resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
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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