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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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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).
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.
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.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
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%.
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.
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.
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.
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.
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.
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.
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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