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Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
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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