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Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
February, 2012, Vol. 12, Issue 02
Dealing with Fibromyalgia
By Stuart Taws
It is estimated that between two to four percent of the population are now suffering from fibromyalgia, including Irritable Bowel Syndrome and TMJ. Perhaps our massage school education did not include how to successfully deal with fibromyalgia.Massage therapists often express a lack of confidence, some fear and anxiety along with the lack of a clear program for how to go forward and help their clients diagnosed with fibromyalgia.
In 1990, the American College of Rheumatology (ACR) established the definition of chronic widespread pain and the 11 of 18 tender point test to diagnose this "mystery illness." Interestingly, for most people, these points are naturally a little tender. This protocol has proved to be somewhat of a tragedy. A male MD "prodding" a female in pain looking for tender points then announcing that she has fibromyalgia has a negative downside. Once a medical practitioner determines that you have a certain condition and names it, then you get to keep it. You become like Alice in Wonderland going down the "Rabbit Hole" of a series of elaborate and sophisticated medical tests. The results confirm your symptoms and perhaps your worst fears, but along with the diagnosis there is no forward looking answer to your pain free recovery. Please note: the ACR 11-18 tender point protocol was for study criteria only and was never meant to be used as a diagnostic tool.
After decades of research, there is still no satisfactory answer by the medical profession for chronic pain syndromes. You receive prescriptions for painkillers, sleeping medication and anti-depressants. These deal with symptoms, not the cause of the condition.
When you're in pain for many years, you change physiologically. In one study by the University of California, they found that persistent stress shortened the length of the telomeres in the DNA. If stress can affect your very DNA, imagine what it can do to your sensitive molecules. Stress changes you at a molecular level. When you are in pain, life changes and you change. All the happiness of life has been put into the mortar and pestle of life, crushed like chaff and blown into the wind of despair. Sleep is continually disturbed so the REM phase, where all emotional stresses of the day are processed keeping mental health and stability, is rarely achieved.
In 1997, F. Wolf (University of Minnesota) published an article looking at some of the data collected in population-based studies. He found "that the number of tender points an individual has is highly correlated with the number of measures of distress. High threshold tender points are a sedimentation rate for distress."
In the mechanism of pain, it is observed that after injury the nervous system can delay it's response to that injury by a day, week or a month. When a person is diagnosed with cancer, the oncologist often asks what happened in their lives two years previously. When you ask a similar question of your fibromyagia clients, surprisingly I have found there was a serious illness or a vehicle accident, death in the family or a bitter divorce and custody battle over the children, all within the last two years. As the manifestation of pain is delayed, the connection is not made and falls into the mystery illness category.
"Information regarding pain is immediately transmitted from the injured tissue to the cerebral cortex," according to Dr. Linda Sorkin. Notice that pain quickly becomes a matter of the higher centers. She continues, "The peptides and injury products activate the pain fibers, sensitize and excite the nociceptors. There 'silent nociceptors' that signal well after tissue damage and that inhibition of this activity diminishes the perception of pain. There are spinal cord sensory cells, that when activated by injury refers pain to portions of the body that share these neurons, or cell cross talk. These fibers release glutamate and peptides from their central terminals and this biochemical cascade magnifies and enhances the response, becomes triggered into a long lasting spinal sensitization and the resulting hyper sensitization to pain even spills over into un-injured tissue."
This biomechanical cascade throughout the body over a period of developing hyper-sensitivity means you can have sites of pain all over where there is no injury. This understanding is vital. Similar to many MD's, some massage therapists fall into the trap of being judgmental, supposing their clients are somewhat neurotic and using an imaginary pain as a secondary benefit in life. You must always believe everything they tell you. "When they tell you the pain is real, it is real," said Dr. Daniel Clauw, Professor of Rheumatology and the director of the University of Michigan Chronic Pain and Fatigue Research Center, is the country's leading expert on Fibromyalgia and the author of many studies. "In people without pain, these structures encode pain sensations normally. In people with fibromyalgia, the neural activity is increased."
"It is time for us to move past the rhetoric about whether these conditions are real, and take these patients seriously as we endeavor to learn more about the causes and most effective treatments for these disorders," said Richard Harris, a Research Investigator.
These studies indicate that fibromyalgia patients have abnormalities within their central brain structures. Clauw states, "this is a diffuse, central problem with pain processing, a problem with the way people are processing pain or sensory information." Pain, he says, "is a miscommunication between the brain and the spine. It's as though someone has increased their volume control center, turning the volume up."
How do we use this information? The brain, spinal cord and the CNS are described as listening systems. The new neuro-sciences when referring to the brain and CNS use the expression plasticity. They are not fixed but are plastic; the input from the extremities can be changed. We do this by giving the listening systems new information and changing the direction of the input back into the higher centers. This remodels how the brain and CNS modify how they process pain.
The handmaidens of chronic pain syndromes are fear, anxiety and underlying anger. Pain in itself is harmless.
It is how the brain and CNS process and respond to perceived injury insult that cause the alarm. There is not the software to do an MRI, CAT scan, PET scan and X-Ray of the sensitive nervous system. The sensitive nervous system has gone off like a fire alarm, every fire department in the region has been mobilized, lights flashing, loud sirens piercing the night, and guess what, there is no fire! I tell the client that rightly or wrongly their "silent alarm has been tripped" and their brain and CNS believes they are under attack. They only response the body has to protect them is the inflammation response with the end result of pain.
Now here comes the tricky part, especially for a male therapist talking to women in pain. I compliment them on being so sensitive, as the truly caring and compassionate souls of this world often end up in pain. I try to change the context of the pain from not being some sort of divine punishment, but rather an unfortunate random reaction to a very stressful world. If your intention is good and kind, that shines through. When you carefully and gently suggest there is nothing physically wrong with them, rather they have a lovely kind friend deep inside trying so hard to help them, maybe too hard, they seem to accept that. Not only are you the only one that has patiently listened to them, but you also are the only one that is actually going to gently touch them for an hour, a rarity in the medical profession.
Listen to your client; but you must have a specific program in mind. If this is done seamlessly, moving back to the original site of pain briefly, there is not the time for the client to work out what you are doing, so there is a certain amount of distraction. I really like a side lying position with the client at the very end of the table. This is not working on soft tissue only; my intention is to dramatically change the input into the CNS. If you get the nervous system on your side first, then any therapy you use will be infinitely more successful.
Remember, during all this time you are talking to the sensitive nervous systems, re-assuring these delicate systems they are safe and secure and to desist in their protective mode. That is what getting the nervous system on your side first means. This is the most important part of any treatment.
Stuart Taws is a Sports Rehabilitation Therapist originally from England, now living in California. Stuart is the developer of Soft Tissue Release - the Taws Technique. For 20 years he has been teaching through Massage Schools and Weekend Workshops. For more information, visit www.softtissuerelease.com or
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