resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
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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