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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.
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.
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?
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?'
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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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