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Talking to Patients About Healthy Aging
I've noticed that a particular category of patients seems to make up more and more of my practice – they work out, but still experience lots of degenerative joint disease (DJD) issues.
5 Ways to Occupy Occupational Health
Despite the progress that has been made to better protect workers, occupational health and safety remains a priority area for many national governmental organizations due to the widespread problem of occupationally related morbidity and mortality.
The X Factor in Clinical Research: The Patient
It was the great baseball legend, former New York Yankees catcher Yogi Berra – he of countless aphorisms, each with a mind-bending twist – who once declared, "You can observe a lot by watching."
Blaming the Gluteus Medius, Overlooking the Deltoid
The gluteus medius (Gmed) is commonly written about, strengthened and blamed for many conditions, and rightfully so. After all, the Gmed plays a role in pelvic stability, hip motor control and lower-quarter dynamic movements.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Calcium Helps Prevent Colorectal Cancer
Over the past 25 to 30 years, studies have suggested calcium may confer protection against colorectal cancer.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Help Patients Achieve Optimal Vitamin D Levels
Much research has been done on vitamin D levels and their impact on health; optimal levels have been correlated with a reduced risk of developing numerous conditions.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Saying No to Medicine
An interesting article recently appeared in Men's Journal titled "When to Say No to Your Doctor." The article begins with the summary statement above and effectively arms readers with information that will help them "take more responsibility for your own health care, because you can't be sure anyone else is.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Web Marketing: Content Is King
Google's sweeping updates to its search algorithms over the past few years have brought a paradigm shift in how you can optimize your chiropractic website to gain maximum marketing leverage.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Transparency and Accountability: Q&A With the CCE
Every profession needs an organization dedicated to upholding the quality and integrity of its degree programs and educational institutions.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Understanding and Identifying Pediatric Growth-Plate Fractures
In general, fractures in children heal well with little intervention as long as the alignment is good. Fractures involving the growth plate, however, are a different issue. In fact, growth-plate injuries are the primary reason for the subspecialty of pediatric orthopedics.
October, 2009, Vol. 9, Issue 10
Red, White and Black Reaction
By Leon Chaitow, ND, DO
In the current edition of my book, Palpation & Assessment Skills, there are 12 "special topic" sections, where subjects that don't quite fit into the regular chapters, have been placed. The special topic I want to bring to your attention is the so-called "red and white" reaction - the name of which has been expanded to "red, white and black" reaction. Mysterious? Not really - but it's a catchy name for a simple but useful assessment method that dates back well over 100 years. The name refers to superficial responses that take the form of red, white and sometimes blue-black lines following skin-friction, applied by a finger or probe, usually running down each side of the spine.
In the early days of osteopathy in the 19th century, the assessment method was already in use. Carl McConnell, one of the original osteopathic pioneers wrote this in 1899: "I begin at the first dorsal and examine the spinal column down to the sacrum by placing my middle fingers over the spinous processes and standing directly in back of the patient, draw the flat surfaces of these two fingers over the spinous processes from the upper dorsal to the sacrum in such a manner that the spines of the vertebrae pass tightly between the two fingers; thus leaving a red streak where the cutaneous vessels press upon the spines of the vertebrae. In this manner slight deviations of the vertebrae laterally can be told with the greatest accuracy by observing the red line. When a vertebra or section of vertebrae are too posterior, a heavy red streak is noticed and when a vertebra or section of vertebrae are too anterior, the streak is not so noticeable."6
Much more recently, another osteopathic physician, Marshall Hoag, discussed the same phenomenon: "With firm but moderate pressure the pads of the fingers are repeatedly rubbed over the surface of the skin, preferably with extensive longitudinal strokes along the paraspinal area. The blunt end of an instrument or of a pen may be used to apply friction, since the purpose is simply to detect color change, but care must be taken to avoid abrading the skin. The appearance of less intense and rapidly fading color in certain areas as compared with the general reaction is ascribed to increased vasoconstriction in that area, indicating a disturbance in autonomic reflex activity."3
On the same theme, Upledger and Vredevoogd wrote: "Skin texture changes produced by a facilitated segment [localised areas of hyper-irritability in the soft tissues involving neural sensitisation to long-term stress] are palpable as you lightly drag your fingers over the nearby paravertebral area of the back. I usually do skin drag evaluation moving from the top of the neck to the sacral area in one motion. Where your fingertips drag on the skin you will probably find a facilitated segment. After several repetitions, with increased force, the affected area will appear redder than nearby areas. This is the 'red reflex.' Muscles and connective tissues at this level will:
De Jarnette, the chiropractor who developed the sacrooccipital technique (SOT), wrote extensively on the subject of the red reaction, suggesting some complex interpretations.2 He used such assessments as part of a process of evaluating the particular category of patient he was treating. In one variation he describes the process as follows: "Making a firm pressure, draw fingers down the spine, with a fairly slow motion. You should be able to count to 15 while drawing the fingers from the seventh cervical to the coccyx, by counting steadily. With a good light on the back, the results should show a line which becomes red, some portions brighter and some very faintly colored. Now watch the lines fade. The area which shows the whitest is marked as the major [lesion] for this is the most anaemic spinal muscle area. It will be paler than any portion of skin on the patient's body."
Eminent physiologist Irvin Korr described how this red reflex corresponded well with areas of lowered electrical resistance, which themselves correspond accurately to regions of lowered pain threshold and areas of cutaneous and deep tenderness (termed "segmentally related sympatheticotonia").5 He cautioned: "You must not look for perfect correspondence between the skin resistance (or the red reflex) and the distribution of deeper pathologic disturbance, because an area of skin which is segmentally related to a particular muscle does not necessarily overlie that muscle. With the latissimus dorsi, for example, the myofascial disturbance might be over the hip but the reflex manifestations would be in much higher dermatomes because this muscle has its innervation from the cervical part of the cord."
By use of a mechanical instrument that quantified the pressure applied at a constant speed, followed by measurement of the duration of the redness resulting from the action of the frictional stimulator on the skin, Korr could detect areas of intense vasoconstriction which corresponded well with dysfunction elicited by manual examination.
But was the opportunity to feel the tissues being ignored during all these strokes? Marsh Morrison discussed this: "Run your fingers longitudinally down alongside the dorsal and lumbar vertebrae (anywhere from the spinous processes extending laterally up to two inches [5 cm]) and stop at any spot of tissue which seems 'harder' or different from normal tissue. These thickened areas, stringy ligaments, bunched muscle bands, all represent indurated tissue; they are usually protective and indicate irritation and dysfunction. Once these indurated areas are palpated press down and almost always they will be sensitive, indicating a need for treatment."7
Osteopathic researchers Cox, et al., wrote: "'Red reflex' cutaneous stimulation was applied digitally in both paraspinal areas [T4 and T9-11] simultaneously briskly stroking the skin in a caudad direction. Patients were divided arbitrarily into three groups.
Hruby, et al. describe the thinking regarding this phenomenon. "Perform the red reflex test by firmly, but with light pressure, stroking two fingers on the skin over the paraspinal tissues in a cephalad to a caudad direction. The stroked areas briefly become erythematous and almost immediately return to their usual color. If the skin remains erythematous longer than a few seconds, it may indicate an acute somatic dysfunction in the area. As the dysfunction acquires chronic tissue changes, the tissues blanch rapidly after stroking and are dry and cool to palpation."4
Newman-Turner described the research of osteopath/naturopath, Keith Lamont, who first described the "black line" phenomenon: "It is a common observation of osteopaths...that pressure on either side of the spine with a hemispherical probe of approximately 0.5 cm diameter, will, in some patients, elicit a dark blue or black line. Local engorgement of the capillary bed with de-oxygenated venous blood causes the appearance of the line which slowly fades as the circulation returns."8
I hope these glimpses onto different interpretations of the red reflex will stimulate you to explore the concepts described, remembering that what you feel and see is not the basis for a diagnosis; only an indication of dysfunction that may be local or reflex, chronic or acute, or significant or not.
Click here for more information about Leon Chaitow, ND, DO.
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