Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
The Winter of Life: A Personal and Chiropractic Practice Perspective
Last November, my wife and I invited an elderly relative, Uncle Josh, to spend the winter with us. He was 82 years old at the time and turned 83 during his stay. As soon as he accepted our invitation, we began preparing.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
7 Reasons You Want a Beacon in Your Office
Have you heard about how "beacons" are transforming the way businesses interact with their customers? Beacons are low-energy Bluetooth devices that have the ability to send information to a smartphone app.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Are You Making the Wrong Impression?
Taking a page from Stacy and Clinton of The Learning Channel's hit television program, "What Not to Wear," we recently published an article in the summer issue of Chiropractic History: The Archives and Journal of the Association for the History of Chiropractic, that explores the evolution of physician attire from prehistoric times to the present.
Research: Know What You're Talking About
Have you ever seen a patient in your office with multiple serious health problems you weren't sure exactly how to address?
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Chiropractic Care and Risk of Stroke: The Shoe Moves to the Other Foot
For decades, numerous papers have linked upper cervical chiropractic care to the incidence of vertebral artery dissections and stroke.
Reverse Digit Span: A Useful Assessment Tool for Patients With and Without Concussion
Reverse digit span is an easily administered test of attention span. It is a component of the SCAT3 test, which is frequently used to assess concussion. It has been part of the armamentarium of cognitive assessment for many years.
Looking Back: Abstracts From Chiropractic History (Summer 2015 Issue)
The following abstracts are reprinted with permission from Chiropractic History, the official journal of the Association for the History of Chiropractic. Chiropractic History is the leading scholarly journal of the chiropractic profession dedicated to the preservation and dissemination of the profession's credible history.
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 previous articles by James Waslaski.
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