resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
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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