resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Why You Should Include the Single-Leg Stance Test in Every Patient Assessment
The single-leg stance (SLS) test, also known as the single-limb stance test, unipedal stance test or one-legged stance / balance test, is often used in the geriatric population to assess static postural and balance control.
The Science of Stretching
In 1986, Rob DeCastella set a course record by running the Boston Marathon in 2:07:51, just 39 seconds off the world record.
Fibromyalgia: Put the Pain in Its Place
While some fibromyalgia patients respond favorably to regular chiropractic care, others experience minimal relief. Unfortunately, many of these patients must rely on pharmacological management to relieve their constant pain.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
By the Numbers: 3 Common Financial Mistakes With Major Consequences
Warren Buffett is on record for sharing the hidden art of becoming wealthy and making it simple enough for anyone to grasp.
Remembering Clarence Gonstead and 50 Years of the Gonstead Clinic
Dr. Clarence Selmer Gonstead (1898-1978) took chiropractic practice from back-alley bone setting to an understandable biomechanical science. His life was dedicated to clinical competency.
Curbing Label Overwhelm
For the average consumer, reading a food package can be overwhelming: natural, organic, non-GMO, gluten free, free range ... you get the picture.
Are You a Bad Chiropractic Patient?
My father was a great DC. In fact, as you might expect, he was the doctor of chiropractic I measured all other doctors against. Sadly, he died at age 61 when I was in my early 30s.
Immunizations by Colorado DCs: Really?
You probably didn't hear about it, but back on Nov. 21, 2013, the Board of Directors of the Colorado Chiropractic Association (CCA) adopted "immunization authority" for Colorado DCs as its No. 2 legislative goal.
Physical Exam 101: The Hands
I am sure you are familiar with the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Coding for the Subluxation: ICD-9 vs. ICD-10
When I attended chiropractic school, I was taught that chiropractors approach health care differently than the traditional medical establishment.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Vaccines and Chiropractic: Evidence-Based Medicine or Medical Dogma?
Right or wrong, the chiropractic profession has historically been against vaccinations. However, a growing trend within the profession is seeking to reverse this position.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
July, 2009, Vol. 09, Issue 07
The Risks of Vascular Compression in Soft-Tissue Therapy
By Whitney Lowe, LMT
The muscles in the anterior neck can become hypertonic or develop myofascial trigger points as a result of injury, poor posture, or simple overexertion. Some anterior cervical muscles are superficial and easily accessible, while others are deep and difficult to access with soft-tissue therapies.Because of sensitive neurological and vascular structures in the neck, it is important to reconsider the wisdom of applying treatments to the deep anterior neck muscles.
The two main muscles that lie closest to vascular structures in the anterior neck are the longus colli and longus capitis. Practitioners applying manual treatments to these deep neck flexors could run the risk of causing a serious injury to their client, such as stroke or drop in blood pressure, due to the proximity of the vascular structures.
One of the structures that can be impacted with pressure from soft-tissue treatment to the anterior neck is the carotid sinus, which is located at the division between the internal and external carotid arteries (Figure 1). There is a slight enlargement of the arterial diameter at this juncture where the two arterial branches separate. A group of very important sensory cells, called baroreceptors, are also located in the carotid sinus. The baroreceptors play a primary role in the regulation of blood pressure and heart rate.
Carotid Sinus Hypersensitivity
In a condition called carotid sinus hypersensitivity (CSH) or carotid sinus syncope, the carotid sinus develops an increased sensitivity to pressure. Syncope is a term meaning loss of consciousness or postural tone caused by a decrease in blood pressure to the brain. Unintentional pressure on the carotid sinus from massage treatment of deep anterior neck muscles could cause adverse effects on blood pressure or heart rate in a person with CSH.
For a person with hypersensitivity in the baroreceptors, even a mild stimulation to the neck can result in bradycardia (reduced heart rate) and a drop in blood pressure.1 However, CSH is not common so clients may not have any problem with pressure applied in this region. For the few that do have this sensitivity, the consequences of pressure on the baroreceptors could be serious. Unfortunately, a massage practitioner would not know if their client had this sensitivity in advance. It is also unlikely that the client would know they have the condition either. Consequently, it is a bit of a statistical gamble to perform massage on the deep anterior neck muscles. There are many practitioners moving away from this type of treatment for safety reasons.
There is another concern with pressure applied in the region of the carotid sinus. In addition to housing the baroreceptors, the shape of the carotid sinus allows this structure to be a repository for arterial plaque buildup. Plaque that has collected on the inner walls of the arteries is a well-known danger. Unintentional pressure applied to the carotid sinus could dislodge some of these plaque concentrations causing them to migrate through the arteries and cause a stroke.
Practitioners may think that by avoiding pressing on tissues with a pulse, they can feel confident that they are not pressing on vascular structures. However due to the multiple layers of soft-tissues, massage can put pressure on other nearby structures that subsequently press on the arteries, so this method is by no means foolproof.
The possibility of adverse affects for anterior neck treatment should lead the practitioner to explore alternatives in soft-tissue treatment for the deep anterior cervical muscles. Reducing hypertonicity can be accomplished by techniques that do not apply direct pressure, such as facilitated or static stretching. Facilitated stretching can be very effective in reducing tightness in the deep neck flexors without putting pressure on the carotid sinus. A position such as that shown in Figure 2 is used for these facilitated stretching methods.
However, the practitioner should be cautious even with stretching. Ironically, there is a risk of a different arterial compression with the neck flexor stretching position shown in Figure 2. The vertebral arteries run through the transverse processes of the cervical vertebrae on each side of the neck. They join to form the basilar artery, which then extends into the cranium to supply blood to the brain (Figures 3,4).
When the head is held in hyperextension or rotation (or a combination of both) the vertebral arteries can be compressed, causing a reduction in blood flow to the brain.2 Compression of these arteries is a condition called vertebrobasilar insufficiency (VBI). Symptoms of VBI include vertigo, dizziness, seeing stars, disorientation, ringing in the ears, or general feelings of sensory disturbance. If the practitioner is working in this area or moving the client's head into rotation or hyperextension and they report any of these symptoms, treatment should immediately cease and the client's head should be brought back to neutral.
The majority of problems with VBI result from hyperextension or rotation movements of the head. However, due to the location of the vertebral arteries it is possible that VBI could also occur from common massage techniques in which pressure is applied to the suboccipital region. While it is a rare occurrence, some people could have VBI from techniques such as those depicted in Figure 5, with only the weight of the head applying pressure. Techniques such as those used in CranioSacral Therapy where pressure is on the occiput and not the suboccipital soft tissues will not cause VBI. Problems occur when pressure is applied directly into the suboccipital soft tissues.
There is a way to test for the possibility of vertebral artery compression prior to performing massage techniques. This procedure is called the vertebral artery test and it is considered an accurate means of predicting VBI.3 To perform the test, the practitioner has the client in a seated position and instructs the client to hold their head in extension or extension with rotation (as if looking over the shoulder). If within about 30 seconds, the client reports the beginning of VBI symptoms, the practitioner should consider the client susceptible to arterial compression. Techniques that would put the client in a position that could aggravate the compression should then be avoided.
Massage is one of the safest interventions for treating soft-tissue pain and injury conditions in the cervical region. However, soft-tissue therapy is not benign. As these examples show, there are times when massage or other soft-tissue therapies could have serious detrimental effects and that requires the practitioner to think carefully about appropriate treatments to these sensitive areas.
Click here for more information about Whitney Lowe, LMT.
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