resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
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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