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Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
May, 2011, Vol. 11, Issue 05
Understanding Central Sensitization and Pain
By Leon Chaitow, ND, DO
Central sensitization is defined as 'an augmentation of responsiveness of central pain-signalling neurons to input from low-threshold mechanoreceptors' (Nijs 2009). The evolution of chronic pain has been shown to have strong association with the process of central sensitization, in which there is enhanced sensitivity to various modes of painful and non-painful stimuli (Buchgreitz et al 2006).
Staud (2006) has described the ways in which peripheral pain impulses can lead to central sensitization. In many chronic pain states, including chronic migraine, irritable bowel syndrome, fibromyalgia syndrome, repetitive, persistent or recurrent peripheral nociceptive features can lead to neuroplastic changes in the spinal cord and brain, that results in central sensitization and consequent pain.
Yi-Meng Xu et al (2010) have explained that even the nociceptive input from latent trigger points can contribute to central sensitization, and that only minimal nociceptive input (resulting from touch, pressure or heat) may be required to maintain the chronic pain state, once central sensitization has evolved.
A generalized central sensitization is identified as operating in fibromyalgia syndrome which is also common accompanying diagnosis in patients with chronic headache. Yunus (2007) has described the overlap of a number of chronic pain as Central Sensitivity Syndromes - asserting that in such conditions hyperexitability exists of central neurons resulting from the influence of various neurotransmitter and neurochemical activities, with this (central sensitization) itself being contingent - for both development and maintenance – on abnormal or continued peripheral inputs.
Background to sensitization
Selye (1984) defined both the general adaptation syndrome (GAS) affecting the individual as a whole, and the local adaptation syndrome (LAS), affecting a local area of the body that is subjected to stressors demanding adaptation. The GAS and LAS models explain how adaptation progresses, over time, with modifications to function occurring, leading eventually to adaptive capacity becoming exhausted, and symptoms emerging.
Neuromusculoskeletal adaptive changes involved in such processes can be seen to represent a record of the body's attempts to adapt and adjust to the multiple and varied stresses which have been imposed upon it, over time. The results of repeated postural and traumatic insults over a lifetime, combined with the somatic effects of emotional and psychological origin, will often present a confusing pattern of tense, shortened, bunched, fatigued and, ultimately, fibrous soft-tissues. Some of the many forms of biomechanical stressors that affect the body include the following (Lewit 2009).
Widespread functional changes develop – for example, affecting respiratory function and posture – with implications for the total economy of the body. (Timmons & Ley 1994) In the presence of a constant neurological feedback of impulses to the CNS/brain, from neural reporting stations, there will be increased levels of psychological arousal and a reduction in the ability of the individual, or local hypertonic tissues, to relax effectively, with consequent reinforcement of hypertonicity, and inevitably relative ischemia – an environment ideal for myofascial trigger point evolution (Shah 2005).
Functional patterns of use, of a biologically unsustainable nature, are likely to evolve, leading to chronic musculoskeletal problems and pain. (Crockett et al 2002) At this stage, restoration of normal function would require therapeutic input to address both the multiple changes that have occurred, as well as there being a need for re-education of the individual as to how to use the body, to breathe, and to display posture in more sustainable ways.
For more on the topic of adaptation the following two links will take you to some of my blog postings on this subject:
Soft tissue changes
Soft-tissue changes involving pain, hyper- or hypotonicity, joint dysfunction, antagonist muscle imbalances, overactive synergist muscles, lead to localized areas of hyper-reactivity, in the form of myofascial trigger points, and/or neural entrapment. (Lewit 2009) Additionally, pain due to damage or inflammation of peripheral tissues is clearly capable of causing chronic widespread pain. Another example of a local musculoskeletal disorder associated with chronic pain, frequently seen in manual therapy practice, is arthritis, possibly causing continuous activation of local nociceptors that initiate or sustain, central sensitization.
Reducing the nociceptive barrage Yunus (2007) has suggested that effective manual therapy in sub-acute cases of musculoskeletal dysfunction should be capable of limiting the afferent barrage of noxious input to the central nervous system, so preventing chronicity. Nijs et al (2009) goes further and affirms the importance of decreasing the afferent nociceptive barrage of trigger points, by means of soft-tissue mobilization, in comprehensive care of cases of chronic pain.
Neuromuscular therapies (NMT) aim to reduce the effects of adaptation/compensation as described above, by enhancing musculoskeletal function – including improved posture, respiratory function, and general mobility and stability, and by reducing noxious inputs resulting from the active presence of, for example, myofascial trigger points.
Recognizing Central Sensitization in patients Nijls et al (2010) have summarized the many associated features of central sensitization;
The presence of some or all of these symptom, together with information gathered during the history taking and the medical diagnosis, and confirmatory results from assessments listed below, can all help in recognition of the existence, in a given patient, of central sensitization. In this assessment the following tests have been suggested (Yunus 2007):
Symptom exacerbation, at both symptomatic and distant sites, indicates central sensitization. It is important to note that a variety of other indications may also suggest this, including increased pain during, or following, exercise
A fundamental principle emerges from current understanding of the sensitization process – sensitization can be reversed.
Affaitati et al (2011) have clearly demonstrated – in fibromyalgia - that therapeutic strategies that reduce the overall stress burden, whether these relate to biomechanics, biochemistry or psychosocial features, will reduce central sensitization.
Click here for more information about Leon Chaitow, ND, DO.
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