Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
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.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
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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