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Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
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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