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Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
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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