resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
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.
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.
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."
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.
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.
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.
November, 2010, Vol. 10, Issue 11
Treatment of Flexor Hallucis Longus Dysfunction
By Whitney Lowe, LMT
In a previous installment of this column, we discussed dysfunction of the flexor hallucis longus (FHL) muscle. Our discussion covered the basics of the condition and some primary assessment principles.However, it's also important to have appropriate strategies for treating the problem. This article covers specific technique suggestions that are valuable in addressing this challenging lower extremity problem.
Traditional medical approaches for addressing FHL dysfunction may advocate treatments such as corticosteroid injections. Keep in mind that one component of the FHL dysfunction may involve stenosing tenosynovitis, a narrowing of the synovial sheaths around the affected tendon. Some medical practitioners advocate the use of anti-inflammatory medications because there can be inflammatory activity with the tenosynovitis.
Despite the fact that there is often an inflammatory component with this problem, as in the case of stenosing tenosynovitis, corticosteroid injection is usually contraindicated due to the very close proximity of the neurovascular bundle. There is a risk of potential nerve or vascular tissue damage by using injections so close to neurovascular structures. Avoidance of corticosteroid injections is also a good idea because they can lead to long-term collagen degeneration in the tendon, which is detrimental for optimum tendon function.1
FHL dysfunction can usually be treated with conservative measures, and soft-tissue treatment is a mainstay of the conservative approach. Massage is helpful as a non-invasive way to address the biomechanical dysfunction as well as the primary tissue pathology. One of the most helpful methods for addressing this problem is deep longitudinal stripping techniques applied to the FHL and deep posterior compartment muscles. (Fig. 1) This technique can be performed in several positions. A side-lying position is particularly effective and is shown here. Use the thumb, fingertip or other small contact surface to apply a slow but deep stripping technique along the medial tibial border directly on the deep posterior compartment muscles such as the FHL. This can be quite tender so make sure you go slowly and stay in close communication with your client about appropriate pressure levels.
Friction techniques applied to the medial side of the ankle may be helpful to mobilize the tendon against adjacent tissues in the region. However, be cautious about the amount of pressure used in this area as there may be corresponding compression of the tibial nerve on the medial side of the ankle and you don't want to aggravate that problem.
Deep stripping with a small contact surface such as the thumb, knuckle, fingertip, or pressure tool should also be performed to the tendons and muscles on the bottom surface of the foot. As mentioned earlier, sometimes there may be adhesions developing between the tendons of the FHL and flexor digitorum longus (FDL) on the bottom of the foot. These adhesions can be broken up by good friction and stripping techniques. The client should also be encouraged to stretch the FHL frequently in order to encourage better mobility. Stretching is best performed in the same position that is used to stretch the gastrocnemius and soleus muscles (Fig. 2). This stretch can also emphasize the FHL a little more and discount any tightness in the gastrocnemius by flexing the knee and hyperextending the hallux during the stretch.
Another technique that is highly effective for FHL dysfunction is an active engagement stripping technique to the deep posterior compartment muscles. You will use a similar stripping technique to the one mentioned earlier. However, active movement is used in conjunction with the stripping technique.
Begin with the client's muscle in a shortened position. That means the foot is in a plantar flexed position. Use the side-lying position shown in Figure 1 because it allows for full movement of the foot. Have the client perform an active plantar flexion and dorsiflexion movement that is slowly repeated. Each time the client dorsiflexes, the foot performs a short stripping method on the FHL muscle. The stripping technique is applied each time the muscle is elongating. Release pressure as the client moves the foot back into plantar flexion. Repeat that sequence of movements until you have covered the entire muscle group thoroughly. If there are areas that are particularly tender, repeat the technique several times in those areas until muscle tightness or fibrosity has been adequately reduced. This active engagement technique is highly valuable for any overuse disorders of the lower extremities that affect the deep posterior compartment muscles.
If conservative treatment is not effective for this problem, surgery may be performed in some cases. Surgical procedures usually consist of tenolysis, a procedure where the tendon is freed from scar tissue or entrapment by adjacent structures. Following the surgical procedure, adequate mobilization of the FHL will be important and massage can play a significant role in the post-surgical management of this condition as well.
This problem or group of problems, known as FHL dysfunction may occur more often than realized because the symptoms are so similar to other pathologies. The massage practitioner is encouraged to thoroughly evaluate this condition, including detailed information from the client history, in order to determine if the problem will respond well to soft-tissue treatment. Because this is such a specific muscle/tendon pathology, massage may offer great results for successful resolution and a return to pain-free movement.
To see a demonstration of the active engagement technique for deep posterior compartment muscles described in this article, go to this YouTube video: www.youtube.com/watch?v=U1qVge1TGIo
Click here for more information about Whitney Lowe, LMT.
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