resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Vaccines and Chiropractic: Evidence-Based Medicine or Medical Dogma?
Right or wrong, the chiropractic profession has historically been against vaccinations. However, a growing trend within the profession is seeking to reverse this position.
Physical Exam 101: The Hands
I am sure you are familiar with the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Remembering Clarence Gonstead and 50 Years of the Gonstead Clinic
Dr. Clarence Selmer Gonstead (1898-1978) took chiropractic practice from back-alley bone setting to an understandable biomechanical science. His life was dedicated to clinical competency.
Why You Should Include the Single-Leg Stance Test in Every Patient Assessment
The single-leg stance (SLS) test, also known as the single-limb stance test, unipedal stance test or one-legged stance / balance test, is often used in the geriatric population to assess static postural and balance control.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
By the Numbers: 3 Common Financial Mistakes With Major Consequences
Warren Buffett is on record for sharing the hidden art of becoming wealthy and making it simple enough for anyone to grasp.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Curbing Label Overwhelm
For the average consumer, reading a food package can be overwhelming: natural, organic, non-GMO, gluten free, free range ... you get the picture.
Immunizations by Colorado DCs: Really?
You probably didn't hear about it, but back on Nov. 21, 2013, the Board of Directors of the Colorado Chiropractic Association (CCA) adopted "immunization authority" for Colorado DCs as its No. 2 legislative goal.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
The Science of Stretching
In 1986, Rob DeCastella set a course record by running the Boston Marathon in 2:07:51, just 39 seconds off the world record.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Fibromyalgia: Put the Pain in Its Place
While some fibromyalgia patients respond favorably to regular chiropractic care, others experience minimal relief. Unfortunately, many of these patients must rely on pharmacological management to relieve their constant pain.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Coding for the Subluxation: ICD-9 vs. ICD-10
When I attended chiropractic school, I was taught that chiropractors approach health care differently than the traditional medical establishment.
September, 2012, Vol. 12, Issue 09
By Whitney Lowe, LMT
As the population of the country ages, massage practitioners should be aware of various diseases and conditions that are increasingly common in an older age group. One such condition is a connective tissue disorder that affects the palmar fascia of the hand, called Dupuytren's contracture.
The primary structure affected in Dupuytren's contracture is the palmar fascia (Figure 1). The fibers of the palmar fascia are arranged in different directions. However, it appears that the longitudinally-oriented fibers (ones parallel with the long tendons in the hand) are the ones most affected in this condition.
The palmar fascia is strongly tethered to the skin and underlying bone, unlike most of the sub-cutaneous fascia in other regions of the body. This tethering is to increase the strength of the fascia against tensile stresses between the skin, fascia, and bones that would have a tendency to pull the fascia free from its attachments. The skin and fascia of the hand are susceptible to this kind of problem because stresses occur on the soft tissues of the palm when grasping objects with strong force. These forces are significantly higher in the palm than in other areas of the body.
Dupuytren's contracture begins with a fibrous shortening of the longitudinal palmar fascia fibers. The pathological process that starts the contracture is still unclear. However, it appears to begin with a proliferation of fibroblasts, producing new collagen that forms into nodules and fibrous restrictions.
There are different types of collagen in the body. Type 1 collagen is most prevalent in tendons, ligaments and superficial fascia. Type 3 collagen is present in high concentrations in scar tissue. The fibrous nodules and collagen binding that occurs in Dupuytren's contracture is predominantly Type 3 collagen, which may be one of the reasons it is so difficult to stretch and elongate. As the collagen binding progresses, the fascia will further contract and draw the digits of the hand into a fixed flexion deformity (see Figure 2). The metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the fourth and fifth digits are the ones most commonly affected.
There appears to be a strong genetic predisposition to development of Dupuytren's contracture. It is most common in people who are of northern European descent.1,2 While the condition does not appear directly related to traumatic incidents in the hand or forearm, there is some indication that some inciting disease or event may encourage development of the condition.
There are several other common factors in the symptom picture of people with Dupuytren's. It is far more common in men than in women and appears with greatest frequency for people in their 40s or 50s. The incidence of this pathology increases with smoking, alcoholism, diabetes, epilepsy or other convulsive disorders.
Information in the client history helps identify any of the risk factors mentioned above. If the condition is in the early stages, there may be some fibrous nodules that are palpable in the palm region, especially over the fourth and fifth digits. In many cases, the skin will pucker a bit in the region over the fibrous nodules. The surface of the palm is also likely to be tender to palpation.
If the condition is in an early stage, there will probably be some limitation to active as well as passive extension in the digits; the full flexion deformity, however, will not be evident. In later stages, the flexion deformity will be much more pronounced and the hand will appear more like the image in Figure 2.
Some pathologies in the hand may have similar symptoms. Trigger finger (stenosing tenosynovitis) may have movement restrictions and pain patterns similar to those in Dupuytren's contracture. However, with trigger finger you can usually force the digit into full extension, even if the action is a bit painful and the palmar nodules are usually not present.
In the early stages, massage and other forms of soft-tissue manipulation are far more likely to be helpful than in later and more advanced stages. The greatest benefits come from techniques such as deep longitudinal stripping, myofascial approaches, and vigorous regular stretching.
It is very helpful to teach the client an aggressive plan of self-stretching so the tissues can have the greatest opportunity to reduce the fibrous binding. Stretching the fingers and wrist in hyperextension is the motion to emphasize most.
Myofascial trigger points in the palmaris longus or other forearm muscles may contribute to either pain or movement restrictions that may exacerbate the fibrous restriction process.3 Therefore, when treating this problem, address the forearm muscles and any other soft tissues of the upper extremity that might also be contributing to further tension in the palmar fascia.
Other conservative treatment approaches may be used in physical or occupational therapy to address this condition. If these conservative approaches are not beneficial, surgery may be performed to reduce the restrictions of the fascia and restore proper range of motion in the hand.
Surgical treatment will most often include procedures such as a fasciotomy, involving a longitudinal incision following the course of the hand and finger tendons in order to free up any restriction between the fascia and its adjacent tissues. In other cases, a fasciectomy may be performed. This is a procedure in which a portion of the palmar fascia may be resected or removed in order to enhance mobility. This mobility can be further enhanced by a surgical incision called a Z-plasty. In this procedure, the incision looks like a zig-zag (Figure 3). Due to the disruptive nature of this procedure, there can be a long period of post-surgical healing. However, mobility is restored for most people who have this surgical procedure performed.
There may be some alternatives to the surgical procedure in advanced cases of contracture. Initial trials indicate that injection of collagenase (an enzyme that can encourage the breakdown of collagen) is helpful in reducing the fibrosity of Dupuytren's. However, further clinical trials are necessary to validate this theory.4
If addressed early in the development phase, massage is very helpful in addressing this complaint and may prevent it from becoming a more serious problem. If the condition has progressed further and surgery has become necessary, massage can still be valuable in the post-surgical phase. For example, the Z-plasty procedure runs the risk of scar tissue developing after the surgery. When sufficient time has passed, soft-tissue mobilization can be helpful to encourage free movement between the skin and adjacent fascia.
Click here for more information about Whitney Lowe, LMT.
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