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The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
September, 2010, Vol. 10, Issue 09
Advanced Stretching: Using Neural Inhibition to Enhance the Stretch, Part 1
By Joseph E. Muscolino, DC
There is an art and a science to practicing manual and movement therapies. The science yields a set of guidelines that provide the structure for our therapy. We develop this science as an extension of our understanding of the anatomy, physiology, and kinesiology of the body.The art of our practice involves how we apply and combine these guidelines for the optimal treatment of the client who is on our table. As an artist, the medium of the client's body that we primarily work upon is the myofascial system of muscles, tendons, ligaments, and other dense and loose fascial structures. We could look upon this myofascial system as the canvas upon which we work.
One of the major objectives of a massage therapist is to loosen these soft myofascial tissues when they become taut. Taut tissues may be overly contracted muscles. They may also be musculature or other soft tissues that have accumulated fascial adhesions. The problem with taut soft tissues is that they decrease flexibility of the body. Whenever a joint moves in one direction, soft tissues on the "other side of the joint" need to lengthen to allow this motion to occur. Taut soft tissues do not lengthen, therefore they limit motion of the body.
Massage therapy treats these taut tissues by the use of soft tissue manipulation. This manipulation is often direct as in the case of actual massage strokes such as gliding, kneading and compression. The use of hot and cold therapy can also be used. Another extremely effective treatment option, and one that is within the scope of practice of massage therapists, is stretching. When combined with heat and massage therapy, stretching can make a critical difference in the progress of our clients.
Stretching is essentially a mechanical process wherein we place a tension (pulling) force into the client's body, causing a lengthening of the target soft tissues. Although standard stretching performed in this manner often works quite well, there are advanced stretching options that are usually more effective. (With all forms of stretching, it is critically important that the force of the stretch is never excessive, or a muscle spindle reflex may be triggered that results in spasming of the muscle, defeating the purpose of the stretch.)
Advanced Stretching Techniques
The most commonly practiced type of advanced stretching technique is one in which a neurologic reflex is used to inhibit, in other words, relax the target muscle that is being stretched. Creating neural inhibition then allows greater stretch of the musculature when the mechanical tensile force of the stretch is applied. There are two types of advanced neural inhibition stretching techniques: contract relax (CR) and agonist contract (AC). (We will discuss AC stretching in-depth in Part 2 of this series.)
Contract Relax (CR) Stretching
CR stretching is also known as postisometric relaxation (PIR) stretching. AC stretching is the basis for Aaron Mattes' Active Isolated Stretching (AIS) technique. Both CR and AC stretching are often described as proprioceptive neuromuscular facilitation (PNF) because they utilize a proprioceptive neuromuscular reflex to facilitate the stretch.
CR Stretching: The basis of CR stretching is the Golgi tendon organ (GTO) reflex. GTOs are proprioceptive receptors that are located in the tendons of a muscle and are sensitive to stretch. If a muscle belly contracts forcefully, it pulls on and stretches its tendon; this stretching force is detected by the GTO. If the muscle belly contracts too forcefully, the tendon might be torn; therefore the role of the GTO is to protect the tendon by monitoring the stretch forces that are placed on it. The GTO prevents tearing of the tendon by sending a signal into the spinal cord that triggers the GTO reflex, which then inhibits the muscle from contracting, in other words relaxing it. We can make use of the GTO reflex to more effectively stretch a muscle.
CR stretching is performed by asking the client to contract the target muscle to trigger the GTO reflex. We then ask the client to relax and we stretch the target muscle, taking advantage of the increased relaxation (inhibition of the muscle) caused by the GTO reflex. The usual CR stretching protocol steps are carried out as follows. The right lateral flexor (RLF) group of the neck is used as our target musculature in this example (Fig. 1):
a. Have the client begin in a neutral starting position.
b. "Pre-stretch" the client into left lateral flexion (LLF) until the beginning of tension is felt.
c. Ask the client to gently isometrically contract the RLF target musculature against your resistance for approximately 5-8 seconds to trigger the GTO reflex. The client can either exhale or hold in the breath during this step. When providing resistance, it is important to not push against the client, but rather to simply meet and resist whatever contraction force the client is creating.
d. Have the client relax, wait a split second, and then further stretch the client into LLF. This completes one repetition. Typically 3 to 4 repetitions are done, each one beginning at the end (stretched) position of the previous repetition; and the client is asked to increase the force of contraction with each repetition. Although CR stretching usually involves isometric contraction, the client could be allowed to concentrically contract the muscle instead. Also, even though each repetition most often begins where the previous repetition ended, it is possible to ease off the stretch and begin the next repetition from a less-stretched position. What is important with CR stretching is that the target muscle contracts with sufficient strength so that the GTO reflex is triggered.
Clinically, the choice to use standard mechanical stretching or to employ an advanced technique such as CR stretching should be made based on the needs of the client on the table. Any stretch can be converted into a CR stretch.
As a clinical therapist, it is important to have as many treatment tools in our tool chest as possible. CR stretching does require participation on the part of the client; and generally there is a learning curve for both the therapist and client to become efficient and smooth when performing it. However, once the protocol becomes familiar, it is quite easy to employ and incorporate into the treatment session. CR stretching is especially valuable when working on clients who have not responded well to massage and standard stretching. If you have not yet worked with CR stretching, try adding this tool to your practice.
Part two of this article explores the other advanced neural inhibition stretch, agonist contract (AC) stretching. It also compares CR with AC stretching, and discusses the contract relax agonist contract (CRAC) stretching technique.
Joseph E. Muscolino, DC, has been a massage therapy educator for 24 years, teaching both core curriculum and continuing education classes. He currently teaches anatomy and physiology at Purchase College, SUNY. He is the owner of The Art and Science of Kinesiology in Stamford, Conn., and is the author of The Muscle and Bone Palpation Manual, with Trigger Points, Referral Zones, and Stretching; The Muscular System Manual, 3rd edition; and Kinesiology, The Skeletal System and Muscle Function, 2nd edition (Elsevier, 2009, 2010, 2010), as well as other publications. For more information or to contact Joseph, visit www.learnmuscles.com.
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