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Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
April, 2012, Vol. 12, Issue 04
Tissue Density's Relationship to Pain and Dysfunction
By Linda LePelley, RN, NMT
A new client presented with a diagnosis of severe pain in her right arm. She had been seen by several doctors and specialists and undergone a number of tests, including an MRI and a CAT scan.A neurologist informed her that all of the tests were negative and nothing appeared to be wrong with her arm. He suggested she see a massage therapist to deal with her stress. He also suggested she seek emotional counseling to address her, "exaggerated pain" symptoms. It is not my intention to discuss her medical condition, but to share an example of what so many of us massage therapists often face in the course of our massage careers – not just a hurting client who is seeking relief, but a person experiencing anxiety over whether or not we will even believe their pain is real.
After carefully examining her arm with my fingertips, I could tell her where it was hurting. My client's relief that I believed her was just as palpable as the affected tissues I'd found in her hand, arm, neck and shoulder. Had any of her doctors laid hands on her, and known what to look for, they would also have felt the differences in tissue density. They would have known that something actually was there, something assessable, measurable, documentable and most importantly – something treatable.
Tissue Density (TD), as it pertains to therapeutic massage, is an expression of the compactness and consistency of body tissues. My theory is that musculoskeletal pain and dysfunction increases in direct association with an elevation in TD. This is significant because TD is alterable as massage therapists do it all the time. Muscle "knots", "tight" muscles, and "trigger points" are some examples of elevated TD, as well as firm, swollen areas that may be congested with lymph, or thick, hard areas such as the plantar fascia when it is engaged in plantar fasciitis. Other examples include, but are not limited to, tissue that has become fibrous, nodules, "bony overgrowth" or areas that appear to be nothing but skin over bone, and any joint, ligament, or tendon that "pops" or "twangs" with movement.
My thoughts regarding the etiology of elevated TD involve the lipid-rich components of our extracellular fluids, which I believe are attracted to the bio-polymeric nature of our cartilaginous tissues. This attraction, combined with a variety of dynamic factors, including body heat, compressive force, overuse, injury, hypo-hydration, torsion, sheer force, tensile force, inertia, chemical environment and fluid viscosity may cause the extracellular fluid to accumulate, thicken and eventually precipitate into gelatinous plaque. Over time, I believe that these plaques harden and become mineralized, turning into the rubbery nodules or bone-like overgrowth of arthritic joints, as well as contributing to many other conditions. The plaque may be as thin as a sheet of a single layer of fascia cells or it can form a large area of many tissue layers sandwiched together, such as those found over arthritic hip joints and the thick, tender pads which so often develop at the medial aspect of knees.
We know that studies have shown massage can improve blood pressure. I surmise that the improvement occurs when the massage therapist has facilitated a successful reduction of TD. We work on a client with tight, dense muscles, they get off of our tables relaxed, their muscles have softened, loosened and become much more pliable. Once the heart no longer has to force the blood through constricted vessels trapped within clenched musculature, it stands to reason that this alleviation of compression will result in a reduction of blood pressure and heart rate.
As TD increases, involved nerves, blood vessels and lymphatic pathways will become engulfed, compressed, displaced, congested or a combination of all of the above. Untreated elevated TD has many complications. Consider what might happen to tissues that have become partially isolated from a normal environment where adequate nutrients, hydration and waste removal are available for example, The plantar fascia receives the full brunt of our weight. Add compression, force and any number of other events, such as stepping on a stone, poorly fitting shoes, running, etc. Any of these factors can generate heat in the foot, melting local fat deposits. Force and condensation will have pressed much moisture out of the fascia making re-hydration even more difficult. Nerves and nerve endings get caught up between layers of ligament, aponeuroses and fascia, becoming hot-glued together into a thick, rubbery sheet. It seems likely that, given enough time in a hydrophobic environment, the result would be a loss of elasticity and tissue shrinkage. The affected plantar fascia must be warmed up with movement and painfully forced to stretch back out, bringing a measure of relief, but after a period of rest and cooling the pain cycle starts all over again when attempting to walk. Until the TD is properly restored, nerves trapped in the dense tissue matrix are going to suffer with every step.
Done correctly, TDRM is a highly effective modality whereby the client achieves pain relief and improved mobility. TDRM is a powerful tool for us massage therapists, caring professionals who lay our hands on our clients, quite literally feel their pain, and then do something about it.
Linda LePelley, RN, NMT is a registered nurse and licensed massage therapist with 19 years of clinical massage experience. She developed Tissue Density Restoration (TDR) Massage, an effective treatment for the pain found in hyper-dense tissues. For more information, visit www.MyHealingHands.com.
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