resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
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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