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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.
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.
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.
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?
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.
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.
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.
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.
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?'
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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