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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.
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.
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).
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
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?
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?'
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.
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.
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.
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.
Click here for more information about Linda LePelley, RN, NMT.
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