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Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
May, 2011, Vol. 11, Issue 05
Does Fascial Research Alter Assessment?
By Whitney Lowe, LMT
Tom Myers recently wrote an article highlighting some outstanding research published by the Dutch osteopath and anatomist Jaap van der Wal. I was intrigued by the concepts Myers highlighted in this article and looked for more of van der Wal's publications.
In addition to his previous papers on the subject of fascia, van der Wal also published a paper in the International Journal of Therapeutic Massage and Bodywork in 2009 that explores these anatomical concepts in great detail.
It is interesting to note that van der Wal wrote of these very important findings almost 20 years ago, but did not find acceptance of those ideas within the traditional scientific publishing community until recently.
The essence of van der Wal's research points out that dissection and anatomical science has for centuries focused on a very reductionistic and mechanistic view of the musculoskeletal system. However, he suggests it is a much more complicated and intricately woven web.
In his dissection studies, van der Wal demonstrates that ligaments are not discrete structures separated from muscle and fascial connective tissue. His research shows that at least some ligaments around the body's joints are actually connected in series with muscular tissues - meaning that muscles have fascial connections with ligaments and thus may not act independently.
Does this information impact our practice?
For years the dominant model of orthopedic assessment has been the foundation of James Cyriax's model of contractile and non-contractile (inert) tissues. Contractile tissues included muscle and its associated tendon, because the tendon was strongly pulled once the muscle contracted. Inert tissues were all the soft tissues other than muscle and tendon. They are called inert because they don't actively contract and they are only passively lengthened or shortened during motions of the joints.
Clinicians used this structural format to establish a systematic process of evaluating soft-tissue dysfunction. The central point of this evaluation method is that certain evaluation procedures produce pain or discomfort if a contractile tissue is at fault, while other methods produce pain if an inert tissue is at fault.
As an organizational system it makes very good sense and works quite well in the evaluation process. But there are times when the pattern of pain or discomfort does not seem to fit this classical formula. That leaves the clinician to discover and interpret what the anomaly means. Now, we may have an explanation that helps unravel some of these inconsistencies.
If there are direct fascial connections that tie ligaments and muscles together in series, then ligaments will have tensile loads applied to them when muscles contract. Traditionally, we have said that a manual resistive test applied to a particular joint motion isolates the muscle-tendon tissues, but not the inert tissues. The muscle-tendon tissues are engaged in a contraction generating a tensile load. Because there is no movement at the joint the inert tissues are not stressed at all.
With this new research, that axiom no longer holds true. If muscles have direct serial connection with ligaments, a manual resistive test with no movement could still put a tensile load on a ligament. If that ligament was damaged, pain could ensue. Under the old paradigm one would assume pain during a manual resistive test is only a muscle-tendon injury, but now we see it could be a ligamentous injury. What does this mean?
For the therapist in clinical practice these concepts have tremendous importance in attempting to identify which tissues might be the source of the client's pain. There are very important implications for both assessment and treatment from these exciting research findings.
From the assessment perspective, it means we must consider the possibility of a greater number of tissues causing client pain if muscle contraction or stretch is involved, especially if that pain is localized near a joint. From the treatment perspective, it means we must look at the extensive functional relationships between different tissues and consider how treatment of one type of tissue (muscle for example) may affect the function of another (ligament).
I have always been an advocate of staying current with research findings and looking for innovative ways to apply them to clinical practice. It is exciting because we're constantly learning new things, and these new concepts and ideas help us become ever more effective with the clients who come seeking our help for pain and injury complaints.
Click here for more information about Whitney Lowe, LMT.
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