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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.
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?'
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.
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.
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.
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.
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.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
February, 2012, Vol. 12, Issue 02
Positional Release Self Care for Soreness and Other Pains
By Leon Chaitow, ND, DO
If your patients are anything like mine, they will report to you that there is commonly a degree of discomfort, soreness or stiffness a day or so following manual treatment no matter how gentle or appropriate that treatment might have been.As a result, I offer advice regarding home care of such problems, and I tend to repeat a mantra to most patients who have received treatment for musculoskeletal problems as they depart. I ask them to largely ignore any soreness they might feel the next day. I tell them that it is perfectly normal for there to be an adaptive reaction/response to treatment for a day or so of their knee, neck, or whatever focal point of distress brought them to see me and that it will probably not be until around 48 hours later that they will know whether today's treatment was helpful.
And of course, if your patient happens to have a chronically painful problem, it's highly likely that a degree of sensitization will have occurred, making their responses and reactions to treatment far less predictable and potentially excessive. For more on that subject please see my May 2011 article, "Understanding Central Sensitization"
How common are short-term adverse effects following manual therapy? Bronfort et al (2010), conducted a major review of the effectiveness of manual therapies and it also looked at negative effects: "Adverse events associated with manual treatment can be classified into two categories: 1) benign, minor or non-serious and 2) serious. Generally, those that are benign are transient, mild to moderate in intensity, have little effect on activities, and are short lasting. Most commonly, these involve pain or discomfort to the musculoskeletal system. Less commonly, nausea, dizziness or tiredness are reported."
Carnes et al (2010), also conducted a detailed review of the evidence relating to the safety and side-effects following use of manual therapy modalities and concluded that: "Nearly half of patients after manual therapy experience adverse events that are short-lived and minor; most will occur within 24 hours and resolve within 72 hours. The risk of major adverse events is very low, lower than that from taking medication."
Even in relation to muscle energy technique (MET), one of my favorite modalities because of its extreme versatile efficacy, gentleness and safety, there are commonly minor degrees of discomfort for a day or two following treatment, even when appropriately applied. Greenman (2003) has explained some of the processes leading to post-MET-treatment discomfort: "All muscle contractions influence surrounding fascia, connective tissue ground substance and interstitial fluids, and alter muscle physiology by reflex mechanisms. Fascial length and tone is altered by muscle contraction... The patient's muscle effort requires energy and the metabolic process of muscle contraction results in carbon dioxide, lactic acid and other metabolic waste products that must be transported and metabolized. It is for this reason that the patient will frequently experience some increase in muscle soreness within the first 12 to 36 hours following MET treatment. Muscle energy procedures provide safety for the patient since the activating force is intrinsic and the dosage can easily be controlled by the patient, but it must be remembered that this comes at a price. It is easy for the inexperienced practitioner to overdo these procedures and in essence to overdose the patient."
In other words, when correctly applied, MET will commonly lead to mild discomfort for several days, BUT, when incorrectly applied (contractions too strong, stretching too vigorous, etc.) more severe reactions may result and without the bonus of benefits that correct usage might offer! For more on muscle energy techniques, you can visit my web site, www.leonchaitow.com/muscle.htm.
Are there strategies that you might be able to teach patients to manage this adaptive stage? What else might you offer your patients as self-care for minor reactions to treatment? Depending on the specifics of the individual's problems, a number of options are available, ranging from simple hydrotherapy (hot and cold compresses, ice massage) to relaxation methods, self-stretching (if appropriate) and from my perspective the most potent self-care we can teach patients in pain is self-applied positional release.
Derived from osteopathy, Positional Release Technique (PRT), or that version of it known as Strain-Counterstrain (SCS), can relieve pain by relaxing tight (shortened) tissues and improving local circulation. Unlike massage and stretching, PRT is safe to apply even on damaged or inflamed tissues. If painfully shortened (hypertonic) soft tissues can be gently placed into a position in which they are made even shorter, pain is usually temporarily removed. If that "position of ease" is maintained for a minute or so, the tight, tense muscle (and often trigger points housed there) are likely to release and relax, sometimes permanently, but at least for a while with pain diminishing subsequently.
Try the following exercise, self-treatment of tense suboccipital muscles, and consider teaching it to patients as an example of this remarkable method of self-care. This is adapted from Chapter 5 of my book, Positional Release Techniques.
Patient instructions for suboccipital self-treatment using SCS:
General Guidelines For SCS Self-Care Of Pain Anywhere Else
If a painful point/local area is on the front of the body, bend forward to relieve it; the further it is to one side, the more you should slowly turn toward that side. If the point is on the back of your body, bend slightly backward until the pain reduces a little, then turn away from the side where you feel the pain, and "fine-tune" to release the discomfort. If the point is on a limb, try to shorten the relevant muscles (don't stretch them) by slowly moving the area to find the position in which the pain is most reduced. When there are many areas of pain it is often best to start with those nearer the head and nearer the middle of the body, using this extremely noninvasive and effective form of treatment.
Click here for more information about Leon Chaitow, ND, DO.
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