resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
December, 2011, Vol. 11, Issue 12
Osteoporosis: Another Insidiously Silent Progression, Part III
By Dale G. Alexander, LMT, MA, PhD
The premise in writing this series is that many "chronic somatic conditions" include the silent progression of osteoporosis for both genders. If one's bones are insidiously weakening, then how do you imagine the body is going to pick up the slack during the weight bearing activities of standing and movement, let alone the more fun activities of running, twisting, jumping, golfing and dancing?
My postulation is that, as bones weaken, the human body will increase the internal pressure within its cavities promoting the cringing of body sacs and the shortening and narrowing of the tubes within organs and between organs including the arteries throughout the body. Such cringing, shortening and narrowing of the body's core structures stimulates a reflexive tightening of the soft tissues, includingligaments, tendons, muscles and fasciae associated with all of one's joints.1
Also, as one's bones progressively weaken, their myofascial tissues will endeavor to function more like bone. The autonomic nervous system begins to alter the consistency of soft tissues by becoming fibrotic and resetting their length and tone to a calibration of bracing from within and along the body's sleeve to add structural support.2
Consider the association of the silent progression of osteoporosis to the chronic somatic problems clients present to you in your office. Especially those persistent problems that just won't go away. It is one, among many, variables to consider. Yet, one that I believe has long been under-appreciated.
Chronic problems tend to be multi-factorial in their nature. Other physiologic progressions may co-exist simultaneously along with the compensatory/substitution matrix that inevitably emerges as traumatic events and/or illnesses accrete over the course of one's lifetime. Or, as a result of a undiscovered genetic predisposition within an individual of any age.
When I sense osteoporosis might be a variable, I do inquire with a client as to whether they have had a bone density test or DXA scan done and, if not, I encourage them to do so.
DXA is most often performed on the narrow neck of one's femur bone, just below the hip joint and a picture of the lumbar vertebrae is also usually taken. The narrow neck of the femur is a good predictor of one's risk of hip fracture, which is the most serious complication of osteoporosis. Other testing technologies include CT imagery, ultrasound and high-resolution MRI. Some of these are specific to checking the density of the forearm, wrists, fingers, ankle or the heel. The key concept that we all need to anchor in our understanding is that bone loss can accelerate in different parts of the human body at different times and in various places.3 I am clinically suspicious of wrist/hand, ankle/foot or rib fractures that occur with clients in the 45 to 65 age range.
The somatic markers for our consideration as massage therapists is to palpate our clients wrists and ankles with an increased sense of awareness. What do you perceive their density to be? Sounds fantastic yet, by simply attuning yourself, you will be amazed at your ability in a very short period of time to pick up on cues and clues that previously you did not notice before. When the soft tissues of a client's low back continue to splint even after you have done everything you can to assist, this can be a flag that the splinting is being driven by the soft tissues valiantly trying to do the job of the bones.2
Most importantly, mobilize your client's hips in any way you know how. It is the key to how we might assist to slow the progression of osteoporosis in my clinical experience. The father of osteopathic medicine, Andrew Still, had a notion that when the head of the femur bones were squarely in the center of the hip joints, all physiologic processes work better.2 This presumption has borne itself to be accurate in my opinion over 31 years. I evaluate and treat every client's hips, every session. It is core to any clinical orientation to therapeutic massage and bodywork.
The central question to ask a client is whether their mother or grandmother became bent forward as they aged. I ask about fathers and grandfathers too, but the maternal line tends to be more closely correlated. If the answer is yes, then the probabilities of them experiencing some degree of osteoporosis are much higher and preventative steps need to be taken as early as possible.
Let's return to our exploration of osteoporosis so that we cover the main points of this controversial progression. Is the incidence of osteoporosis actually increasing? According to Dr. Alan Gaby M.D., author of Preventing & Reversing Osteoporosis, "more than twice as many osteoporotic fractures occur now, compared with 30 years ago, and this difference cannot be explained by the aging of the population."5 His premise is that the "degenerative diseases of modern civilization are caused in part by chronic nutritional deficiencies, hormonal imbalances and environmental pollution." He strengthens his assertion by citing a forensic study of skeletons recovered from a London church dating from 1729 to 1852. The rate of bone loss in the hip was found to be significantly greater in modern-day women than in the women's skeletons from two centuries ago, both before and after menopause.5
What are the most appropriate sources of calcium and other substances crucial to the health of our bones? Boy, is there a diversity of opinion on this question! If you read the more traditional medical literature on osteoporosis you will find a consensus that calcium from dairy products is not only acceptable but preferred. They don't disregard the importance of dark green leafy vegetables and a balanced diet, however, it seems ironic that they emphasize dairy products in face of the fact that the the top dairy consuming countries report the highest incidence of osteoporosis.6
Dr. Gaby further asserts in his book that magnesium, vitamins D and K, DHEA, the judicious use of progesterone, and a host of micronutrients have shown themselves to be superior to the more traditional emphasis on calcium intake, hormonal therapy and exercise alone.
Wading into this same calcium controversy are those who assert that the maintenance of a normal pH within the body's narrow homeostatic range is the crucial tipping point to prevent the slide into osteoporosis. That our culture's high intake of protein actually is one of the major reasons that the body is forced to pull calcium from the skeleton in order to buffer the acidic environment created by a high protein consumption. Amy Joy Lanou, PhD and Michael Castleman have described this process their book entitled, Building Bone Vitality, asserting that calcium, estrogen, and medications are not the answer, again, with compelling discussions of possible alternatives for people to consider.6
Encourage your clients to research this topic for themselves and find a philosophy that fits for them. "Doing nothing", is not a plan.
Dr. Fred Harvey M.D. in Sarasota wrote to me how he approaches caring for his patients with this common sense perspective; "Bone density tests are helpful, but if normal, they do not indicate that the bone will remain healthy. There is a blood or urine test called N-telopeptide (NTx) that assesses the rate of bone loss. It looks at the health of the bone matrix by examining turnover of bone collagen. I use this test as a screening test and between bone density tests to assess progress." He goes on to further describe how he believes this test can in combination with a DXA scan predict future bone health and maybe even more importantly, to track whether a therapeutic regime for a person with identified osteopenia or osteoporosis is actually working or, not.8 I like this style of logic and the fact that there are at least some reliable ways to monitor treatment options.
The NTx-telopeptide test is one of 4 bone marker tests according to the Mayo Clinic that are used to track both bone resorption(breakdown) or bone formation3. It is important for us all to remember that no medical technology is perfect nor can be absolutely comprehensive because as stated in the last article there are many aspects of bone loss that have yet to be clearly understood. Which is all the more reason for us to educate ourselves as professionals.
What additional medically related difficulties promote the escalation of osteoporosis or, may fly undetected under the general diagnosis of osteoporosis? According to the Mayo clinic, there are many secondary causes of osteoporosis progression. These include certain diseases, surgical procedures or medications that accelerate bone loss. These are listed in Table I at the end of the article.3 Read this list carefully, especially if you have an aging parent or work with elderly clients. Encourage them to review their medications with a pharmacist with an emphasis on whether any medication they are taking could accelerate their bone loss.
One physiological progression which I will highlight and sometimes is not considered by competent physicians is the role of the parathyroid hormones. If serum calcium drops, whatever the provocation, it is the job of these hormones to pull calcium from the bones to maintain its appropriate level. It has been my clinical experience that many peri- and post- menopausal women have thyroid and parathyroid difficulties and, occasionally younger women, too. I have had my best success in helping these individuals by encouraging them to seek a thorough evaluation by an endocrinologist, an internist who specializes in dysfunctions of these crucial endocrine glands or, a nutritionist who uses blood and hair analysis in their evaluation. Typical presenting symptoms include a diagnosis of fibromyalgia, sleep disorder, an intolerance to cold, periodic systemic sweating and chronic pain. More sensitive thyroid tests are needed to discover this insidious hormonal slide.
I have come to recognize that my palpation skill sets can help many but not all without the assistance of more sophisticated medical testing. We are a crucial link in the medical health delivery system in our country because we take the time to listen, by recognizing our limitations and by referring clients to their physicians or other alternative health practitioners when our best efforts fail to assist our clients to regain their quality of life.
How effective are the many medicines prescribed for osteoporosis? This answer depends on what your professional experience has validated and whose perspective you tend to believe. My experience professionally suggests that the myriad of medications that retard the resorption of bone have their place as a one to two year regime. But to take them for the rest of one's lifetime defies common sense to me.
One obvious exception are men who are chemically castrated as part of their prostate cancer therapy. There really are no other options at present than for them to rely on the bisphosphonate medications (detailed in the previous article) and, there are many women with complex medical problems for whom this is true as well.
It has been my intention in this article series to delineate many of the categories for your further research. It is my personal intuition that there exists 6 to 7 distinct regimes of diet, exercise, vitamin supplementation, hormonal support and medications that would enhance the bone health for those who are aging in our nation based on familial genetic history, race, blood type, body type, level of exercise and lifestyle choices. I encourage each of you to research the references I have detailed in this series on osteoporosis as each has something to offer. In conclusion, moderate exercise, periodic medical testing, therapeutic massage and bodywork, and an intelligent diet are together the least expensive and most reliable form of maintaining one's healthy bones.
Table I: Secondary Causes of Osteoporosis in Adults
The following medications, diseases, and procedures can accelerate bone loss, increasing your risk of osteoporosis.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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