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It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
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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