resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
November, 2010, Vol. 10, Issue 11
Advanced Stretching: Using Neural Inhibition to Enhance the Stretch, Part 2
By Joseph E. Muscolino, DC
In part 1 of this series, we discussed contract relax (CR) stretching, which involves neural inhibition to augment the mechanical stretch of the target musculature.Here, in Part 2 of this series, we will discuss agonist contract (AC) stretching, which also uses neural inhibition to augment the mechanical stretch of the target musculature.
Similar to CR stretching, AC stretching also relies upon a neurologic reflex. However, whereas the Golgi tendon organ (GTO) reflex is the proposed neural mechanism for CR stretching, reciprocal inhibition is the proposed neural mechanism for AC stretching. The mechanism of RI is that whenever a mover muscle contracts and shortens to create a joint action, the antagonist musculature (that is usually located on the other side of the joint) must lengthen to allow that motion to occur. RI reflex acts to facilitate the lengthening of the antagonists by inhibiting them from contracting. This inhibition causes a relaxation so that the antagonists more effectively lengthen. As with the GTO reflex, we can take advantage of this reflex to create a better stretch.
AC stretching is performed by creating a scenario in which the target muscle that will be reciprocally inhibited is the antagonist to the joint motion that is performed. The usual AC stretching protocol steps are carried out as follows. The right lateral flexor (RLF) musculature of the neck are used as the example (Fig. 1):
a. Have the client begin in a neutral starting position.
b. Ask the client to actively concentrically contract the left lateral flexion (LLF) musculature, moving the neck into LLF. By doing this, the target RLF musculature is the antagonist of the motion. Their stretch is begun and the RI reflex is triggered. The client usually exhales during the contraction (think "e" for exhale and "e" for exertion).
c. The client then relaxes and we further stretch the client into LLF. The client usually completes the exhale during this step.
d. The client continues to relax as we passively bring the client back to the starting position. The client inhales during this step so she is ready for the next repetition.
Typically eight to 10 repetitions are performed, and we progressively increase the force of the stretch with each repetition. Because a large number of repetitions are performed with AC stretching, each repetition is usually performed fairly quickly. An entire repetition takes approximately 3-5 seconds.
Comparing CR and AC Stretching
To more easily learn these techniques, it can be helpful to compare CR with AC stretching. With CR stretching, the target muscle group isometrically contracts against our resistance. (Note: Part 1 of this series, the target right lateral flexors isometrically contract.) With AC stretching, the target muscle group is turned into the antagonist of the joint motion. Note that in Figure 1a, the left lateral flexors concentrically contract (again the right lateral flexors are the target musculature). It can help to remember that with AC stretching, the client's contraction actually begins the stretch of the target musculature.
Contract Relax Agonist Contract Stretching:
CR and AC stretching can be combined to create contract relax agonist contract (CRAC) stretching. As its name implies, a CRAC stretching repetition is done by sequentially performing the CR and then the AC stretching techniques. The benefit of CRAC stretching is that it triggers both the GTO and the RI reflexes, therefore potentially creating a more powerful inhibition/relaxation of the target musculature. The usual CRAC stretching protocol steps are carried out as follows. The RLF musculature of the neck are again used as the example (Fig. 2):
a. Have the client begin in a neutral starting position.
b. Ask the client to gently isometrically contract the target RLF musculature against our resistance for approximately 5-8 seconds to trigger the GTO reflex. The client holds in the breath during this step. This is the CR portion of the stretch.
c. Then ask the client to concentrically contract the LLF musculature to move into LLF. This begins the stretch the RLF musculature and it triggers the RI reflex. The client exhales during the contraction. This is the AC portion of the stretch.
d. The client then relaxes and we further stretch the client into LLF.
e. We then passively bring the client back to the starting position as the client inhales. This completes one repetition.
Three to five repetitions are usually performed, each one beginning from the same neutral starting position, as is done with AC stretching. Typically, the client is asked to increase the force of contraction with each repetition, and we progressively increase the force of the stretch with each repetition.
Most every stretch can be performed as a CR or an AC stretch, or even a CRAC stretch. Both CR and AC advanced stretching techniques are equally effective. Which one you choose to use will most likely depend upon client preference and which technique is logistically easier for that particular muscle and the position that the client is in. Advanced stretching techniques might take a little more time, effort, and practice to master, but the benefits to your clients are well worth it.
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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