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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.
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."
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.
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.
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.
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?"
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
January, 2013, Vol. 13, Issue 01
Solving a Client Puzzle
How To Know Whether It's Tennis Elbow Or Nerve Entrapment
By Whitney Lowe, LMT
Suppose a client comes to see you complaining of lateral elbow pain. She reports that the pain has been going on for quite some time despite efforts to treat it. A first consideration might be that the client has lateral epicondylitis, commonly known as tennis elbow; not an unreasonable assumption since lateral epicondylitis is a common problem. However, it's also entirely possible that the client's complaint derives from another condition called radial tunnel syndrome.
The most effective results occur when you choose treatment techniques whose physiological effects best address the client's existing complaint. Conditions and treatment techniques both have physiological effects, which are the specific ways in which tissues respond either to the pain/injury or the intervention. Treating a client suffering from radial tunnel syndrome with techniques appropriate for someone suffering from lateral epicondylitis would aggravate the problem rather than help it. So, let's take a look at these two problems and explore how one might mistake radial tunnel syndrome for lateral epicondylitis.
Exploring the Conditions
Most people are aware that lateral epicondylitis is a chronic overuse condition affecting the common extensor tendons where they attach at the lateral epicondyle of the humerus. Despite the implication from its name, because it ends in –itis, epicondylitis is rarely an inflammatory problem and is not caused by the common explanation of torn tendon fibers. Instead, it is caused by collagen degeneration in the extensor tendons. Pain is most pronounced where the tendons attach at the lateral epicondyle of the humerus.
Epicondylitis presents several clear signs and symptoms that can be picked up during the evaluation process. There is likely to be pain with palpation of the extensor tendons and it is likely to be particularly tender where they attach at the lateral epicondyle. It is also common for pain to be reproduced when stretching the extensor tendons by moving the wrist into full flexion. Resisted wrist extension also reproduces the client's pain, especially if the affected tendons are palpated during the resisted wrist movement. (See Figure 1)
Unlike lateral epicondylitis, radial tunnel syndrome is not as common. However, when present, it can easily be confused with epicondylitis. Radial tunnel syndrome is frequently called resistant tennis elbow, because the symptoms are very similar to tennis elbow and they persist even after attempts at treatment (usually for lateral epicondylitis).
In the elbow region, the radial nerve divides into a superficial sensory branch and a deep motor branch. The primary problem in radial tunnel syndrome is compression of these branches as they course through fibro-osseous tunnels created by surrounding muscles, ligaments and bones. The deep motor branch innervates the wrist extensor muscles and is called the posterior interosseous nerve (PIN). Compression of the PIN most commonly causes weakness or atrophy in the wrist extensors because the PIN contains motor fibers almost exclusively. However, pain similar to lateral epicondylitis is possible because the superficial sensory branch of the radial nerve may also be compressed in this region. (See Figure 2)
Nerve compression occurs in radial tunnel syndrome where the PIN courses under the supinator muscle. The archway created by the edge of the supinator muscle under which the PIN passes is called the Arcade of Frohse. (See Figure 3) The Arcade of Frohse often has fibrous bands that compress the nerve causing the tunnel compression syndrome. These fibrous bands are small and deep under the extensor muscle mass, so they are challenging to palpate.
Although radial tunnel syndrome and lateral epicondylitis may initially present with similar symptoms, there are some key aspects of assessment that will help differentiate the problems. Lateral epicondylitis is most likely to cause pain during resisted wrist extension. Radial tunnel syndrome, on the other hand, is more likely to present with less pain but significant weakness during resisted wrist extension because it is the PIN motor fibers that are most affected.
Pain can be reproduced during palpation with both these conditions. However, when palpating the lateral elbow region, radial tunnel syndrome pain is more likely to be felt somewhat distal to the epicondyle in the soft tissues. Epicondylitis pain is predominantly in the extensor tendons and right at the epicondyle. In addition, pain arising from nerve compression in radial tunnel syndrome is likely to be less specific and extend into the forearm. Epicondylitis pain is usually far more local right at the proximal extensor tendon group and their attachments.
Based on her initial symptoms, our client could have either one of these conditions. This is a great illustration of why it is so important to perform a thorough assessment and not immediately jump to conclusions. Assuming she has lateral epicondylitis, the most likely treatment approach would include deep transverse friction of the common extensor tendons. The physiological effects of this treatment technique (stimulation of fibroblast activity which encourages collagen rebuilding) would match the physiology of the tissue injury (collagen degeneration). The friction technique would be valuable in addressing the chronic tendon degeneration of epicondylitis.
However, if the primary problem is radial tunnel syndrome, applying deep friction could significantly aggravate the problem by placing adverse pressure on the nerve. For radial tunnel syndrome it would be far more important to address muscular hypertonicity throughout the wrist extensors and the supinator muscle so they don't further compress the nerve. In addition, neural mobilization techniques for the radial nerve would encourage full freedom of movement of the nerve and eventually reduce symptoms. Neural mobilization engages gentle pulling actions during certain motions of the upper extremity that encourage smooth and free gliding of the nerve near any adjacent structures.
This case illustrates two very important points that will make your treatments more successful. It is valuable to know about soft-tissue pathologies in order to be able to distinguish between conditions. In addition, in cases like this, it is possible to make treatment errors that make a client's condition worse. Performing accurate assessment and considering the physiological effects of the treatment on the specific tissues being treated will make your treatments far more effective and successful.
Click here for more information about Whitney Lowe, LMT.
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