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CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
October, 2011, Vol. 11, Issue 10
Challenging the Traditional Diagnosis of Carpal Tunnel Syndrome
By James Waslaski
In the light of clinical studies, and research available today, this article will take a close look at common forearm, wrist and hand problems that often seem to be diagnosed and treated incorrectly.This article is based on a true case study of a client from one of my seminars in Boston. This particular client had recently undergone surgery at both his wrist and elbow. Both surgical procedures were attempts to release the pressure on his median nerve, to treat carpal tunnel syndrome. Unfortunately, the actual nerve compression problem was actually in his neck and shoulder before the nerves ever branched off to become the median nerve at the elbow and wrist. Once we treated the tight muscle groups such as his SCMs, anterior and posterior scalenes, and his pectoralis minor, the numbness, tingling and parasthesia that surgery did not correct in his arm and hand went away.
The term multiple crush phenomenon refers to a condition when there is more than one compression on a nerve trunk. Sections of the nerve distal to the first site of compression become nutritionally deficient because of axoplasmic flow blockage. Consequently, these distal areas are more susceptible to irritation from even a minor degree of compression (i.e. becoming the second or third site of the crush).
If you look at a classic postural distortion pattern of someone talking on the phone, it is clear to see that poor work ergonomics can shorten muscle groups in the neck, shoulder, elbow, forearm, wrist and hand. (Figure 1 ) When muscles like the SCMs, anterior and posterior scalenes, and pectoralis minor shorten, the brachial plexus of nerves get compressed under the clavicle. (Figure 2)
This is often compounded with cervical nerve compression problems. So the nerves are compressed twice already. Then at the elbow, the median nerve runs through the bicipital apeneurosis, and again through the pronator teres. (Figure 3) If there is tension or damage to the bicipital apeneurosis or teres minor, the nerves are now compressed four times before they ever reach the carpal tunnel.
Therefore, when a client complains of clinical symptoms such as parasthesia, numbness, and pins and needle sensations in their hands, the manual therapist should look at all areas of nerve compression between the brain and the fingertips. In my opinion, the assessment should start in neck and shoulder, progress to the elbow, and then end at the wrist. This approach to treatment would address what Dr. Erik Dalton refers to as descending syndromes.
Based on the photo of the woman on the telephone, let's look at a simple road map. This assumes that posturology has addressed a true leg length discrepancy, and myoskeletal alignment techniques have facilitated alignment of the bones in the cervical spine.
Step 1. Release the tight SCMs, and anterior and posterior scalenes.
This should start with myofascial release, followed by treating active and latent muscle belly myofascial trigger points, and stretching those muscles that often pull the first rib up onto the clavicle to compress the brachial plexus of nerves. (Figure 4)
Step 2. Release the pectorals major and minor muscles.
After doing myofascial release to the pectorals major (Figure 5), treat trigger points in the pectorals minor (Figure 6), and stretch the pectoralis major and minor muscles. Make sure to treat a muscle strain in the pectorals minor, if found, and address capsular adhesions of the shoulder if there is a bone on bone like end feel when stretching the pecs.
Step 3. Release the biceps (taking tension of bicipital apeneurosis). (Figure 7) If there is a strain in the bicipital apeneurosis treat that after releasing the biceps muscle belly. The median nerve will be scarred down by scar tissue in the bicipital apeneurosis if that is strained.
Step 4. Release the pronator teres. (Figure 8)
Keep in mind the median nerve passes through this muscle. In people that work on the computer, this is a posturally short muscle that often gets neglected in clients diagnosed with carpal tunnel problems.
Step 5. Release the wrist and hand flexors. (Figure 9) There are nine tendons that pass from these muscles under the flexor retinacculum. Tension in the wrist flexors cause overdevelopment of their tendons, and can compress the median nerve under the tight flexor retinaculum leading to "true" carpal tunnel syndrome.
Step 6. Free up the flexor retinaculum, and release individual tendon adhesions in the carpal tunnel. Active myofascial release is done by having the client spread and extend the fingers to help release the flexor retinaculum and flexor tendons in the tunnel. (Figure 10)
This should be followed with the client stretching those same muscles as part of client self care. Ergonomics of the work station would also be addressed. This article will flow into a series of articles, starting with complicated forearm, wrist and hand conditions, to take a more detailed clinical look at conditions like "true carpal tunnel syndrome" and the significant difference between tendinitis, tendinosis and tenosynovitis conditions. The treatment by the manual therapist cannot get optimal results if we do not understand the different pathologies of these very different basic clinical conditions of the forearm, wrist and hand. Manual therapists will get their best results with complicated clinical conditions when they learn to match the appropriate modality or manual therapy discipline to each specific underlying pathology. Our industry also needs to also take a closer look at things like multiple crush phenomenon to eliminate multiple causes of conditions such as carpal tunnel syndrome.
Editor's Note: Art images and case study information were taken from James Waslaski's new book with Pearson Publishing, Clinical Massage Therapy: A Structural Approach to Pain Management.
Click here for more information about James Waslaski.
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