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Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
Don't Trust What Your Patients Say
When a patient presents to the office for care, they typically have a specific complaint – lower back pain, whiplash, sinus congestion, sciatica, etc. They are often not interested or engaged in what they consider "unrelated" personal health history.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
February, 2009, Vol. 09, Issue 02
By Erik Dalton, PhD
Every year, more and more clients come in complaining of generalized pain around the kneecap (patella) aggravated by activities such as squatting, stair climbing, or hiking over hilly terrain. Symptoms typically worsen during prolonged knee flexion (i.e., long car rides, sitting in class or in a movie theater). Clients often carry with them a diagnosis of chondromalacia or patellar tendinitis. In most cases, neither of these terms accurately describes the cause of this painful condition, which remains elusive and poorly understood.
In attempting to discern the source of the client's pain, an important question is whether it primarily involves the surrounding soft tissues or the patellofemoral articulation itself. Some clinicians (including myself) tend to lump patella-related symptoms into a category of chondromalacia. Since most researchers agree that nerve endings are relatively absent in articular cartilage, chondromalacia shouldn't be labeled as the true anatomic cause of anterior knee pain.1 Chondromalacia is a surgical finding that denotes areas of softening of hyaline cartilage due to trauma or aberrant loading, but is not the cause of pain.
Oddly, this shiny, smooth tissue underlying the patella and covering the surface of the femoral head receives the most accolades as a knee pain generator but is possibly the least innervated of all human tissues. I don't mean to say that cartilage degeneration may not be a precursor to knee pain. Certainly, a roughened and degraded cartilaginous surface could impair mobility and joint function leading to irritation in surrounding tissues. But the anatomical source of pain in this area probably originates from compression and torsion to the richly innervated subchondral bone, infrapatellar fat pad, or medial and lateral retinacula.
I've had surgeons tell me that many of their non-traumatic, non-specific knee pain cases have been traced to pinching of the synovial lining between the patella and femur. They speculate that accumulation of inflammatory waste products leads to increased swelling and even greater synovial "nipping." But when it comes to understanding patellofemoral pain, no one can top this guy. In 2005, a surgeon and renowned researcher Scott F. Dye, MD, enlightened the orthopedic community in a rather unusual way. In a brazen experiment using no anesthesia, Dr. Dye, a long-time sufferer of patellofemoral pain, opened an incision in his affected knee large enough to insert a probe so he could test the sensitivity of various interarticular tissues. As he prodded the damaged hyaline cartilage beneath the patella, to his surprise, he found the tissue to be completely painless. But when the probe contacted the joint's synovial lining, the familiar pain he had been feeling for months screamed back at him. I encourage you to review this man's outstanding work in an article, "The Pathophysiology of Patellofemoral Pain: A Tissue Homeostasis Perspective."2
As the knee flexes and extends, the patella glides through the trochlear groove in the distal femur. (See Figure 1) This patellar mechanism enhances leverage of the quadriceps by improving the angle of pull on the tibia. Resembling a shim (the thicker the better), the patella helps push the quadriceps tendon further away from the tibia to allow for more powerful knee extension - and powerful it is. The forces executed during knee extension exceed all other body movements. Surprisingly, much of the literature implies that the patella moves only in an up-and-down direction when, in fact, it also tilts and rotates. Imagine the massive forces the patella must withstand during hill climbing or squatting. Pressures per square inch under the patella rise to more than three times the body weight when climbing a ladder and greater than eight times the body weight during various stages of deep squatting...whew!
Many believe that repetitive contact caused by maltracking of the patella is a likely mechanism of non-traumatic patellofemoral pain. Some of the factors believed to be the main culprits are: overuse or repetitive weight-bearing activities, arch variations - flat or high arches, wider hips and knock-knees (known as the Q angle), and lower limb muscle imbalances. Although I've had some success alleviating stubborn cases of patellofemoral pain using myoskeletal alignment and joint mobilization routines, I've found no consensus in the literature indicating that manual therapy procedures are of significant value. Regrettably, no solid (reproducible) research has surfaced to confirm that any type of medical or manual intervention is reliable. Having said that, I'd like to discuss a couple of strategies you might try when dealing with this illusive and pervasive condition.
Theory & Treatment
The therapist's treatment goal is to eliminate excessive compressive and/or torsional forces at the patellofemoral articulation. (Figure 2) Early in my days as a certified Rolfer, I'd place a dot in the middle of the kneecap and ask the client to slowly squat so I could observe the direction of the knee tracking. It was an interesting experiment trying to identify the painful knee strictly from my tracking observations. Surprisingly, I only got it right about 60 percent of the time so I abandoned the test and proceeded on to a more holistic evaluation that garnered better results.
One common structural abnormality that seemed to respond better than the rest is depicted in Figure 3. Basically, this drawing represents a person presenting with a pronated foot, internally rotated tibia, externally rotated femur and pelvic obliquity. As the tibia internally rotates, and the kneecap is being pulled laterally (squinting patella), strong torsional forces travel through the knee during gait. Tissue often builds up on the medial side of the knee as the stretch weakened vastus medialis recruits help from the adductor magnus muscle. Theoretically, during running, the person with this dysfunction would land on the lateral portion of the flat foot and roll inward, causing the lower leg to internally rotate. At the same time, vastus lateralis and iliotibial band (ITB) resist this motion by externally tugging on the lateral side of the kneecap causing increased friction between the patella and femur. Figure 4 shows an effective spindle-stimulating technique for tonifying the weakened arch muscles, mobilizing the ankle and foot, and correcting the internal fibular rotation.
When working properly, the patella acts as an efficient pulley system between the medial and lateral quads in leg extension and during deceleration of leg flexion. (Figure 5) Unfortunately, when massive lateral thigh muscles shorten and their fascial bags glue together, the medial knee musculature loses the patella-tracking battle. As the patella begins migrating too far laterally, the eloquently designed pulley system is compromised predisposing surrounding tissues to injury. Reciprocal weakness and loss of anti-gravity function in the foot and ankle's "stirrup spring system" (tibialis anterior and peroneus longus) produces painful compensations at the knee and hip. (See "Don't Get Married, Part 2" MT August 2008.) Foot pronation also interferes with precisely coordinated neurological movements during gait.
Neurologic coordination demands balanced and rhythmic lower extremity movement. An infant's "cross crawl" pattern organizes many innate musculoskeletal functions at the spinal cord level permitting a smooth cross-patterned gate without thinking about posture and conscious planning of each movement. But when a foot maintains prolonged pronation, many global and core muscles forget how to "turn on" and "shut off" in proper sequence. This leads to altered posture, excessive efforting during normal movements and "kinetic chain kinks" that often manifest in the knee. In Figure 6, a fibular mobilization technique is applied to help lift the lateral arch and restore functional balance between the tibia and fibula.
Myofascial manipulation and joint stretching routines designed to restore alignment, function and firing order are helpful, particularly when combined with home retraining exercises using elastic bands, loops and ball squeezes. Together, they can help correct aberrant tracking patterns decreasing the risk of injury. I find the vastus medialis a difficult muscle for clients to isolate so I recommend general quadriceps strengthening which includes a properly designed deep squat training program.
It's reasonable to blame much of the escalation of patellofemoral knee pain syndromes on our society's transition from a population of movers to a nation of sitters. The advent of chairs has been one of the major predisposing factors leading to the prevalence of knee, hip and back pain in modern man. The deep squat position used for working and resting was, and is, an extremely beneficial exercise. Millions of people in Africa, Asia and Latin American countries still practice this very therapeutic squatting position. Contrary to popular opinion, I believe deep squatting exercises performed correctly are a very therapeutic adjunct for preventing and rehabbing certain types of knee pain.
The deep squat is, perhaps, the single best exercise for leg strength and development. Squatting significantly balances the muscles responsible for knee and hip extension: quadriceps, hamstrings, and glutes, as well as the smaller stabilizing core musculature. It has benefits not just for strengthening, but for balance, cardiovascular capacity, and active flexibility. Knee injury usually results from varus or valgus force (twisting of the joint in either direction), inappropriate loading or forcible shear across the joint. It does not occur simply by taking the knee joint through a full range of motion using correct squatting exercises. As my grandaddy used to say, "Squats are the only thing standing between me and getting stuck on the toilet."
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