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Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
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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