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Not All Evidence Is Equal; An Abundance of Misinformation; A Well-Researched Decision; Far Too Dangerous.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Are Your Work Orders in Order?
There are times when a patient's occupational duties will delay or prevent them from recovering. These circumstances create the need for the doctor to recommend modified duty or remove the patient from work.
The Wisdom of the Second Office Location (SOL)
There are some things I never want to do again, like riding a motorcycle 100 mph. I call these things my "negative bucket list." Other things I have on that list include water skiing, riding a roller coaster and eating habanero peppers.
Love a Nurse – and They'll Love You Back
According to various sources, there are about 3 million registered nurses in the U.S., and according to the American Nurses Association, they are under serious pressure in today's health care reality.
A Dream Come True for Chiropractic: Funding Prevention and Public Health
Back in 2005, Sen. Tom Harkin (D-Iowa) said: "Let's face it, in America today we don't have a health care system, we have a sick care system.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
Image Is Everything: The Power of Branding
Successful businesses use color and design to attract people to their service. They understand how important image is and hire experts to create an attractive package. Starbucks works hard to create an atmosphere that is warm and inviting.
Billing for Same-Visit Extraspinal and Spinal Manipulation
Q: I have always been under the premise that when billing 98943, extraspinal chiropractic manipulation, on the same visit as spinal manipulation, 98940-98942, that the extraspinal manipulation requires modifier 51.
Women's Health: Herbal Formulas to Help Patients With Dysmenorrhea
Chiropractors have long treated women for menstrual pain (dysmenorrhea). Since roughly 60 percent of all chiropractic patients are women and 30-50 percent of women have a history of menstrual cramps, the vast majority of doctors of chiropractic will inevitably see patients with dysmenorrhea.
State by State: Comparing Chiropractic Scope of Practice
"The issue of 'scope of practice' has been a bugaboo ever since our early quests for legal recognition for chiropractic," according to Dr. Claire Johnson, editor in chief of JMPT and National's other two chiropractic journals.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Is the EHR Ship Setting Sail Without Us?
The numbers are in: As of July 2014, 10,253 doctors of chiropractic have received $123,059,868 in EHR stimulus funds – and yet that represents less than 15 percent of our profession.
Overcoming Barriers to Exercise Compliance
One of the most common questions other practitioners ask me is, "How do I get patients to do their exercises?" I am not frustrated by my patient compliance, as many doctors are; in fact, I am actually happy with my patients' involvement and commitment.
The Art of Day-to-Day Assessment and Treatment: Clinical Pearls
Let's focus on the day-to-day process of assessing and treating the patient. I am proposing a particular attitude; a way of looking at the patient. This often evolves over a few treatments and then changes as you figure out what is significant.
Defending With Vitamin D: Helps Prevent Progression to Diabetes
A 2014 clinical trial published in the American Journal of Clinical Nutrition provides additional evidence that optimal vitamin D nutritional status may be important in preventing the progression of prediabetes to diabetes in prediabetic adults.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
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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