motion (ROM) necessary to begin running without immediate injury. Assuming you possessed this ROM before sleeping, the shortness is going to be an issue of muscle hypertonicity rather than one of actual tissue length. The immediate cure is controlled movement through an increasing ROM, until you reach your homeostatic ROM. The movements both relax the shortened muscles and, by stimulating release of synovial fluid, prepare the involved joints for movement. Essentially, the same goals would apply for pre-event sports massage. It's about facilitating movement within the athlete's normal ROM.
What remains are the effects and benefits of longer-term stretch programs. Michael Alter comments that the most important component of muscle related to ROM is the connective tissues that develop and surround the muscle at its various levels of organization.1 He presents an "overstretching principle" as an analog to the overtraining principle:
By the "overstretching principle," Alter is noting that the tissue both accommodates in length to the regular stretching and in its patterns of neural response. In response to stretching, the muscle-tendon unit becomes more "compliant" (i.e., easier to stretch). Witvrouw, et al., comment that some of the literature disagreements on stretching may result from not considering the types of sports activities.7 They note that sports involving bouncing and jumping, with a high intensity of stretch-shortening cycles (SSCs), require a muscle-tendon unit that is compliant (stretchable) enough to store and release the high amount of elastic energy that benefits performance in such sports. Sports that contain low-intensity of limited SSCs don't require the same compliance, making stretching to increase compliance less beneficial.
Another useful clue comes from Ingraham, who concludes stretching to increase flexibility beyond that needed for sport-specific movements might cause or augment the chance of injury, particularly if time spent in such stretching reduces time spent in general conditioning exercises.5
The pattern that emerges is that we need enough ROM to freely complete the movement a sport requires, but more flexibility than needed may only add instability. We need our muscles to be able to elastically respond to the stress placed on them, which is sport specific. Too little ROM or too little elasticity and we ask for trouble. Balancing strength, flexibility and our activities leaves us free to move - whether "too early" or when the sun is high.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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