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Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
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.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
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.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
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!
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.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
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.
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.
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.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
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.
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."
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
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.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
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.
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.
February, 2012, Vol. 12, Issue 02
Freeing the Heart, Part 2: Equalizing the Pressure
By Dale G. Alexander, LMT, MA, PhD
Cardiovascular disease does not happen overnight. It is a progression that evolves over decades and genetic pre-disposition can accelerate this progression dramatically. That is why we read of so many people in the obituary column dying between the ages of 45 and 65 which is the prime demographic age range of so many of our clients.What is rarely considered is how these progressions toward cardiovascular disease figure into chronic somatic profiles that clients present to us every day and can dramatically affect their quality of life.
Two core principles of the Inside-Out Paradigm assert that the body's two imperatives are to allocate resources (oxygen and nutrition) as equitably as possible to all body tissues and to distribute the strains of physical and emotional stresses across as broad an area as possible. The allocation function is carried out by the blood vessels while the body's intricate reflex arc system governs the distribution of strain thesis. It is my premise that all forms of therapeutic massage and bodywork can positively influence these dynamic relationships.
The names that are given to cardiovascular problems are many and varied. The basic categories concern the heart itself and blood vessels. These terms include: heart attack, stroke, angina pectoris, atherosclerosis, arteriosclerosis and high blood pressure; all pathological progressions are labeled as diseases. I will explore other heart progressions that relate to disruptions in its electric rhythmic activity, infections and congenital pre-dispositions in a separate article.1
In order to de-mystify some of these terms, let's review the contrasting definitions of arteriosclerosis and atherosclerosis since even pronouncing them tangles my tongue. According to the Mayo Clinic, healthy arteries are flexible, strong and elastic. Over time, however, too much pressure in your arteries can make the walls thick and stiff and sometimes restricting blood flow to your organs and tissues. This process is called arteriosclerosis, or hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis. Atherosclerosis refers to the buildup of fats in and on your artery walls (plaques), which can restrict blood flow. These plaques can also burst, causing a blood clot which can either affect your heart causing a heart attack or, if it reaches the brain, may provoke a stroke.1
Functionally then, the term that I propose which makes the most sense to our orientation as massage therapists is "endothelial health."2 This relates to understanding what happens along the internal walls of arteries as a result of increased pressure and the accumulation of calcium and fatty deposits along their inner vascular tubes. Constant high blood pressure hardens and stiffens the arterial walls and makes them more likely to sluff off plaques. Again, it's a progression of deterioration. Pressure is like the Goldilocks fable... too hard, then, too soft, and finally, ah, just right! Instead of seeing pressure as the enemy, let's resolve to learn how we might assist the body to equalize its internal pressure(s) "between" the body's three great cavities and "within its 60,000 miles of blood vessels."3
In 1987, Dr. Jean Pierre Barral DO, inspired my understanding that the pressure within the thoracic cage needs to be "less" than the pressure of the cranial cavity and within the abdominal-pelvic cavity in order for circulation to maintain a normal homeostatic flow of fluids back to the heart.4 With this perspective, our goal as massage therapists is to increase the pliability of the chest wall, especially around the space of the heart, and to also ease the tensions throughout the thoracic cavity. Let's add two steps to the proposed screening protocol from my last article. First, lift the client's head, memorize its weight. Next, palpate the tension of the abdominal wall.
At the end of any bodywork session, not only do we want the chest to become more distensible, we would also like the head to weigh less and the tension of the abdominal wall to ease. All three markers are reliable indicators in my clinical experience that the pressure between the cavities has equalized to some degree.
Let's review one "inside-out" technique that can jump-start the easing of thoracic pressure. Its effectiveness relies on the loosely organized areolar connective tissue along the posterior margin of the diaphragm muscle. Standing on the right side of your supine client, posteriorly contact the opposite side of the spinous processes, beginning at C7, with your upper hand and placing the palm of your lower hand just below the anterior costal arch. Softly anchor C7 with finger tips in contact with the opposite side of the vertebra then stretch the abdominal tissue inferior and medial toward the belly button. Feel for the connectedness between your hands. Your intention is to stretch the internal tissues within the chest so that at the interface of the diaphragm, the downward and medial stretch gaps the loose connective tissues allowing the thoracic pressure to flow from an area of greater concentration to one with a lower concentration. A diffusion gradient is being manually produced. This same procedure can be repeated along each vertebra from C7 - T12. Yes, do both sides.
This approach is not the whole enchilada, but it consistently primes the pump between the thorax and the abdominal-pelvic cavities. And, this technique allows for a two for one potential effect. This same long lever stretching while anchoring each vertebra creates a potential rocker effect to the vertebral/rib complex which is theorized to hydrate and contribute to mobilizing the posterior thoracic spine. Therefore, is my premise that the progression toward all forms of cardiovascular disease is a backstory lurking behind many chronic somatic problems. It is also my assertion that as massage therapists we can make a real difference in the quality of life for our clients as we aspire to comprehend how the human body really works.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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