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Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
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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