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Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
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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