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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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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.
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.
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.
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.
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:
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?"
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.
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.
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.
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.
November, 2011, Vol. 11, Issue 11
Adaptation Perspectives and Low Back Pain
By Leon Chaitow, ND, DO
A prospective patient arrives with a problem for you to manage – say a backache (a not uncommon scenario!). Where do you begin? I would suggest you begin by viewing the problem through a broad lens.The tissues of your (and your patient's) body respond to applied demands (stressors) deriving from backgrounds of overuse, misuse, abuse (trauma) and disuse, overlaid onto a combination of developmental and maturational experiences of life – the inherited and acquired habits and patterns of use (for example postural or respiratory), ergonomic, work and leisure stresses, as well as the results of injuries, surgeries, emotional burdens and more.
These features and experiences will have blended to create tissues that may gradually have changed from a state of normotonicity to a palpably dysfunctional state, at times involving hypertonicity, and at others hypotonicity, along with altered firing sequences, modified motor control, abnormal postural and/or movement patterns and ultimately dysfunctional chain reactions. What emerges is a picture of impaired or altered function of related components of the somatic framework; skeletal, arthrodial, myofascial, as well as related vascular, lymphatic and neural features, all examples of adaptational overload.
But to the patient, it is simply "a backache." Such changes almost always demonstrate functional, sometimes visible, often palpable, evidence, that can frequently be assessed in order to guide you towards clinical decision-making, as to what form of management may be most appropriate. What therapeutic and rehabilitation strategies, in the context of acute and chronic somatic dysfunction, may be able to assist in normalization of dysfunction, pain management and rehabilitation? Parsons & Marcer (2005) note that "it is through the summation of both quantitative and qualitative findings that one obtains an indication of the nature and age of the underlying dysfunction"
Repetitive Lumbar Injury: An Example of Adaptation Overload
In discussing a form of low back pain that they describe as Repetitive Lumbar Injury (RLI), Solomonow, et al (2011a), outline the etiology of a complex multi-factorial syndrome that fits the model of adaptive overload. This involves an adaptation sequence, in which prolonged cyclic loading of the low back can be shown to induce a process of creep – defined as continued deformation of a viscoelastic material under constant load over time - in the spinal tissues (Sanchez-Zuriaga 2010), reduced muscular activity, triggering spasms and reduced stability, followed by acute inflammation and tissue degradation (Fung et al 2009), as well as muscular hyperexcitability and hyperstability (Li et al 2007).
These adaptive changes are seen – in animal studies (Solomonow 2011b) and in humans (Solomonow 2003) - to be a response to rapid movement, high loads, numerous repetitions and short rest periods. Behaviours that are not uncommon in many common work and leisure/athletic activities. The conclusion is that viscoelastic tissues ultimately fail via a process involving the triggering of inflammation, due to overuse, a process that appears to initiate the mechanical and neuromuscular characteristic symptoms of the disorder.
In contrast, Solomonow, et al (2011a), found that low magnitude loads, short loading durations, lengthy rest periods, low movement velocity and few repetitions do not constitute significant risk factors, yet nevertheless triggered transient stability deficits and pro-inflammatory tissue degradation. It is suggested that it might be more appropriate to designate these conditions as low risk instead of no risk. In perspective, Repetitive Lumbar Injury – manifesting in your patient with backache - is seen to be a complex multi-factorial syndrome. A clear example of adaptation to imposed demands that exceed the ability of the tissues involved to respond. Repeated bending activities in daily living appear to change both structure (ligaments, discs) and function (protective spinal reflexes).
Therapeutic interventions in such a spectrum of progressive dysfunction (such as myofascial release, muscle energy technique etc) need to offer various potential benefits, for example improving restricted mobility (Lenehan et al 2003), possibly reducing excessive inflammatory responses (Fryer & Fossum 2010), while simultaneously enhancing motor control (Wilson, et al 2003). But, unless the patterns of use that fuelled this degenerative process are modified, the manual interventions will offer short-term symptomatic relief at best.
Grieve's Decompensation Model
In 1986, Grieve presciently offered a perspective on the evolution of chronic dysfunction. He described the example of a typical patient, presenting with pain, loss of functional movement, or altered patterns of strength, power or endurance and suggested that, all too commonly, this individual would either have suffered major trauma which had overwhelmed the physiological tolerances of relatively healthy tissues or might be displaying "gradual decompensation, demonstrating slow exhaustion of the tissue's adaptive potential, with or without trauma." As this process continued, Grieve explained, progressive postural adaptation influenced by time factors and possibly by trauma, would lead to exhaustion of the body's adaptive potential, resulting in dysfunction and ultimately, symptoms.
Grieve correctly noted that therapeutic attention to the tissues incriminated in producing symptoms often gives excellent short-term results, however "unless treatment is also focused towards restoring function in asymptomatic tissues responsible for the original postural adaptation and subsequent decompensation, the symptoms will recur."
A Therapeutic Formula: Reduce Adaptive Load And Enhance Function
A therapeutic formula is proposed for the clinician who is confronted with chronic adaptive changes, of the sort highlighted by Solomonow or Grieve, who may well walk into your office with a backache. It is suggested that the focus should be on both reducing adaptive demands; altering the patterns of behaviour that have produced, or which are maintaining, dysfunction, while at the same time focusing on enhancement of function, working with the self-regulatory systems of the body, so that those adaptive demands can be better managed by the body (Chaitow et al 2005). The only other therapeutic possibility would seem to be symptomatic attention.
In simple terms, musculoskeletal tissue absorbs or adapts to forces applied to it and many manual and movement approaches are capable of modifying these changes – for example the use of Muscle Energy Technique (MET) in dysfunctional shoulders of the elderly (Knebl 2002); following sporting injuries (Bolin 2010); hamstring problems (Smith & Fryer 2008), or even in backache (Licciardone et al 2010)! Why do I emphasise MET? Because its track record is excellent (see citations) and because it is safe and easy to use. But I admit to being biased – and acknowledge that other modalities may be equally useful, but not unless underlying stressors are also dealt with.
Click here for more information about Leon Chaitow, ND, DO.
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