resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
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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