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News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
May, 2011, Vol. 11, Issue 05
The True Grit of Muscle Spasm
By Erik Dalton, PhD
Much has been written about loss of flexibility and range of motion due to fascial contractures, trigger points, spasmodic muscles and the like, with less emphasis on the neurology that may be initiating these soft tissue changes.Here are some thoughts on how injuries to joint capsules and spinal ligaments can reflexively spasm neighboring tissues leading to decompensation, altered movement patterns and pain-spasm-pain cycles.
When the brain senses bony instability or ligamentous damage in-and-around the spine, information is collected so split decisions can be made to determine the extent of threat to the individual and what actions (if any) need to be taken. Layering the area with protective myospasm is one such decision. It's the brain's reflexogenic attempt to prevent further insult to the injured tissues. By 'splinting' the area with spasm, the hypercontracted (shortened) muscles, ligaments and fascia effectively reduce painful joint movements. Splinting is a common form of protective guarding clinicians address day-in and day-out... but how does it develop and how should we treat it?
Recently, a chiropractic buddy referred a client named Hank who came in carrying a diagnosis of chronic muscle spasm. During Hank's history-taking, he related a story of a bending/twisting incident that occurred while lifting his toddler out of the back seat of the car. Apparently, this asymmetric spinal loading maneuver resulted in 'stabbing' back pain which almost brought him to his knees. After a few treatments, the chiropractor decided Hank's back was too locked up and needed some deep tissue and stretching work. His treatment plan was to have me 'dig out' the spasm and then he would mobilize the fixated spinal joints.
Observations during gait revealed a lack of smooth cross-patterned movement between Hank's torso and hips and very little "lift" in his antigravity spring systems1. In fact, he wobbled from side-to-side much like John Wayne's Rooster Cogburn character in "True Grit"2 (Fig 1). The chronic low back pain had disrupted Hank's hip abduction firing order pattern forcing him to recruit the ipsilateral QL (instead of gluteus medius) to hip-hike and lift the swing leg. It was obvious that Hank's lumbar spine had been locked with spasm for some time but elbowing the spasm didn't seem to be the answer.
History and Motion-Testing
Hank's back pain history and motion testing results suggested an unstable spine that had not been allowed proper healing time due to overstretching and chiropractic adjustments. The heat emanating from Hank's back indicated an active inflammatory process at work...probably due to articular cartilage derangement and/or spinal ligament damage. When pain and inflammation bombard the central nervous system, joint reflexes are stimulated that can disrupt normal low back myo-mechanics. To test, I asked him to slowly forward bend as I palpated for low back asymmetry. This maneuver intensified Hank's dull, aching pain on the right side at about L4-5. As he reached his end range of trunk flexion, I applied a little overpressure which caused the right L4 transverse process to posteriorly rotated against my palpating thumb suggesting the L4 facets on the right were unable to disengage from L5 (Fig 2). To verify, I had him stand straight and try to right sidebend his torso. Normally, I'd expect the L4 transverse process to left rotate against my thumb during this maneuver, but the joint mechanoreceptors refused to take the joint beyond its painful restrictive barrier by inhibiting the left spinal side-benders...particularly QL (Fig 3). While motion-testing the joints, I noticed lack of tone in Hank's multifidus muscle on the right.
Typically, when palpating deep lamina groove muscles (rotatores, multifidi, intertransversarii, etc.), I expect to feel 'knotty' fibrosis on the side of dysfunction. These are usually the first muscles recruited as the brain's neuromatrix scans and 'maps' the dysfunctional area. If it senses exceptional weakness, it'll stiffen these short-lever muscles to protect an unstable spine (Fig 4). The burning question is this: Does joint blockage or ligamentous damage always result in deep intrinsic muscle hypertonia (fibrosis) or, as in Hank's case, can the tissue sometimes become hypotonic or inhibited? Contrary to what I was taught in Philip Greenman's osteopathic model3, secondary muscle changes in the deep groove muscles from joint blockage do not always result in hypertonicity or spasm. In fact, Dr. Stuart McGill found that when a lumbar facet joint became displaced during a lifting incident, the multifidus on the side of the fixated facets began to atrophy within 24 hours.4 (Fig 5).
Calling in the Subs
When the brain senses weakness or injury in osteoligamentous tissues, it calls for help from middle layer (core) stabilizers such as the QL, psoas, transverse abdominis, etc. Regrettably, this middle layer postural support system is best designed for lumbopelvic bracing to allow global (extrinsic) muscles and fascia to carry out normal movements of daily living...not for facet joint stabilization. Therefore, when the middle layer is recruited to "sub" for fixated facets or damaged spinal ligaments, firing order patterns are skewed, motor recruitment is garbled, and coordinated movement suffers. Bottom line: Prolonged joint damage can set the stage for aberrant posturo-movement patterns which, in time, causes the brain, through the process of sensitization, to re-map and re-learn the dysfunctional movement as normal (neuroplasticity).
Due to our population's general lack of proper core support and our inability (through lack of good functional movement training) to adequately activate the middle layers, many, like Hank, find it hard to "hold on" until ligaments heal, fixated facets are released and myo-mechanics are corrected. Sadly, when the oxygen-burning middle layer muscles run out of gas, the load falls back to the damaged joint capsules, spinal ligaments and articular facets which further intensify the pain-spasm-pain cycle.
Regardless of the reason for loss of joint play, when vertebrae are not free to move, muscles assigned the job of moving them (prime movers) cannot carry out their duties and are substituted by synergistic stabilizers, i.e., the brain sends in the subs when a key player is injured. The final stage of dysfunction occurs when the middle and deep spinal layers both collapse causing the load to shift to global (outer layer) dynamic muscles such as the erectors, obliques and lats. These fast-twitch muscles burn glucose and are designed to provide bursts of energy. Spasm develops when they're forced to act both as movers and stabilizers. As they tire and tighten, the lubricating fluid between fascial bags begins to dehydrate and the facial envelops adhere to neighboring structures often resulting in a big 'wad' of hypertrophied erector spinae tissue that therapists beat on session-after-session.
Once ligaments and joint capsules have healed, manual therapists can help maintain flexibility by elongating cross-linked collagen fibers in the joint capsules and balancing the middle and outer musculo-fascial tissue layers. Myoskeletal articular stretching techniques designed to minimize the accumulation of nociceptive tissue irritants at the injured site help normalize afferent messages to the brain; thus reducing protective muscle guarding around the dysfunctional joint. Once pain-free movement is established, functional movement training effectively restores motor control patterns and allows the brain to reestablish optimal posturo-movement patterns.
Click here for more information about Erik Dalton, PhD.
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