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The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
July, 2011, Vol. 11, Issue 07
Understanding Lumbar Disc Herniation
By Whitney Lowe, LMT
Practitioners are frequently concerned about whether or not it is appropriate to work on clients with herniated discs. Unfortunately, there is a great deal of misinformation about this condition.Disc herniations are sometimes blamed for back pain when they are not actually the cause. It is important to understand the anatomy and symptoms of disc herniation to make proper clinical decisions. Massage can be an effective adjunct treatment for clients with this condition.
When x-ray technology first emerged that could show herniations of the lumbar intervertebral discs, there was a rush to assign blame for low back pain on the bulging intervertebral disc, which clearly appeared to be protruding towards nerve roots. For decades it was assumed that if a person had back pain it was from a lumbar disc herniation. Sadly, this led to an excessive number of – and in many cases unnecessary - surgeries. Soft-tissue treatments are now proving to be quite effective at helping in pain relief for this condition.
In addition, it is now understood that many people with herniated discs function without any pain at all. With the advent of the MRI, disc herniations were proven to occur in a large percentage of the population. More interesting is that many people with disc herniations have no back pain whatsoever.1,2 Thus it is important to know that the presence of a disc herniation is not enough to assume that the disc herniation itself is the cause of the pain. Consequently, sound assessment (including referral if needed) is critical for determining what causes a person's pain.
The following is a more detailed look at the structure of the intervertebral disc and what occurs in pathological herniations in the lumbar region.
Anatomy Of The Disc
Intervertebral discs are made of a dense fibrocartilage. There are two component parts to the disc: the inner gel-like substance called the nucleus pulposus and the denser layered fibrocartilage on the outer rim called the annulus fibrosis (Figure 1). Compressive loads applied to the intervertebral disc cause the inner nucleus to push against the annulus fibrosis. With continued pressure over time, the annulus loses its structural integrity and breaks down causing the disc to change shape.
As the disc changes shape, it will push out in the direction with the least restraint. The most common direction with least restraint is in a posterior and lateral direction. The intervertebral foramen is located close to this region and this is also where nerve roots exit the spine (Figure 2).
There is various terminology used to describe the change in the disc's shape as it is impacted with chronic compressive loads such as protruding, herniated, prolapsed, bulging, or ruptured disc. Also frequently heard is the misnomer, slipped disc, which is technically misleading because the disc has not slipped anywhere, it has just changed shape. An effort has been made to update the terminology so it is consistent with the differing levels of severity of the disc herniation. The terms shown in Figure 3 reflect the types and severity of disc herniation and are preferable for describing disc herniation.
Signs And Symptoms
The most common signs and symptoms of disc herniation involve sensory or motor impairments. Sensory symptoms include sharp, shooting, electrical-type pain sensations, as well as paresthesia (pins and needles) or numbness. Motor impairments are evident with either muscle weakness or atrophy. Lumbar nerve roots feed the nerves of the lower extremities, so symptoms from lumbar disc herniation are generally felt in the lower extremity, although pain may be felt in the back as well.
The region of the lower extremity where the impairments are present helps indicate the corresponding affected nerve root. For example, in the upper lumbar region the nerve roots primarily feed into the femoral nerve and therefore symptoms are generally felt in the anterior thigh region. If the disc herniation is in the lower lumbar region, symptoms will generally be felt down the posterior side of the leg because these nerve roots feed the sciatic nerve. Other nerve compression pathologies can produce symptoms similar to disc pressure on a nerve root. Assessment will help determine crucial information about where the nerve compression is originating.
A key question for massage therapists is whether or not it is appropriate to work on somebody with a herniated disc. Massage therapy can be a valuable means of helping to reduce the aggravating factors that perpetuate lumbar disc herniation and the subsequent pain and dysfunction that result. As with other potentially serious medical conditions, it is a good idea to obtain a doctor's clearance before treating the client.
Many of the muscles in the lumbar region, and especially those attaching directly to the lumbar vertebra, increase compressive loads on the intervertebral disc when they are tight. Consequently, reducing tightness in the lumbar muscles helps decrease compressive stress on the intervertebral disc, thus relieving symptoms. Massage will not reverse the process of disc herniation that has already occurred, but it can help reduce compressive forces that can further deform the disc.
A common concern expressed by massage therapists is whether or not working in the lumbar region will press the protruding disc against the adjacent nerve roots. Note that in Figure 4 we see the relationship between the lumbar muscular structures, the transverse processes of lumbar vertebra and the nerve roots. The transverse processes prevent direct pressure on the nerve root. While the specific massage techniques will not directly compress the disc against the nerve roots, it is possible to aggravate pain from a disc herniation with massage in the lumbar region indirectly by moving the vertebral bodies.
Because the disc does not always protrude in the same direction in relation to the nerve root there is no way to know for sure which motions or positions will aggravate nerve root compression. A good general rule of thumb is that if any motion or position or technique further aggravates the client's symptoms, it should be immediately stopped. However, relieving muscular tension in the lumbar region is an important step to reducing disc compression.
Because herniated discs are more common than once thought, it is likely you have had clients with this condition. In general you should consider it relatively safe to work on clients who have disc herniation. A standard rule of caution should be that anything that further aggravates the client's neurological symptoms should be immediately stopped. As usual, if it is at all possible to get further clarification of the exact nature of the problem from a physician you should definitely try to do that. Massage therapy can be a valuable adjunct treatment for clients with disc herniations, so the more you know about this condition the more effective relief you can provide your clients.
Click here for more information about Whitney Lowe, LMT.
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