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Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
November, 2011, Vol. 11, Issue 11
Joint Capsular Patterns
By Whitney Lowe, LMT
Passive and active range-of-motion tests are routinely used to identify soft-tissue pathologies. Unfortunately, practitioners often do not derive the full benefits of the information they can acquire through these tests.An expanded understanding of joint biomechanics will help you gain much more valuable information in your range of motion evaluations that will greatly improve your treatment strategies. When certain soft-tissue pathologies are present, many joints have a characteristic pattern of limited movement. Each pattern of movement limitation is unique to a particular joint. This movement restriction is caused by dysfunction in the joint capsule. Consequently, it's called the joint's capsular pattern.
Diarthrodial (freely moveable) joints have a space between the two articulating bones. The joint capsule is a fibrous connective tissue that holds the two bones together. It is composed of two different tissues. The outermost layer is a tough connective tissue called the fibrous capsule and is mostly made of ligamentous fibers. Inside the fibrous capsule is another layer of tissue called the synovial membrane (Figure 1). This membrane is responsible for secreting synovial fluid, which helps to lubricate the joint, supply nutrients and remove metabolic wastes from the area.
The fibrous capsule is richly innervated so it can produce a great deal of pain if there is any damage to it. The synovial membrane, however, has very little, if any, innervation and so it is rarely a source of pain. However, any irritation or restriction of the synovial membrane may also affect the fibrous capsule and therefore cause pain. In fact, stretching a fibrously adhered or restricted joint capsule is thought to be the chief cause of pain in osteoarthritis. Damage or dysfunction to the fibrous capsule or synovial membrane is then likely to produce a capsular pattern of motion restriction.
Not all joints have capsular patterns. The pattern appears to be more characteristic of joints with significant range of motion. For example, the sacroiliac joint, which is more of a tight and fibrous articulation with very little movement, does not have a capsular pattern. It makes sense that joints with very limited movement would not have a capsular pattern because it is very difficult to measure range of motion in them anyway. If the pattern of motion restriction in a joint is not the characteristic capsular pattern for that joint, the restriction is referred to as a non-capsular pattern. A non-capsular pattern would exist in a situation where there was joint or soft-tissue pathology but the joint capsule was not the primary tissue at fault.
The shoulder (glenohumeral joint) has the greatest range of motion of any joint in the body. Consequently this is also the joint where the capsular pattern is most important to evaluate, and where capsular pattern evaluations are used most frequently. Capsular patterns are also very important in the shoulder because unlike most other joints where motion is first limited by muscles becoming taut, it is actually the joint capsule that can limit shoulder motion in certain directions before the muscles become fully stretched.
In the shoulder, the capsular pattern dictates that motion restrictions occur first in lateral rotation, then in abduction, and third in medial rotation. In the early stages of a capsular restriction you may only see limitations to external rotation. As the condition progresses, there would be further limitations including abduction and eventually medial rotation. If an individual has a significant limitation to abduction, but no problem with lateral rotation, this would be considered a non-capsular pattern. As a result, this pathology is probably not primarily a joint capsule pathology. A much more likely cause would be some type of external structure causing the movement restriction such as an impingement problem under the acromion process.
Putting The Information To Use
In many cases, massage practitioners are not likely to be treating internal joint pathologies that involve joint capsule damage. However, certain conditions such as adhesive capsulitis (frozen shoulder), directly involve the joint capsule. There are effective massage treatment strategies for adhesive capsulitis, so it will be very helpful to identify if the joint capsule is involved. One of the big advantages of understanding the capsular pattern in this condition is you can continually monitor range of motion in the capsular pattern to measure how successful your treatment is at improving range of motion and reducing the capsular restriction.
Muscles are also a common limiting factor in joint range of motion. Consequently, muscular restrictions could mimic or magnify the capsular pattern of restriction. When performing range of motion evaluations, be sure to consider the musculotendinous unit, as well as ligamentous/capsular restrictions. There are a number of resources that have lists of capsular patterns for specific joints. The resources indicated here have charts or lists of capsular patterns that are very informative.
Click here for more information about Whitney Lowe, LMT.
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