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Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
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.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
April, 2010, Vol. 10, Issue 04
Multifidus: The Multitasker
By Judith DeLany, LMT
Back pain is one of the most frequent complaints by massage therapists and their clients. In fact, 15 percent to 20 percent of Americans report back pain yearly, and 80 percent will suffer from at least one episode of back pain during their lifetime.2
A number of risk factors have been determined, including smoking, being overweight and poor physical fitness. Common causes of back pain include spasm, tension, disc degeneration, scoliosis, spondylosis, spondylolisthesis, arthritis, spinal stenosis, pregnancy, kidney stones, infections, endometriosis, fibromyalgia, tumors, stress and trauma.3
Back pain divides into simple backache, nerve-root pain and serious pathology. Although it is easy to blame work as the culprit, pain originating from the latter two may stem from sinister causes, including visceral disease. Beware of the following red flags, as they might indicate advancing pathologies. Further investigation is needed if the sufferer:
Simple backache, on the other hand, often emerges from a compounding of minor predisposing myofascial factors, such as tight muscles, trigger points and muscle weakness. After considering the muscles that lie in the region of the low back, investigation moves to the anterior and lateral abdominal muscles, muscles of the lower extremity that attach to the pelvis, habits of use, posture and gait. Tucked away deep to the erector spinae (Figure 1), the multifidus (Figure 2) often is overlooked as potentially a substantial source of lumbar dysfunction.
The obliquely oriented thoracic multifidi are undoubtedly associated with rotational movements or perhaps as stabilizers during rotation. This is consistent with the angulation of the zygopophysial (facet) joints of the thoracic vertebrae, which allow rotation, while discouraging flexion, extension and lateral flexion.
In the lumbar, lying deep to the erector spinae, multifidus is considerably thicker, more vertically oriented and significantly more powerful. The vertical orientation of the fibers of most of the lumbar multifidi implies that they would not be involved in direct vertebral rotation. This is consistent with the orientation of the lumbar facets, which allow flexion, extension and lateral flexion and discourage rotation.
Since the line of action of multifidus lies posterior to the lumbar curve, it extends the lumbar spine and increases lumbar lordosis with a "bowstring" effect. As the oblique muscles fire to rotate the upper body, lumbar flexion would be mandatory if it were not for the action of multifidus, which prevents flexion from occurring.1 This allows the spine to remain vertical (rather than flexing forward) when pure rotation is desired.
Multifidus fibers are the only muscle fibers posterior to the lumbosacral transitional point (L5-S1). Therefore, multifidus must produce enough tension to ensure that L5 does not slide forward on the sacral plateau (spondylolisthesis), even though this surface naturally, sometimes significantly, slopes downward. Fortunately, multifidus presents its mass precisely in this segment of the spine. Unfortunately, it often suffers from disuse atrophy, appearing as "moth-eaten" and infiltrated with fat.
The lumbar multifidus is particularly thick and almost completely fills the lamina. Although repetitiously applied gliding strokes can influence multifidus, the thick, overlying tendinous elements of the superficially placed erector spinae, latissimus dorsi, and associated dense fascia impede results.
The most lateral fibers are usually available by approaching them more directly; lateral and deep to the erector spinae (Figure 1), particularly at the level of L2-L4. However, careful hand placement helps to avoid compressing (and potentially bruising) tissues against the lateral aspect of the transverse processes, which lie deep to the lateral fibers of multifidi (Figure 3).
Multifidus contracts with contralateral rotational movements. Twisting at the waist, while maintaining a vertical upper body can help to strengthen it. A stationary bicycle or glider equipment that incorporates the arms and mandates upper body rotations will help to keep multifidus healthy and help to avoid low back pain associated with weakness of this muscle.
Judith DeLany serves as director of NMT Center, writes textbooks for Elsevier Health Sciences, and lectures internationally in the field of neuromuscular therapy. For more information regarding her work, visit www.nmtcenter.com or call toll-free at (866) 571-7942.
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