Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
February, 2011, Vol. 11, Issue 02
The Bike Body
Working With Cyclists
By Erik Dalton, PhD
It's astonishing the money and time many elite and "weekend-warrior" cyclists devote to retrofitting racing bikes to conform to their bodies rather than first restoring function to the most critical piece of racing equipment: the rider's body.When muscle imbalances, faulty movement patterns and joint fixations distort the body's bony framework, the cyclist is led on a never-ending journey searching for that perfect bike fit. (Fig. 1)
My personal mantra: "Fit the body to the bike, stupid!"
Bodyworkers and functional movement trainers whose practices cater to amateur and elite cyclists are keenly aware of the clinical and performance advantages gained by restoring optimal mobility, flexibility and stability to the biker's muscle/joint complex. It makes sense to first get the kinks out before sending the client off for an expensive and sometimes useless bike retrofit. Without hands-on maintenance and functional fine-tuning, cyclists often unknowingly reinforce dysfunctional movement patterns ingrained from long-forgotten micro- or macro-traumatic injuries.
Confusion and controversy over this chicken-or-egg (bike-or-body) thing is primarily due to lack of understanding of the Law of Cause and Effect. For instance, let's say a bike shop performs a retrofit and Bob, the cyclist, smilingly pedals away on his newly reconstructed machine feeling secure and pain-free. Life is good... or is it?
Unfortunately, if Bob is one of many "flexion-addicted" Americans with a sedentary job that keeps him glued to the computer terminal day-after-day, gravitational exposure will gradually drag his body into a big "C" curve. (Fig. 2) In time, Bob's brain relearns this aberrant posture as normal and on weekend outings his "hip-flexed" desk posture morphs into a similarly distorted riding posture. (Fig. 3)
To make matters worse, stubborn pain-spasm-pain cycles often appear as the hip stiffens and the imposed stress destabilizes sacroiliac and low back structures. In the presence of lumbar spine instability, the brain may decide to lock down the low back and ribcage with protective muscle guarding. Thoracic cage rigidity not only inhibits proper diaphragmatic breathing but also sends shock waves through the thoracolumbar and pectoral fascia and into the upper extremity joints where reverberations are met with strong resistance from habitually locked hands, elbows and arms. (Fig. 4) Meantime, compensations from adhesive hip capsules also traverse down through Bob's knees, ankles and feet searching for a weak link in the lower kinetic chain.
Cyclists who opt for a bike retrofit prior to receiving manual therapy to release fibrotic hip capsules and hip flexors, soon notice a loss of endurance and may develop soft tissue or joint sprains associated with lumbopelvic imbalance. Oddly, many flexion-addicted cyclists attempt to work through the injury despite sensing a noticeable reduction of speed, power and efficiency. "No pain, no gain" is an unacceptable working model for those seeking longevity in the cycling sport.
Does decreased hip angle equal less power?
One of the most common bike positions used by "flexiholics" has the hip flexors locked short and the hams and glutes overstretched and weak. This imbalance pattern as described by Vladimir Janda in his lower crossed syndrome, forces the pelvic bowl to be drawn too far forward creating a decrease in hip angle. (Fig. 5)
Cyclists who consistently ride with an anteriorly rotated pelvis and decreased hip angle are subject to capsular and ligamentous adhesions and a subsequent loss of economy and power. To accommodate the loss of hip extension, many recreational and competitive racers compensate by posteriorly tilting their pelvic bowl and rounding their backs into a hyperkyphotic posture just to increase hip angle and power. The famed cyclist Andy Pruitt believes that changing the seat height by a mere inch alters mechanics and motor control patterns of every joint in the lower extremity. By decreasing seat height, excessive force is transferred to the patellofemoral joint, while raising the saddle too much strains the hamstrings, low back and hands.
Stand and try this: Lift one leg with the knee bent about 90 degrees as high as possible without straining or rounding the back and forcing hip flexion. Most people are able to comfortably hip-flex about 90 degrees. Try this maneuver again except this time forward-bend your trunk about 50 - 60 degrees, while raising the knee. Notice a dramatic reduction in the amount of hip flexion? Try both tests again and this time, measure available hip flexion by observing how high your foot raises off the ground. This test illustrates what can happen to hip-impaired cyclists: decreased hip flexion = greater effort = more work = poor performance.
Riding Postures and Rehab
The first order of business when treating adhesive (motion-restricted) hip flexors and capsules is to mobilize the hip in all three cardinal planes. (Fig. 6a) To restore myofascial balance, fast-paced "spindle-stim" maneuvers such as those shown in Fig. 6b help tonify weakened (neurologically inhibited) gluteal and hamstring muscles. Once the therapist manages to increase hip angle and establish proper functional balance and range of motion, the cyclist is free to decide which type of riding posture (he believes) suits him best.
Some cyclists prefer a high seat so they can posteriorly rotate the pelvis to increase hip angle. Other riders find greater mechanical advantage by putting a little curve in the low back, engaging the core, and then slightly backing off the curve to allow a neutral lumbar spine. Either way, both groups should avoid:
The Yin-Yang of Muscles and Joints
To perform well in such a challenging event, cyclists like Bob would greatly benefit from a well-constructed manual and movement therapy program that focuses on restoration and maintenance of proper intrinsic/extrinsic muscle balance and diaphragmatic breathing patterns. Fluid and dynamic body movement during cycling events is dependent on the ability of muscles and fascia to stay strong, yet flexible. A healthy lumbar spine is the driving engine in most athletic endeavors and length/strength balance between muscles, ligaments, joint capsules, and thoracolumbar fascia is essential for providing that stable platform. Any weakness or motor control issues are magnified by traumatic shocks from funky road conditions or recurring bike injuries. Eventually, excessive neurological input cannot be handled at the spinal cord level and the information is "fast-tracked" to the brain for interpretation via pain-signaling nociceptors. If the brain decides to "splint" the vulnerable area to prevent further insult, pain-spasm-pain cycles may ensue.
Ingrained muscle and motor imbalance patterns such as those discussed by Vladimir Janda, Gray Cook, Craig Liebenson and others, often require a concerted team effort to reestablish normal movement behavior. In most cases, the ideal treatment protocol is to first restore lost mobility to impaired structures and then address stability issues via functional movement training.
Like many of America's other popular, but abnormal, athletic endeavors such as golf, tennis, bowling, etc., cyclists bring with them a complex biomechanical downside that's often hard to completely fix. The "arched back" model is generally the most problematic. In an attempt to level the eyes, the rider must hyperextend occiput on atlas. The cervicothoracic junction is also forced to hyperextend (neck-on-shoulders) causing chronically locked intervertebral joints and rib jamming. This area is particularly affected by road vibrations due to the stationary position of arms, shoulders and hands. Additionally, ligamentous laxity may develop from excessive thoracolumbar and lumbosacral bowing which, in time, sets the stage for low back pain and disability.
The good news is that the human body is both adaptable and dynamic; the bad news is that our biker clients often bring along a lot of baggage including flexion-addicted sitting postures, old injuries, compensations, poor training habits, etc. Once the skilled manual and movement therapist makes necessary corrections, the bike can then be retrofitted to conform to the rider's optimally functioning body. A properly fitted bike combined with a revitalized and functionally balanced neuromuscular system allows muscles and joints to work at optimal levels of motor unit recruitment and synchronization. As endurance and performance improve, so does the natural love of cycling.
Click here for previous articles by Erik Dalton, PhD.
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