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Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
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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