resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
July, 2009, Vol. 09, Issue 07
Spotlight on Palmaris Longus
By Judith DeLany, LMT
The forearms and hands are the most important tools used in massage therapy. Preventing the development of career-ending conditions, such as Dupuytren's contracture, is a critical, yet often overlooked, step in self-care.When these muscles are neglected, consequences can range from nagging, aching arms, wrists or hands, to debilitating chronic pain.
Palmaris longus (PL) is a great example. This long (extrinsic) muscle courses from the medial epicondyle to attach broadly onto the palmar fascia which, in turn, spans into five directions, each of which projects toward a digit (ray). Its tendon is the only anterior forearm tendon to remain outside the flexor retinaculum at the wrist, making it distinctly visible when the wrist is flexed and the hand is curled upon itself.
Although the muscle belly may be absent on either arm or both, its palmar fascia is always present.1 Its tendon may be more easily distinguished from the carpal (wrist) flexors by having the person place all five digital pads together, with the metacarpophalangeal joints flexed and the fingers and thumb extended (as if picking up a marble with all five digits). It may be necessary to simultaneously flex the wrist to make the tendon more distinct.
PL may be strained with loaded wrist flexion. The associated palmar fascia may be injured with the use of hand tools that can inflict trauma, such as when pounding on an ice pick, sculpting tool, or kitchen chopper, when twisting with pressure while using trowels in gardening, or when applying pressure with hand-held tools in massage therapy. Associated trauma can result in shortening of the connective tissue of the palm, similar to that seen in Dupuytren's contracture.
Indicators for treatment of PL include:
Dupuytren's contracture is a hand deformity in which the palmar fascia contracts and thickens over time. The characteristics of Dupuytren's contracture2 include:
Due to slow progression, observation and minimal or no treatment are often indicated initially for Dupuytren's contracture. A non-surgical intervention of injection coupled with forceful finger extension may be indicated.3 Surgical excision of the fascia may be necessary and the hand may lose up to 25 percent of its grip power as a result.
Heredity may be a factor in Dupuytren's contracture, however, it is important to rule out trigger points as part of the problem.4 Trigger points in this muscle may simulate Dupuytren's contracture and may even produce flexion contracture of the fingers. A distinguishing feature is that while Dupuytren's may cause a painful palm, only trigger points in PL produce the prickling sensation. Simons, et al., describe a spray and stretch technique that covers the anterior forearm and hand that is often beneficial to this condition. NMT hand and forearm protocols are also effective. (For hand and forearm treatment protocols, visit www.nmtcenter.com/articles.)
The value of contrast hydrotherapies should not be underestimated, especially when followed with stretching. Not only is this therapy readily available and very inexpensive, it can easily be self-applied, especially to the forearms and hands.
Prevention of injury is the foremost key to maintaining healthy hands. Particular care should be exercised when using tools that can damage the palmar fascia. Work gloves, alternative tools and employed help should be considered for jobs that might place stress on the tissues of the palm.
Judith DeLany serves as director of NMT Center, writes textbooks for Elsevier Health Sciences, and lectures internationally in the field of neuromuscular therapy. For more information regarding her work, visit www.nmtcenter.com or call toll-free at (866) 571-7942.
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