resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols and treatment Timing: A course of treatments should be performed over a period of 12 weeks if possible. Microneedling should be performed once every two weeks.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
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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