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A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Fish Oil: A Key Component of 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?
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
December, 2008, Vol. 08, Issue 12
The Progression of Cervical Stenosis Toward Cervical Spondylotic Myelopathy (CSM), Part 4
By Dale G. Alexander, LMT, MA, PhD
There is an assumption that the progression of CSM emerges in males more often than females, according to my Google searches of the literature.1 My own clinical experience with clients since beginning to recognize and research this progression eight years ago is fairly 50/50 in terms of gender occurrence.
Richard MacDonald, DO, explains an osteopathic distillation in his functional anatomy courses suggesting that, based on his profession's cadaver studies, males have a tendency toward lower back weakness because the iliolumbar ligament generally does not extend to L4 as it does more typically in women. The inferred evolutionary implication of this anatomic difference is that this extended stabilization represents a pragmatic genetic selection providing women with more low back, pelvic stability for birthing a child. Correspondingly, the first rib and sometimes the second rib of most women tend to be less stable in their unifacet mooring to the T1 and T2 spinal vertebrae.2
These anatomical gender-specific differences have been cited as a possible explanation as to why males experience more low back pain and dysfunction, while females tend to experience more craniofacial, neck and upper extremity pain and dysfunction. A further inference based on personal speculation is that these gender differences have functioned in our human evolution as sexual stimuli - the quality of power that is reflected in the strut of a male as he walks and the elevated positioning of the breasts in females. Nature is relentless in its drive for the genders to notice each other and to reproduce. In my opinion, both of these anatomic tendencies can feed into the eventual expression of CSM.3
The principle assertion in the orthopedic literature is that men have larger cervical vertebral bodies relative to the space for the spinal canal (canal/body ratio) that may encroach upon the circumference of the spinal canal more easily than for females; thus they have a greater tendency to exhibit the more acute symptoms of CSM. In numerous Google searches, I was unable to verify with recent studies that this gender difference in etiology is generally accepted. My speculation is that CSM is simply less often diagnosed in females because it is more often diagnosed in its acute expression in males. The orthopedic notion that a congenitally smaller spinal canal in either gender is highly correlated to the expression of CSM was verified.
Let's now add to the theories about how and why CSM begins and progresses, beginning with the obvious - the carriage of the head. Wherever the head goes, the rest of the body must follow.4 There exists within human neurology an exquisitely fine-tuned sense of tracking where the head is in relationship to the field of gravity. The subcortical flexor/extensor relationships are intimately linked to two of nature's most crucial imperatives - "don't fall" and "live long enough to reproduce." The writings of Thomas Hanna are one of the few places where you will find a comprehensive description of these righting reflexes.5 With gratitude, I had the opportunity to study and receive many treatments from him shortly before his too-youthful passing.
What I have found to be missing in the orthopedic theories of CSM are four principles of anatomy and physiology that have evolved from my trainings and my clinical experience with clients:
Based on my clinical experience, what is totally neglected is the capacity of the esophagus to pull the head down onto the neck and thus add direct compression to the cervical discs. The fascial mooring of the esophagus, the pharyngeal raphe, attaches to the basilar portion of the occipital bone just posterior to the sphenobasilar junction.9 The influence of a shortened esophagus is completely overlooked in most whiplash/impact injuries and as an influence in progressive anterior kyphosis of the spine. Additional soft-tissue structures that I find to be locked in a state of contracture or spasm include the CSMs, the longus colli muscles and the scalenes. Diaphragmatic and iliopsoas contracture or spasm adds strain to the extensor musculature.
The most commonly spoken somatoemotional statements of my clients over the years mirror this strain pattern. These include that someone or some situation is a prevailing "pain in the neck," that they feel an overwhelming sense of pressure within their body, or that they feel "all twisted up inside." Trace the pattern down and forward from the neck ... pressure strains the cervical vertebrae given its build-up within the thoracic and abdominal/pelvic cavities. The gut tube is suspended directly from the craniocervical junction. Both of these influences are speculated to directly contribute to the how and why cervical stenosis can progress toward spinal cord compression and CSM symptomatic expressions. I am admittedly postulating an interface between anatomy, physiology and consciousness, so please do consider these as theories.
In part 2 of this article series, I encouraged you to release the tension and lengthen the fascia of any muscular structures that have attachments to the back and the front of the body, to ease the tensions of these myofascial elements. The sternocleidomastoid muscle is a clear example of this.
Massage therapists who desire to become more comprehensive in their work with clients need to seek out training in how to therapeutically work with the visceral suspension of organs and also explore how consciousness can participate in escalating the tensions of visceral organs themselves, thus adding a significant strain to the musculoskeletal system. The educational resources that provided me with such training gave me dynamic insights, leading to my most significant leaps in comprehension of how the dance between psyche and soma expresses itself. (Contact me for information on educational resources.)
My intention has been to draw open the curtain of CSM neurological progression, which is highly correlated to diminishing the quality of life during the aging process and is often not considered, diagnosed or treated until it reaches an acute expression. Many clients will end up on your doorstep in the early and moderate phases of the progression.
In conclusion, the possibility that CSM may underlie many of the chronic somatic complaints of our clients ages 50 and older is what we want to anchor in our awareness. Do remember to inquire as to whether the client has or is currently experiencing any difficulty with urination, ranging from urgency to difficulty initiating a stream. Share with them that it is your understanding that an inability to interrupt the urinary stream is one possible clinical indication that warrants a visit to their physician.
The somatic complaints of CSM tend to come and go, sometimes being expressed in upper extremity problems and then switching to lower extremity difficulties commonly expressed as sciatic pain or the internal feeling of heaviness in the thigh or leg. Often they will bounce back and forth between the upper and lower extremities. As noted in earlier articles, when the complaints involve the same-sided upper and lower extremity, there is a high probability that the CSM progression is expressing itself. Another significant caveat is that in a study that followed patients who had undergone surgery for CSM, the degree and longevity of a successful outcome was based on the symptom profile being discovered earlier than later in its progression.10
Our job is to enhance both the functional capacity and coordinated mobility of our clients. This translates into quality of life. Allow your perception to become a therapeutic modality. Sense, feel and touch from the "inside-out." When I teach classes, I often draw upon an agrarian analogy that emerged early in my career - we plow the field, plant the seeds, weed the field and sometimes are there to assist in the reaping of a harvest of healing. May this continuum reflect your daily opportunity with clients.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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