resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
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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