resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Acupuncture in the U.K. Today: A Personal View
When asked to write a short piece on the current state of the U.K. acupuncture profession, my first response was to say it has all been relatively quiet.
The Year to Make Things Happen
It is hard to believe that the Year of the Ram – 2015 is half over. Time seems to be moving especially fast. This is the year for things to happen for the acupuncture profession.
The Source-Luo Point Combination
The luo collaterals are part of the acupuncture channel system presented in the Su Wen and the Ling Shu (The Nei Jing). The function and clinical application of the luo mai are primarily presented in chapter 10 of the Ling Shu, however, they are also found in others chapters in the Su Wen and the Ling Shu.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Acupuncture and the Pulse
In 1991, I attended a martial arts workshop hosted coincidentally by Sung Baek, a martial artist and the head of his lineage as a Korean trained acupuncturist. I was enamored by the details Sung could attain from the pulse, as told to me by some of his apprentices.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
What Does Success Mean to You?
Recently, I was asked to speak to young, budding businesswomen about running a successful business — and at first I thought, "Me? You want me to speak to others about success?!"
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
Use Technology to Gain New Patients and Improve Efficiency
From the smartphone in your pocket to your microwave oven, advancements in technology have made almost every aspect of our lives easier.
TMF 2015 Scholarships
The Trudy McAlister Foundation (TMF), a nonprofit organization established to support students who are on track to make contributions either to clinical practice and/or to the understanding of the role of Traditional Oriental Medicine, has announced the 2015 scholarship recipients.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
How One Little Symbol (#) Gets You More Patients
Are you struggling to get more fans or followers for your acupuncture practice? Or are looking for ways to simply connect with your patients? Or do you just want to know how to keep them engaged (comments, retweeting, liking and sharing)?
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Calculating Billable Units
I recently learned of an office that was audited based on the number of acupuncture sessions performed in one day. Is there a maximum number of sessions that can be performed in one day?
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
The Nectar of Plants: Essential Oils and Chinese Medicine
Essential oils are a very hot topic these days, especially with the likes of the Ebola virus and the resurgence of measles lurking in our awareness, but when I first became interested in Chinese medicine, essential oils weren't on the radar screen for acupuncturists.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
The Modern Acupuncturist
You studied ancient Chinese medicine, but I'll bet you don't practice it! Contrary to popular belief, our medicine has evolved A LOT over the years. Let's take a brief walk through history and discover the differences between ancient and modern acupuncturists.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Breath: The Movement of Oxygen and Energy
I remember with surprising clarity the first time a patient started crying during an acupuncture treatment I was giving. This is now quite a long time ago, back in 1999, when I was a student.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients, in May 2014, researchers showed that drinking the equivalent of 2 to 4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
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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