resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
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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