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House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
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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