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A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
November, 2008, Vol. 08, Issue 11
The Pressurestat Model Explains the Craniosacral Rhythm
By John Rollinson, D. Eu, CST-D; guest author for John Upledger, DO, OMM
The Pressurestat Model illustrates the mechanism behind the circulation of cerebrospinal fluid through the semi-closed, hydraulic craniosacral system.Originally defined by Dr. John Upledger and a team of researchers at Michigan State University in the 1970s, the model explains the palpable, rhythmic expansion and contraction of the craniosacral system.
The brain and spinal cord are surrounded by cerebrospinal fluid (CSF). This fluid transports nutrients, hormones and peptides. It removes metabolic waste and toxic substances. It serves as a shock absorber, floating the brain to counteract gravity. It even influences respiration and cerebral blood flow, among its many functions. Given all this, it's easy to see how essential it is for CSF to flow unimpaired. If an area of brain tissue is even partially deprived of optimal CSF motion and flow, that area will be forced into some degree of functional compromise.1
Cerebrospinal fluid is held within the dural membrane that surrounds the brain and spinal cord. This tough, watertight sac takes the shape of the interior of the cranium and intervertebral canal. Though dura mater doesn't stretch much, this fluid container is flexible and allows for CSF pressure changes. When pressure increases, the dural membrane expands, and the bones of the cranium and sacrum move along with it. When pressure decreases, the reverse occurs.
This filling of the craniosacral system is known as flexion, and the emptying is known as extension. During flexion, the head becomes wider transversely and shorter in its anterior-posterior dimension. The whole body externally rotates and widens. After flexion, this motion passes through a neutral zone on its way into extension, during which the head narrows and elongates and the whole body internally rotates.
Under normal circumstances, the craniosacral system proceeds cyclically through flexion and extension at a rate of about six to 12 cycles per minute. We can feel this rhythm at various places on the body because "this whole-body response is probably due to the pumping effect of the cerebrospinal fluid upon the motor system ... which causes a rhythmical tonification and detonification of the myofascial system in response to rhythmically fluctuating nerve signals."2
Tracing the Flow of Cerebrospinal Fluid Through the Craniosacral System
So, we have a hydraulic system that surrounds the brain and spinal cord. To understand how it is semi-closed, we must first understand how CSF enters and leaves the system. Within the ventricles of the brain, you'll find a capillary network - the choroid plexus - that produces CSF. In essence, blood circulating through the choroid plexus is "turned into" CSF, which then enters the craniosacral system.
The choroid plexus has stretch- and compression-sensing receptors within the saggital suture of the cranium. As CSF is added to the craniosacral system and its volume increases, the dural container expands, spreading the bones of the head. The parietal bones then move apart and spread the saggital suture. When this happens, the whole neuromechanism signals the choroid plexus to stop or greatly reduce the production of CSF. As the fluid drains from the system, the dura and cranium shrink and the parietals come together, compressing the saggital suture. The pressure-sensing nerve endings connected to the choroid plexus then send a signal to resume CSF production and the cycle repeats.
Normally, the system seems to operate on a cycle of about six seconds; CSF is produced for about three seconds and then production ceases for about three seconds. This creates the rhythmical rise and fall of fluid pressure within the system.
From the lateral ventricles, CSF enters the third ventricle via the foramina of Monro, then the fourth ventricle via the cerebral aqueduct. The CSF then enters the subarachnoid space and the central canal of the spinal cord via the foramina of Luschka and of Magendie, where it joins the CSF that is already bathing the brain and spinal cord, and all neural tissue enclosed by the dura mater. The fluid then circulates down and around the spinal cord and up and around the brain.
Cerebrospinal fluid passes out of the semi-closed hydraulic system via folds - called arachnoid granulation bodies or arachnoid villae - of the arachnoid layer of the cranial meninges that project through the inner layer of dura mater into the venous sinuses of the brain.3 CSF is reabsorbed into the venous blood through these arachnoid villae, which are primarily in the saggital venous sinous.
Although the rate of reabsorption is fairly constant, it seems to be regulated (think of a car idling) by a cluster of arachnoid granulation bodies found at the anterior end of the straight sinus. From its position at the "crossroads" of the intracranial membranes, this cluster can become aware of any tension within the membrane system and may regulate the outflow of CSF accordingly.
To summarize in a different way, the craniosacral system is like a leaking toilet with the tank cracked into pieces and lined with a giant exam glove (which is the dural membrane). The float-switch in the toilet tank is the saggital suture, which causes an inflow whenever enough water/CSF leaks away down the drain (sinuses).
Generating Whole-Body Effects
The craniosacral system is intimately related to the nervous, musculoskeletal, vascular, lymphatic, endocrine and respiratory systems. Just as abnormalities in the structure or function of any of these systems can influence the craniosacral system, abnormalities in or injuries to the structure or function of the craniosacral system can have profound and deleterious effects on the development or function of the nervous system, especially the brain.4
There are also ways in which the craniosacral system directly influences important, ongoing physiological processes. For instance, the continuing rhythmical movement of the system may serve to "milk" the pituitary gland and affect the neuroendocrine system. The rhythmic motion may also be an important stimulus for the development of the brain. Similarly, the motion around the skull sutures may pump the newly formed red blood cells out of the flat bones of the skull and into the general circulation.5
Of course, any abnormality of the craniosacral system could impact the body or any of its parts through the central nervous system. Any deficiency in circulation of CSF could affect brain and nerve functioning. Any restriction of nerves passing out of the craniosacral system due to restrictions in the cranial sutures or membranes may affect their end organs. Thanks to the Pressurestat Model, we can see why.
Click here for previous articles by John Upledger, DO, OMM.
John Rollinson practices full-time in Northampton, Mass., and at several school clinics in the area. You can contact him at www.rosetrust.org.
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