resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Introduce Your Patients to Collagen Induction Therapy
Cutaneous (skin) aging generally occurs from either intrinsic or extrinsic processes. Intrinsic aging results from natural skin tissue damage and degeneration.
Implications of Section 2706: The Non-Discrimination Provision Survey
In late April 2014, NCCAOM diplomates received an email survey with the subject line: "End discrimination against acupuncturists" polling CAM practitioners for a Request for Information from the Department of Health and Human Services, released in mid-March.
Five Element Acupuncture Can Enhance Your Practice
For eight years I have been teaching and supervising TCM students at an acupuncture college in Colorado, in Five Element acupuncture.
Treating Chronic Depression with Acupressure
In Traditional Chinese Medicine there already exists a comprehensive theory linking the body and mind.
The McGill Approach to the Lower Back (Part 1)
Stuart McGill, PhD, brings a unique combination of tools to the table. He is a scientist who also functions as a clinician. He describes himself as a medical consultant who is referred challenging patients. He is both evidence based and practical.
Micro-Needle Dermal Roller Use in the Treatment Room
Recently micro-needle dermal rollers have been getting a lot of media attention. As a practitioner who specializes in acupuncture facial rejuvenation, I know that skin needling with a dermal roller (also known as collagen induction therapy), promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter.
News in Brief
Foundation for Chiropractic Progress Enrolls Second Group Member; Focus on Chiropractic Education at WFC-ACC Conference in Miami; Are You Ready for Another "Have-a-Heart" Campaign?
Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo.
"Turn, Turn, Turn"
Many people are credited with saying, "If you remember the '60s, you really weren't there." Given the fact I didn't become a teenager until 1970, I actually do remember the '60s (or at least part of it). And as a child of the '60s, I was, of course, influenced by the music.
Chronic heightened emotional states create a perfect breeding ground for illness. Through my practice I noted the increasingly obvious relationship between one's mental focus on negative thinking, emotions, resistance to experiencing feelings and disease.
The Bottom Line ... From a Surgeon Who Knows
Regardless of individual relationships between providers, there continues to be a type of Hatfield-McCoy feud between the philosophies of medicine and chiropractic, particularly when it comes to musculoskeletal ailments.
It Pays to be a Foodie
If there is an inner foodie in you, just waiting to burst out—this article is for you! Do you want to know how I know? I'm that girl. My middle name might as well be "Foodie." I love food! And if my patients are any indication, many of them do as well.
Inspire Your Patients to Make Healthy Choices
Have you tried to get your patients to change their eating habits or their diet and couldn't get them to succeed? Were they confused and unsure of what the right thing was to eat? You are not alone!
Acupuncture Detox as Part of Drug Rehabilitation
In the U.S., more than 2,000 alcohol and drug rehabilitation programs have added ear acupuncture to their practice. The development of the protocol was determined by Lincoln Hospital as it delivered 100 acupuncture treatments daily.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
The Acupuncture Now Foundation: What Our Profession Needs
Although acupuncture is growing in popularity it continues to be underutilized due to misunderstandings about its true potential. Only a fraction of those who could be helped by acupuncture know enough to seek it out.
Peer Points: Promoting TCM Knowledge
When Elaine Wolf Komarow, LAc, received her first acupuncture treatment in 1989, she said it changed her life. "I felt more aware, calmer, and happier. I was so fascinated by the changes that I began to learn everything I could about the underlying philosophy of Chinese medicine," said Komarow.
Drug War Rages in Wisconsin
Based on its actions over the past 15 years (review the sidebar in the app version of this article), controversy and the Wisconsin Chiropractic Association seem to go hand in hand.
The Power of Mu Xiang to Treat Irritable Bowel Disease
Bloating and gas pain is something that everyone has had to deal with at one point or another; however, that's usually reserved for holiday dinners and other large gatherings.
Correcting Dysfunctional Movement Patterns – Is Local Treatment Enough?
It is widely believed that mechanical, non-traumatic back pain is largely related to dysfunctional or compensatory movement patterns the body has adopted over time.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
Following the Thinking of the Classics
I have heard about the "best time of day" to carry out certain examinations or therapies. For example, I remember making a note years ago that early morning is the best time to take someone's pulses.
Chinese Medicine: The Natural Way to Children's Wellness
As a child, I did not like going to the doctor. For the most part, when I had to go I wasn't feeling good to begin with, and I was heading into a sterile environment to be awkwardly probed by a man in a white coat for a very short, impersonal period of time.
Giving Chiropractic Some Much-Needed PR
Public relations has not always been the chiropractic profession's strong suit, a shortcoming that has subjected the profession to countless attacks on its legitimacy and seemingly perpetual confusion among the public and the health care world as to the skills and services doctors of chiropractic provide.
Alcohol Consumption Strongly Linked to Risk of Colorectal Cancer
Alcohol intake is one of the primary risk factors for many human cancers, and is strongly associated with cancers of the oral cavity, pharynx, larynx, esophagus, liver, breast, and notably, the colon and rectum.
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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