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Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
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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