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Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
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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