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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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?"
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.
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.
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.
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:
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.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
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."
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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