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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.
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.
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?
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?!"
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.
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)?
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.
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.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
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.
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 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.
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.
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.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
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.
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.
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.
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.
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.
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.
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.
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.
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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