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Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
Don't Trust What Your Patients Say
When a patient presents to the office for care, they typically have a specific complaint – lower back pain, whiplash, sinus congestion, sciatica, etc. They are often not interested or engaged in what they consider "unrelated" personal health history.
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
November, 2009, Vol. 9, Issue 11
An Alternative Approach to Stretching
By Whitney Lowe, LMT
Clinicians, athletes and rehabilitation specialists advocate stretching as a means for injury prevention and treatment. The primary purpose of any stretching technique is to enhance pliability and flexibility in the soft tissues. It is also routinely incorporated with massage in the treatment of pain and injury conditions. There are many different stretching techniques, which all fall into one of three primary categories: static, ballistic or active-assisted stretching.
Static stretching is the most common. In static stretching, you bring the target muscle into a lengthened position and hold it there until you have achieved the desired stretch. The ideal length of time to hold a static stretch is debated in the literature and the results appear inconclusive. Somewhere around 15 to 20 seconds is a common time frame that achieves good clinical results.
Ballistic stretching is used most commonly in the athletic environment. During a ballistic stretch, you bob or bounce into a stretch to encourage tissue elongation in the muscle. Ballistic stretching works by using the momentum of the moving limb to extend past the initial limitation of range of motion. Many people oppose the use of ballistic stretching because the rapid elongation of muscle tissue in the bouncing motion can activate the stretch reflex, which would be counterproductive to stretching.
In active-assisted stretching, the client actively engages a specific muscle contraction prior to, or during, the stretching procedure. There is a variety of active-assisted techniques and they go by different names such as PNF, muscle-energy technique, active isolated stretching or facilitated stretching. There are slight variations in each of these methods, but they are all based on the neurological principles of post-isometric relaxation (PIR) and reciprocal inhibition. Experiments that compare active-assisted methods with static or ballistic stretching show the greatest range of motion gains with active-assisted methods.
Immediately following an isometric contraction, there is an increased degree of relaxation in that same muscle. This immediate reduction in neurological activity is called the post-isometric relaxation (PIR). The methods of active-assisted stretching use the window of reduced neurological activity during the PIR to engage a stretch of the target muscle after it has isometrically contracted. Stretching during the PIR is more effective than stretching without the prior isometric contraction.
The other neurological principle that is of important in active-assisted stretching methods is reciprocal inhibition. When an agonist (target) muscle contracts, there is a neurological inhibition of its antagonist (opposite) muscle. The reduction in neurological activity in the antagonist muscle is called reciprocal inhibition. Because reciprocal inhibition decreases neurological activity in muscles opposite the ones being contracted, it is helpful to use during stretching procedures. Stretching of the target muscle is enhanced when its opposite muscle is contracted at the same time (Fig. 1).
The various techniques of active-assisted stretching advocate different lengths of time to hold the isometric contraction prior to stretch. Initial research has indicated that a relatively short period of nonmaximal isometric contraction (about 3 seconds) seems most effective for holding the contraction prior to stretch.1 These methods also vary in the length of time that the stretch is held. A study investigating active-assisted stretching compared stretch duration times of 3 seconds and 30 seconds and found no significant difference in the outcomes between the two time periods.2 More research is needed to determine the ideal stretching method(s). It may turn out that the optimum stretching method depends on the situation in which it is being used.
Effective Stretching Procedures
Each of the stretching procedures mentioned above must take into account the biomechanical and neurological properties of the myofascial unit. Therefore, all stretching procedures engage two primary components: the physical stretch of muscle and connective tissue (mechanical effects) as well as the reduction in neurological resistance to stretch (neuromuscular effects).
Fascia is interwoven throughout muscles in an extensive network. It has viscous properties that respond better to slow, sustained tensile loads and resist rapid elongation.3 The process of connective tissue gradually lengthening when a sustained stretch is applied to it is called creep. The extensive fascial network running through all muscles suggests greater benefit for longer-duration stretching methods to take advantage of connective-tissue creep.
The neurological resistance to stretch is primarily governed by a specialized proprioceptor called the muscle spindle. It is responsive to both the rate of muscle stretching and the amount of stretch in the tissue. If the muscle is stretched too fast or too far, the muscle spindle sends signals to the central nervous system and an immediate muscle contraction is engaged to prevent overstretching. This immediate muscle contraction is called the myotatic (or stretch) reflex. Stretching procedures attempt to minimize any recruitment of the stretch reflex.
An Alternative Method
Manual-therapy practitioners have been excited by recent research studies enhancing our understanding of the physiological properties of fascia. We have recently learned that fascia contains contractile cells and is capable of releasing its contraction and further elongating when a prolonged tensile load is applied to it.4 Armed with this new understanding, we can use the physiological properties of fascia to enhance stretching procedures. Combining active-assisted stretching methods with fascial-elongation methods would address both the neuromuscular and connective-tissue components of the stretching process.
Consider hamstring stretching as an example of how this works. Engage the hamstrings in a short 3-second nonmaximal contraction. Release the contraction and bring the hamstrings into a stretched position (Fig. 2). Have the individual attempt to further stretch the hamstrings by attempting to flex the hip as far as possible (as they did in Fig. 1). This movement engages the reciprocal inhibition process and encourages further lengthening. While this position is held, apply a myofascial-stretch technique (with the hand or back side of the fist) to the hamstrings and hold it for about 30 to 60 seconds. Holding the myofascial stretch encourages relaxation of the fascial contractile cells and enhances connective tissue creep.
Both the neuromuscular and connective-tissue components of the stretch are emphasized by combining these myofascial and active-assisted stretching techniques. I have found this stretching method helpful with a number of chronically tight muscles. In the future, it will be valuable to perform comparative studies with this and other stretching techniques to find out which ones are most effective under various clinical circumstances.
Click here for more information about Whitney Lowe, LMT.
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