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Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. 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.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
November, 2011, Vol. 11, Issue 11
Gastrocnemius: A Cramp in the Calf
By David Kent, LMT, NCTMB
At some point, patients with posterior leg cramping and pain will seek your services. A multitude of factors produce these symptoms, from dehydration, overuse, poor conditioning, muscle fatique, to low levels of potassium, sodium and or carbohydrates.Let's focus on the gastrocnemius muscle, reviewing key points, showing its four myofascial trigger point locations, pain referral patterns and treatment techniques. If the gastrocnemius muscle is the cause of the pain and not properly treated, the pain will become more persistent and intense.
Gastrocnemius is a two-headed muscle that crosses two joints, the knee and ankle. The medial head is slightly larger and longer than the lateral head. The two heads of the gastrocnemius merge to form the inferolateral and inferomedial boundaries of the popliteal fossa. The gastrocnemius, along with soleus, and plantaris comprise the superficial group of muscles in the posterior compartment of the leg. (Image 1) A three headed calf muscle formed by the two-headed gastrocnemius and soleus. This large muscle merges into the calcaneal tendon or achilles tendon. It plantar flexes the ankle joint, raising the heel off the ground against body weight, as when a person is walking or balancing on their toes.
Complaints from myofascial trigger points in the gastrocnemius muscle include: night cramps and might be activated by climbing up steps, steep slopes, running uphill or riding a bicycle with the seat is adjusted too low. Patients with active trigger points may complain of pain while walking in the soft sand of a beach or on a slanted surface. Any of these activities coupled with cold air temperature, might contribute to the development of trigger points in the gastrocnemius. Other factors that might promote the development of trigger points include having the ankle in a cast, wearing clothing that restricts circulation or reclining chairs that reduce blood flow.
While you may know the location of trigger points and their specific pain referral patterns, your patients do not and they will respect the professional level of patient education you are providing. For example, in photo 2, "X" indicates the common location of trigger points within a muscle. When a trigger point is activated during treatment, it will produce referred phenomena (pain, tingling, pressure, etc) which is shown in red. (Image 2) Solid red areas indicate an essential pain zone or area of pain experienced by nearly every patient that had that trigger point activated. The red dots indicate spillover pain zones. These are areas of pain experienced by some, but not all, patients outside of the essential pain zones.
Locations and Patterns
The most common trigger point (TrP ) in the gastrocnemius is TrP 1. It is located just distal to the posterior knee, near the medial border of the medial head. It has a strong referral pattern to the ipsilateral instep with a spillover pattern that extends from the distal posterior thigh, along the medial aspect of the calf to the medial maleolus. The next most common trigger point is TrP 2, which is located slightly more distally then TrP1, in the lateral head and refers mostly in a regional pattern near the trigger point. (Image 3) TrPs 3 and 4 are located just distal to the knee and also refer very regional patterns near the location of the trigger point.
There are numerous techniques for releasing myofascial trigger points. The patient must always be comfortable with your treatment pressure, so communicate before, during and after the session. If during a treatment session, your patient is reflexively contracting muscles, pulling away, holding their breath or cinching their teeth because the therapy hurts, then your pressure should be released immediately. Assume the treatment pressure was too much, discontinue treating the sensitive area and return a few minutes later with less pressure.
Muscle Belly: Patient's knee is flexed. Glide distal to proximal, starting at the calcaneus treating the muscles of solues and gastrocnemius. (Image 4)
Lateral Head: Patient's knee is flexed. Using pincher compression, treat the lateral head. (Image 5)
Medial Head: Patient's knee is flexed. Using pincher compression, treat the lateral head. (Image 6)
Tendon: Shorten the calcaneal tendon. Useing pincher compression, treat the lateral, medial, anterior and posterior aspects of the tendon. (Images 7) Next, flex the knee and ankle slightly to lengthen the achilles tendon. Glide distal to proximal, starting at the calcaneus treating the posterior, lateral and medial aspects of the calcaneal tendon. (Image 8)
Calcaneus: Treat the tendon attachment on the calcaneous. Check for sensitivity first by treating with your fingers. If necessary a pressure bar can be used to assist the treatment of this attachment. (Image 9)
The gastrocnemius can be a "real" cramp in the calf. It can produce a great deal of pain and dysfunction for your patients. Educate your patients of the contributing causes and symptoms of gastrocnemius trigger points.
Click here for more information about David Kent, LMT, NCTMB.
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