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Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
March, 2010, Vol. 10, Issue 03
Rib Pain "Can't Get No Respect"
By Erik Dalton, PhD
The legendary comedian Rodney Dangerfield coined the phrase "can't get no respect." After careful consideration, I think the same thing could be said of rib pain. It is amazing how little attention or appreciation rib pain receives in the massage therapy community.
Clients typically blame "between-the-blade" pain on tight muscles. Session after session, the therapist beats on the rhomboids and lower traps, only to amplify the problem. In many cases, a simple functional evaluation leads to the true culprit: fixated ribs and intervertebral joints. Not to say muscles don't play an important role in creating and perpetuating rib misalignment, but the muscle itself usually is not the primary pain generator. Highly innervated joint capsules, spinal ligaments and nerve dura often prove to be the main events (key lesions) responsible for long-term pain and disability.
Hypertonic knots palpated in the lamina groove indicate joint dysfunction and an exquisitely tender iliocostalis muscle at the lateral rib angle tells us the rib is fixated in either internal or external rotation (See Fig. 1). I've found external rib torsions to be more common and symptomatic. Below is an example of a sequence of events leading to development of this condition.
Luke, a marathon cyclist, acquired a bad habit of hyper-extending his head, neck and shoulders during training and racing events (See Fig. 2). He presented with dull and sometimes stabbing shoulder-blade pain particularly after a long ride. Luke confided he'd become a "therapy-junkie" over the past three years and sported bruises along his scapular border to prove it. Seated examination revealed tissue-texture abnormality (palpable knots) in the lamina groove at the T3-4 level on his right side. Although neck hyperextension failed to reproduce his symptoms, chin-tucking did flare sharp scapular pain and also caused bony knots to rotate back against my fingers (See Fig. 3).
It was apparent the T3 vertebra was unable to glide forward on T4 during neck flexion, causing the transverse process of T3 to rotate to the side of the motion-restricted joint (See Fig. 4). Adhesive facets usually are an easy fix in acute cases, but long-term cartilage jamming might lead to tissue degradation, protective muscle splinting and osteoligamentous canal pain.
I opted for greater mechanical advantage and specificity by placing Luke in a lateral Sims position (side-lying with arm behind the back). With thumbs meeting in the lamina groove, a slow sustained pin-and-stretch technique was applied to the T3 transverse process as Luke resumed chin-tucking (See Fig. 5). Soon, the deep fibrotic rotatores, multifidi, intertransversarii and levator costalis began to melt, allowing the T3-4 facets to disengage. When it was no longer possible to feel the T3 transverse process pushing against my thumbs, Luke was asked to repeat the neck-flexion test. Although range of motion and pain during chin-tucking had greatly improved, he still felt a deep ache at the extreme end of neck flexion.
In the presence of a dual fixation (rib and vertebral blockage), the associated rib must be carefully evaluated and treated. It's not uncommon for ribs to lose joint-play due to ongoing mechanical stress (microtrauma). To assess, simply follow the T3 rib out to the iliocostalis muscle attachment at the rib angle (medial scapular border) and palpate for extreme tenderness (See Figure 6). Since Luke had a positive "jump reflex" at the iliocostalis, we were able to confirm the presence of an externally torsioned T3 rib.
Fortunately, treatment for the rib torsion is almost identical to the pin-and-stretch technique above, except the thumb pressure is now applied to the superior border of the rib shaft. As Luke began the chin-tucking motion, I asked him to slightly left rotate his head to increase stretch on the rib. This enhanced the ability of my thumbs to internally rotate the rib shaft back into sequence with the rest of the costal cage. However, the rib torsion was a little more stubborn than the vertebral fixation, and when it did completely release, I could hear some crepitus in the costovertebral and transverse joints. To maintain mobility, he was given home-retraining exercises and advice on repositioning his bicycle seat to decrease head hyperextension.
This technique uses bones as levers to release myospasm in the deep transversospinalis and erector spinae groups. Once vertebral and rib fixations have been properly assessed and corrected, normal tone usually is restored to neighboring paravertebral tissues. Once these articular structures recover normal movement within the kinetic chain, deep-tissue work in the area is painless and enjoyable. However, if this articular stretching routine fails to free the dual fixation (due to chronically degraded cartilages), refer the client to high-velocity thrust.
Another commonly misassessed "between-the-blade" pain generator is termed a dorsal dish. Inaccurate understanding of the biomechanics of this dysfunction frequently causes therapists to escalate the pain and sometimes injure the client. Visual observation and thoracic spine palpation reveal a flat spot (approximately T3 to T7) where there should be a convex curve (See Figure 7). If you have access to a plastic spine, contour it until you've established normal lumbar, thoracic and cervical curves. Then, place the spine prone on a table and notice how the T-spine's gentle convex curve continues through the shoulder blades. Now, with a couple fingers, press down on the T5 transverse processes and observe what happens. If your pressure is equal with both fingers, the facet joints will approximate each other causing the intervertebral joints to close bilaterally.
Therapists unfamiliar with the Laws of Spinal Motion commonly dig on the bony knots lying deep to the thick layer of paravertebral tissue, thinking they're releasing trigger points or muscle adhesions. Unfortunately, placing downward pressure on already chronically locked joints really hyperexcites joint mechanoreceptors. Prolonged over-approximation of joint surfaces compacts and, in time, degrades the articular cartilage. Tissue damage might stimulate an inflammatory response that hyperexcites the sensitive chemoreceptors. When mechanoreceptors and chemoreceptors "gang-up" and bombard the neuronal pool with continual noxious stimuli, pain-delivering nociceptors fast track the information to the thalamus, gray matter and other cortical centers. The brain usually responds by locking down the area with protective myospasm. Session after session, the therapist digs on the fibrotic knots until the client finally terminates therapy and moves on in search of someone who can help break their pain-spasm-pain cycle.
Fixing the Flat Spot
Since we're dealing with joints that won't open, examination and treatment follow the same side-lying T3-4 protocol discussed in Luke's case, with two exceptions.
When evaluating the dysfunction, begin spinal-groove palpation one segment below the flat spot and proceed headward with client in flexed position performing chin-tucks. So, if your client has a T3 to T7 dorsal dish, begin at T8 and move up segment by segment, assessing and correcting all vertebra and rib problems on the client's right side. Then, roll them over and perform the identical routine on the opposite side.
Once normal vertebral/rib motion is restored, deep-tissue techniques must be performed with the client prone. Standing on the client's right side, reach across and place extended fingers in the lamina groove so you can hook and scoop the spinalis, longissimus and paravertebral fascia medial to lateral. Ida Rolf used to say, "Dig a hole to allow the spine a place to come back to." After you dig the "guy wires" out of the groove and restore left-sided paravertebral muscle extensibility, walk to the other side and repeat the procedure. Once spinal compression and buckling are removed and extension is restored to the dorsal dish, it's time to share a simple home-retraining exercise.
My favorite (of many) is still the "wall press." With the client standing away from the wall, arms extended, ask for a deep inhalation effort and chin to chest flexion maneuvers. To help neurologically reprogram thoracic extensibility, simply tap with a finger at the T5 spinous process as the client inhales and chin tucks. Engaging the respiratory diaphragm helps expand the costal cage front-to-back and side-to-side. This inhalation movement (respiratory enhancer) activates the scalene, which pull up the top two ribs, the pectoralis minor which helps lift ribs 3-5 and the serratus anterior and posterior, which provides a little "bucket-handle" movement through the lower costal cage.
Pain manifests if a rib loses the ability to properly coordinate movement with the rest of the ribs and spine as part of a functional unit. This would be similar to a rowing team where one oarsman uses his oar out of sequence with the group. Altered rib function can cause difficulty breathing, restricted shoulder movement, referred pain to other areas, and reactive muscle guarding.
Additionally, misaligned ribs can pinch intercostals nerves, sending excruciating pain through the length of the rib and, occasionally, the chest wall (the old heart attack scare). Since rib dysfunction is frequently misassessed and, therefore, improperly treated, do your clients a favor and incorporate some spinal biomechanic principles and articular stretching routines into your toolbox of touch.
Click here for more information about Erik Dalton, PhD.
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