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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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
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.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
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.
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.
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%.
October, 2012, Vol. 12, Issue 10
Neck Pain: You Just Have to Move Like Jagger
By Sheri Wells
Have you ever seen an old video of Mick Jagger performing on stage? One of his vintage moves was to strut across the stage with one hand on his hip while moving his head forward and backward like a chicken.An article appearing in the Wall Street Journal titled: "Neck Pain? Skip the Pills, Just Stretch Like a Chicken" is about the first large federally funded study on neck pain. This published study found that simple home exercises, increasing cervical range of motion, are more effective at relieving acute and sub acute neck pain than medication. Dr. Bronfort, the lead author, said that a neck retraction exercise, or chicken-like maneuver of the head, in which people pull their heads back and then tilt their chins slightly downward "seemed to be especially useful." Maybe Mick Jagger was practicing preventative neck pain exercises?
Neck pain affects around 70 percent of people sometime during their lives. This is a common condition that you most likely see in your clients every day. Neck pain can be caused by many factors including:
Along with the above factors, as we age we begin to lose the fight with gravity and the head starts to slowly, progressively move forward on the neck and shoulders. Part of the problem is that the cervical muscles are simply not strong enough to resist the force of gravity. According to Erik Dalton's article, "Forward Head Posture: The 42 Pound Head," for every inch of forward head posture, the weight of the head on the spine is increased by an additional ten pounds. Through basic anatomy and physics, he explains that a normal head centered on the spine weighs about twelve pounds, but once it starts to move forward on the neck by just an inch, it weighs approximately 22 pounds. In comparison, a gallon of milk weighs about eight pounds. What would happen if you carried a gallon of milk in your hands out in front of you all day long? Wouldn't the muscles of the arms be extremely tired and possibly sore or painful by the end of the day? So, why wouldn't we expect the neck to start to complain with an additional ten pound load on it? Plus, realize that if the head is tilted or shifted to one side that this also increases the weight of the head on the spine and creates compensation patterns traveling down the body as the brain tries to keep the eyes level with the horizon.
As manual therapists, what can we do about this condition? First, educate your clients with the pain problems caused by forward head posture. You will see them immediately try to pull their head backward, but they may not be able to sustain this posture for very long. There are three main problems that need to be solved. The short term "fix," is for you to manually release the tight muscles creating forward head posture and to rebalance the head on the neck. Then, you need to gently stretch the tight muscles to restore normal cervical range of motion (ROM). Finally, the long term solution is to have the clients strengthen their weak anterior deep flexor muscles that are allowing the forward head posture to occur. Basically, to achieve and then maintain normal neck/head alignment, your ultimate goal, you must:
The above mentioned neck pain study involved teaching clients gentle, controlled movements including neck flexion, extension, lateral flexion, rotation and neck retraction. But, do not teach stretches or strengthening exercises if you feel that is outside your scope of practice or if your state does not allow it. As a manual therapist, however, you are allowed to assess and to restore normal cervical range of motion. And, if you are going to correct a neck problem this means you can gently mobilize/stretch your clients during a session to achieve normal ROM.
So, what is normal range of motion of the cervical spine and how do you assess it? Different publications vary with the ideal amount and a great reference is James Waslaski's book "Clinical Massage Therapy." He lists the normal ranges of motion, naming the muscles involved, along with a detailed twelve-step program of soft tissue work that can eliminate or prevent painful neck conditions.
Normal ranges of motion involving single plane movements for the cervical spine are: (Figures 1-4)
It is best to assess active range of motion before you begin your session with the client standing or seated. First, show the client the movement you would like them to perform; flexion, extension, lateral flexion or rotation. Ask them to only move their head as far as they can go without any discomfort. Note the amount of ROM and if it was normal or limited. Use a goniometer or simple plastic school protractor to determine the degree of ROM. If any of the motions had less than normal ROM, then have them gently repeat that same movement again several times and see if their ROM improves. Usually, it will improve 5-10 degrees just through this self mobilization. Make note of any limited ROM you find and your strategy will be to release the tight muscles/fascia that are restricting normal ROM.
Please note that as you restore normal cervical range of motion, you may also need to address forward shoulder posture and any other problems that may have contributed to forward head posture. You must treat the body as an entire structure to achieve better, long lasting results.
Once you have performed soft tissue work and created normal range of motion of the cervical spine, the next steps are to teach your client two simple exercises to stretch their tight cervical muscles: sternocleidomastoid, scalenes and suboccipitals and to strengthen their weak anterior neck flexors longus capitis, longus colli, platysma, sternohyoid and sternothyroid. This "homework" is what I have found is the most important part of correcting and maintaining normal head posture and what I teach every one of my clients (of all ages). If you teach your clients these corrective exercises, it empowers them to take charge of their own healing/wellness. You only see your client for an hour or so at a time and this gives them additional tools to use every day to maintain the normal ROM and structural alignment you achieved during your session.
First, teach them a corrective neck retraction stretch. Have them sit or stand upright and relax their shoulders moving them down and slightly backward (neutral posture). Then, have them place one finger on their chin. Ask them to slightly tuck their chin, and then move their head backward like a "chicken" or like Mick Jagger; whichever cue you prefer, while gently pressing on their chin. Have them hold this position for about two seconds and then release. They can repeat this stretch several times. Advise them to perform this gently and that mild discomfort is not ok. (Figures 5, 6)
The best times to perform this stretch is after daily activities that involve forward head posture: working on the computer, eating, watching TV, etc. Precaution note: this is rare, but if the client indicates pain or neurological symptoms (tingling, numbness in their neck, shoulders or arms), during this stretch, immediately have them return their head to neutral and refer them out.
Once the client has mastered the corrective stretch, teach them a corrective strengthening exercise they can perform every day in their car; "neck press backs." Advise them they can only perform this exercise if there is no discomfort or they are not allowed to do it. Before they start their car, tell them to sit upright and relax their shoulders down and backward (neutral posture). Then, have them slightly tuck their chin and move their head backward like a "chicken" or like Mick Jagger, while pressing back into their headrest (neck retraction). Have them hold this isometric contraction for 5 to 10 seconds, repeating this 2 to 3 times. They could also practice this when they are waiting at a stop light. I don't advise performing it while the car is moving. This is an easy exercise and something that they can and must do every day to help prevent or reverse forward head posture and the resultant pain that accompanies it. (Figures 7, 8)
According to the neck pain study, Dr. Bronfort says that for relief from neck pain "it's good news for patients that there's something they can do themselves." So, if you teach your clients to move like Mick Jagger; retracting their head, it may be one of the most important things you can do to help them relieve and prevent occasional and chronic neck pain.
Sheri Wells is a licensed massage therapist (LMT), and advanced personal trainer (CPT) with a Masters degree in education and a B.S in physical education. She specializes in orthopedic muscle balancing and therapeutic massage for injury rehab, scar tissue mobilization, and postural/structural alignment; restoring pain free normal range of motion throughout the body. She has been an upper level teaching assistant for James Waslaski for more than 10 years. She lives in Dallas and can be reached at
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