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Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
March, 2012, Vol. 12, Issue 03
Freeing the Heart, Part III: Elongating the Esophagus
By Dale G. Alexander, LMT, MA, PhD
The premise asserted in the first two articles of this series is that physically freeing the space around the heart can make a significant contribution to the quality of life for your clients and may reduce the chronic component of their ongoing somatic difficulties.The last article described a technique for equalizing the pressure between the thoracic and abdominal-pelvic cavities. This same technique has also shown itself to assist mobilizing the posterior vertebral/rib articulations of the region.
It is proposed that reducing the pressure within the thorax both decreases the internal resistance to the heart's expansion resulting in greater cardiac output and enhances the efficiency of venous and lymphatic return back to the heart. Two additional steps were added to the initial screening assessment protocol. (A review of the assessment protocol and the suggested techniques can be accessed online at www.massagetoday.com).
This article proposes that elongating the esophageal tube can contribute to freeing the heart. The heart actually enfolds the muscular tube of the esophagus. Even less appreciated is that the upper 2/3's of esophageal fibers are striated fibers while the lower 1/3 -- the part that is juxtaposed to the heart as it pierces the diaphragm and becomes the stomach -- is comprised of smooth muscle fibers.1
There are many implications of this dual innervation and its potential participation in heart-related problems. Selecting the most obvious, consider how any type of cervical whiplash could re-set the resting length of the striated fibers of the esophagus toward varying degrees of chronic contraction or spasm. And, that this shortening of the esophagus may lie dormant for years going undetected yet, adding a posterior resistance to the heart's expansion, as well as influencing the onset of hiatal hernia symptoms and the reflux of stomach acid leading to chronic "heartburn." A shortened esophagus adds friction between itself and the sac of the heart, the pericardium. Friction begets irritation and irritation eventually incites inflammation. Chronic inflammation is increasingly considered the bridge between stress-related ailments and the onset of many pathological progressions during the aging process, including cardiovascular disease.2
Common sense suggests that the sac around the heart cringes in its attempt to prevent the acid from penetrating its protective sheathing. And, should the acid reach the fibers of the heart muscle, it creates an irritable reaction within them. Might this relate to a host of the different heart ailments that increasingly are described both in abnormalities of electrical transmission within the heart and the increasing frequency of atrial fibrillation?
Many years ago I had the unique opportunity to work with an exceptionally gifted physical therapist who was known for her success with helping infants and children. An infant was bought to her office with a diagnosis of non-epileptic brain seizures. As she was a graduate of Ohio State University, she called there and was referred to a Pediatric GI specialist. On the conference call, we both had a galvanizing learning moment as the specialist described that the infant may have been born with a congenitally short esophagus and that the seizures may stem from its central nervous system's attempts to elongate the tube.3 What a concept. He further noted that it was a fairly rare condition but that he had seen it enough times that his model for dealing with such unexplained seizure activity now included this as a possibility.
The epiphany for me was that along a continuum of genetic possibilities, not only could the esophagus be congenitally short, but that in many individuals, it is predisposed to contracting strongly and may re-set its resting length in response to intense emotional reactions and prolonged stress, in addition to the physical provocations described earlier. The most pertinent physical implication of the esophageal fibers bunching is its potential to limit the heart's expansion phase posteriorly. Thousands of clinical experiences with clients now validate this notion for me. The neurological implications of a shortened esophagus will be explored in the next article.
It has long been known that mid-sternal pain more likely relates to esophageal contraction or spasm, whereas pain associated with the left breast area is more likely to relate to some aspect of possible heart dysfunction or impending crisis.4 I carefully inquire with new clients to make sure that they have had a cardiology work-up if they present with either of these and insist that they see their physician if they haven't. It is prudent for us all to encourage clients to rule out any possible pathological or congenital predisposing scenarios.
The addition to the screening protocol I have found to be consistent with esophageal involvement is to palpate along the occipital ridge for the space and ease of distraction of the occiput from the atlas bone. The more close packed and resistant to distraction, the more the esophagus is a variable has become my clinical interpretation. Another primary myofascial structure that co-participates in the compaction of the head upon the neck are the SCM's (sternocleidomastoid muscles). It is my clinical experience that the SCM's function as the guard dogs of preserving the cranium's safety in the event of a sudden shift in position of the head as may happen in a fall, the body flung forward or backward (bicycle or motorcycle accident) or impact trauma of all kinds. So, the answer to the question of what can you do to help your clients is to use whatever techniques you have learned to reduce the tension of the SCM muscles.
A unilaterally contracted SCM or bilaterally so, compresses the jugular foramen through which both the vagus nerves and the accessory nerves exit from the brain. Old time anatomists suggested that the accessory nerve functions as an overflow valve for vagal tensions.1 And, let's remember that the accessory nerve innervates the trapezius muscles as well as the SCM's. Thus, tight traps are also a tip off that compression of the jugular foramen is a variable and that a contracted esophagus may be a crucial variable flying under the radar as a soft tissue structure that we need to treat.
Assisting the esophagus to elongate is accomplished by anchoring the occipital ridge and softly compressing the left side of the sternum along its length toward the left hip with an emphasis around ribs five and six and then into the soft tissue of the abdomen just beneath the left costal arch.5
In the next installment to this series, we will further explore the role of the esophagus along with those of the pericardial sac and explore the possibility that sometimes the heart may shift form its normal position in the thorax. It is my clinical experience that all of these variables can be positively influenced through bodywork, massage, movement and energetic therapies.6
To date, this series has endeavored to offer an assessment sequence and a couple of fairly specific techniques that have clinically shown themselves to assist an easing of thoracic rigidity. The clinical inference is that by doing so we are reducing the workload of the heart to deliver newly oxygenated and nutritious blood systemically.
Assessment Sequence for Freeing the Heart
The central theme is to assess the degree of pliability and distensibility of the thoracic cage. My experience suggests that when the left sternal border and the intercostal space associated with ribs five and six are rigid that the heart is definitely having to work harder to push out newly oxygenated and nutritious blood. Restriction to the lateral excursion of either or both hemi-diaphragms only adds to the workload of the heart.
Technique Review for Freeing the Heart
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.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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