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Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
May, 2009, Vol. 09, Issue 05
The Progression of Airway Obstruction
By Dale G. Alexander, LMT, MA, PhD and Thomas M. Walsh II, DDS
Subtle progressions that reduce the quality of our clients' lives and contribute to many of our clients' chronic somatic problems continues as a theme for this column. Thomas Walsh, DDS offers his 33 years of clinical experience as a general dentist and extensive orthodontics training to bring to light the progression of airway obstruction.
Air is one of our greatest needs for survival as human beings. The "airway is the tube" through which we breathe. It begins at the opening of the nostrils and continues all the way to the lungs. Visualize this tube as the snorkel through which we breathe. The diameter, shape and volume of this tube regulates the rate of exchange between oxygen entering the lungs and the exiting of carbon dioxide out of the lungs. A large diameter airway encourages an easy passage of air whereas a small diameter airway generates a greater resistance to airflow in both directions.
This essential airway tube is formed in utero and continues to develop from infancy until the teenage years. The airway is comprised of multiple spaces including the: nasal chamber; sinuses; and the upper, middle and lower pharynx. In normal growth, these chambers need to form in proportion to the size of the individual. That is to say that one needs a tube to breathe through that is large enough in diameter to support respiration during sleep and daily activity. The genetic design (preprogrammed in our DNA) mediates the enlargement of the bones, muscles, connective tissue etc., of our face and throat, to provide room for these spaces of the airway.1
Unfortunately, many times this airway tube does not form properly. A malformed airway can wreak havoc with muscle tone and head position. Research has clearly correlated head posture with mandibular position and temporomandibular joint disorders.2-7 Many of your clients will likely have these problems. They may complain of pain in the following muscles: masseters, sternocleidomastoid muscles (SCMs), trapezius, scalenes, splenius capitis and cervicis, medial and lateral pterygoids, temporalis and even the muscles of the low back. Simply put, if an airway is obstructed, a person will instinctively modify their muscle function to optimize or open the airway. This postulation reflects the essence of the Inside-Out Paradigm.
Clients rarely sense that they have a problem with their airway. (Dr. Walsh: "After 33 years of practicing dentistry, not one growing child or adult client has ever reported to me that they have a small airway.") The development of the airway is controlled by the autonomic nervous system of the growing child. Nature (your biologic engineer) detects this progressively developing constriction in the airway and makes alternate plans involving compensatory patterns of the musculoskeletal system.
For example, if the constriction is in the nasal cavity, the growing child will start to breathe through the mouth instead of the nose. The muscles of the face will pull open on the lower jaw, the mandible, and redirect the growth of this mandible to a more vertical or open position.8 If the airway obstruction occurs in the middle to lower oral pharynx (throat) the individual will likely extend their head forward to help open this airway tube.9-11 Again, this occurs without any conscious awareness within the individual. The head has now extended forward beyond the normal plane of vertical posture.
Forward head posture is very common and easily misunderstood. It is the opinion of these authors that many cases of forward head posture relate back to early childhood airway disorders, and improper muscle function of the oral cavity and have been clinically correlated to a congenitally short or an emotionally reactive esophagus.12
That being said, it is very difficult to separate the primary cause or etiology. We have the case of the proverbial chicken and the egg scenario, i.e., which came first? For some individuals the muscle function was altered first and in other children the airway obstruction occurred first.
There are many contributors to airway obstruction. Common influences include the following: improper swallowing habits developed from bottle nursing, air pollutants, food allergies, junk foods, broken nose, deviated septum, improper growth of the jaws (the maxilla and mandible), improper tooth position, imbalanced facial muscles, oral habits such as thumb sucking and many more. The thread that links all of these issues to you and your practice tends to be the compensatory forward head posture and associated muscle pain.
Feel this. Your head weighs about 12 pounds much like a bowling ball. Imagine if we placed a stick inside the hole of the bowling ball. Supporting this ball would not be difficult assuming the stick were directly under the bowling ball. Now, let's extend the bowling ball (your head) out beyond the stick (your spine) at a 45-degree angle. Suddenly the force on your spine from your head is dramatically increased. Forward head posture associated with airway obstructions places your neck and shoulders at a leverage disadvantage. It is reasonable to expect cervical bone remodeling and muscle pain to occur over time.
Airway obstructions and improper oral muscle balance commencing near infancy or in a growing individual have been linked to many systemic disorders later in life. These include the following: dental malocclusions, TMJ joint disorders, distorted faces, obstructive sleep apnea in children and adults, bed wetting, migraine like headaches, neck and back pain, lower IQ, stunted growth, criminal behavior tendencies, heart damage and increased risk of heart attack, arteriosclerosis and atherosclerosis, stroke, acid reflux and digestive disorders, anxiety and depression associated with lack of proper REM sleep, increased risk of occupational accidents and the list goes on.13-18
The following images graphically display the difference between normal and obstructed airways. These images have been acquired through cone beam imaging technology similar to CT scanning but with dramatically reduced radiation exposure as part of a comprehensive dental examination to evaluate patients for temporomandibular joint, orthodontic and sleep disorders. Figure 1 depicts the size and shape of a normal airway from a side view (coronal) and figure 2 from a cross-sectioned view looking downward (transverse). Notice the area identified by the pointer. Figures 3 and 4 demonstrate the reduced airway from both a coronal and transverse view. Note the constriction of the airway.
The diameter of the constricted airway is equivalent to the diameter of drinking through a straw. "Imagine the experience of breathing through a straw" all day. This client was completely unaware of any obstruction in the airway yet suffered from many clinical symptoms including lack of sleep, grinding of their teeth, pain and spasms in the neck and shoulders.
In summary, many of our clients suffer from airway obstructions that progress and worsen through life. As massage therapists we see many individuals with underlying problems as have been described here. Clients with head and neck pain including forward head posture are likely to have airway obstructions and are at risk for obstructive sleep apnea, a known contributor to decreased quality of life and reduced longevity. Your sharp observations can actually save lives.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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