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Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
January, 2009, Vol. 09, Issue 01
Recognizing Baker's Cysts
By Whitney Lowe, LMT
The practice of massage therapy helps develop outstanding palpation skills for the practitioner. One of the great advantages of improved palpation skills is the ability to identify structural abnormalities under the skin before the client might be aware of a problem even existing. Many of these structural abnormalities may not even be painful. It is still important to be aware of those that are not painful because they may be an indication of an underlying pathology that could cause problems later on.
One such condition that may be evident during massage of the lower extremity is a fluid-filled cyst called a Baker's cyst or popliteal cyst that develops in the posterior knee region. Most Baker's cysts are benign, but they can cause pain and are frequently an indication of other pathologies so it is important to properly identify them.
Baker's cysts are the most common cysts found around the knee and the most common cysts lined with a synovial membrane anywhere in the body. They develop posterior to the knee joint and are usually found directly behind the medial femoral condyle between the medial head of the gastrocnemius muscle and the semimembranosus tendon. The cyst fills with fluid and becomes a palpable mass in the proximal posterior calf.
Baker's cysts may develop for a number of different reasons, but the cause is not always clear. There seems to be a correlation between the development of a Baker's cyst and the presence of other knee pathologies. For example, these cysts routinely occur after conditions such as osteoarthritis, rheumatoid arthritis, gout, meniscal tears, cruciate ligament tears, or osteochondritis dissecans have occurred in the knee. The reason they develop after these conditions is not entirely clear, but since the lining of the cyst is intimately connected with the joint capsule of the knee, irritation of the capsular tissues may have something to do with it.
The Baker's cyst has another interesting structural feature. Examination of the cyst reveals there is a one-way valve system that communicates between the capsule and the cyst. The cyst develops as a fluid-filled pouch of capsular tissue, but there is not a free exchange of fluid between the cyst and the internal knee structures. The one-way valve only lets fluid pass from the internal knee joint into the cyst. This is one reason for so much fluid accumulating in the area. As fluid develops within the cyst, it may press on other structures in the region and produce pain. Presence of the cyst behind the knee is also likely to prevent full flexion of the knee and may cause some discomfort or limitation to full extension.
There are a number of fluid-filled cysts that occur in different regions of the body, such as the ganglion cysts found around the wrist. A primary focus of treatment for these cysts is aspiration, or drawing the fluid out of the cyst. With Baker's cysts, aspiration is not performed because the fluid is much thicker and can't be drawn through the narrow diameter of a needle during aspiration. Treatment usually relies on conservative approaches such as rest from offending activities, thermal therapies including both ice and heat, and nonsteroidal anti-inflammatory medications (NSAIDS). The rationale for some of these approaches, such as heat or ice, is not entirely clear and is rarely given.
Since the Baker's cyst is often the result of some other pathology associated with the knee joint, it is important to address that underlying pathology. In many cases, the Baker's cyst will resolve on its own if the original problem can be resolved.
There is no benefit to treating a Baker's cyst with massage. Because it is a fluid-filled mass with a one-way valve, mechanical pressure on the cyst will not do anything to help the fluid move out of it and may, in fact, irritate the problem further. Most massage practitioners are cautious about pressure to the posterior knee region due to other delicate neurovascular structures in the region. This caution is warranted, as pressure behind the knee can damage these tissues.
Sometimes, more advanced practitioners may attempt treatment of some of the important muscles in this region, such as the popliteus and plantaris. Because the bellies of these muscles are only in the posterior knee region, they are difficult to treat in any other way. Putting further pressure on a Baker's cyst in this region could occur when attempting to treat one of these deeper knee muscles, and could aggravate the cyst. However, the palpatory skills of the massage practitioner frequently help to identify the tissue abnormality so the person can be referred to someone who can more accurately identify and treat the problem. Other conditions such as deep-vein thrombosis or popliteal aneurysms can also produce similar symptoms, and these problems are all serious enough to warrant referral to another specialist.
Click here for more information about Whitney Lowe, LMT.
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