resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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!
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
"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.
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.
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.
Capturing the Essence of Tai Chi
Over the last 12 years, I have been working on one of the few documentaries about Tai Chi. It's called The Professor: Tai Chi's Journey West and it's about Cheng Man-Ching who moved to New York in the 1960s.
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.
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.
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.
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.
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.
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?
March, 2013, Vol. 13, Issue 03
Know What to Look for in That Other Tunnel in the Wrist
By Whitney Lowe, LMT
When a client comes in complaining of pain, numbness/paresthesia or weakness in the hand, it is likely that carpal tunnel syndrome (CTS) is what comes to mind first. Yet, there is another fibro-osseous tunnel in the wrist where nerve compression occurs, called Guyon's canal or Guyon's tunnel. The ulnar nerve travels through this tunnel and is susceptible to compression here.
There are some key factors to understand about the anatomical arrangement of structures in Guyon's canal that govern the most effective treatments. The first place to begin is with a solid understanding of the anatomical structure of Guyon's canal. Treating compression in this canal differs from treating median nerve pathology (CTS).
The flexor retinaculum, also called the transverse carpal ligament, traverses the base of the hand between the pisiform and hamate on the ulnar side and the scaphoid and trapezium on the radial side. Some anatomy textbooks don't show it, but the flexor retinaculum actually splits into two divisions toward the ulnar side of the hand. There is a broad, deep band and a superficial short band. The space between these two bands is Guyon's canal (Figure 1).
The ulnar nerve artery and vein pass through this canal. Unlike the carpal tunnel which houses numerous tendons, there are no tendons traveling through Guyon's canal. The lack of tendons in the tunnel plays a prominent role in distinguishing ulnar nerve pathology from median nerve pathology.
Guyon's Canal Syndrome
In CTS, structures within the carpal tunnel, such as the flexor tendons, become inflamed and compress the median nerve. Because median nerve compression results from structures within the tunnel, the focus of treatment is on reducing inflammation and compression from these intrinsic (within the tunnel) structures.
In Guyon's canal syndrome (GCS) the only structures within the tunnel are the ulnar nerve, artery and vein, so nerve compression in this condition does not result from intrinsic factors but from those outside the tunnel (extrinsic factors). The nerve compression experienced in GCS is most likely associated with activities where there is either excessive pressure on the base of the hand or pressure applied to the region for prolonged periods.
This condition is frequently referred to as handlebar palsy because of the frequency with which it occurs in long distance cyclists who have their hyperextended wrist pressing on the handlebars and absorbing road vibration. Another common reason for GCS is walking with a cane where body weight pressure is put on the cane handle right over the ulnar nerve in the canal. Falling on an outstretched hand or hitting something hard with the base of the hand can also produce an acute onset of GCS.
The key difference between these situations and that of carpal tunnel syndrome is that in each of the ulnar nerve compression situations, pressure is placed on the base of the hand by some external factor, not compression from within the tunnel. The fact that these causes are all from extrinsic and not intrinsic compression is important when constructing appropriate treatments.
The client with Guyon's canal syndrome may present with both sensory and motor symptoms. Sensory symptoms include pain, paresthesia or numbness in the ulnar nerve distribution of the hand (Figure 2). Motor symptoms include weakness or atrophy in the hypothenar muscles at the base of the hand or in the adductor pollicis muscle of the thumb. The motor symptoms of weakness or atrophy are the most common presentation with this condition.
Visual observation of the base of the hand often reveals an indication of ulnar nerve compression. If there is significant atrophy of the hypothenar muscles, they will appear far less developed than the unaffected side (the other thumb) if there isn't bilateral nerve compression.
The adductor pollicis muscle plays a key role in evaluation of this pathology with a simple orthopedic test called Froment's sign (Figure 3). Have your client hold a thick piece of paper or business card between the thumb and index finger with the fingers folded in as shown in the picture. Instruct the client to hold the paper firmly as you attempt to pull the paper from the client's grip. If you are able to easily pull the paper from the client's grip, it is likely that there is significant weakness in the adductor pollicis muscle and ulnar nerve pathology is likely to blame.
The most important strategies in treatment involve removing any factors that are compressing the nerve and giving the nerve proper time to heal. The client interview is key for determining what the precipitating factors are. Find out what the client's activities are or were that lead up to the symptoms and ask about any changes (use of a cane for example) in their behavior or lifestyle. The reasons for the compression problems are not always obvious, so ask more questions if the symptoms fit the condition but the activities don't initially.
In any nerve compression pathology, the primary goal of treatment is to reduce pressure on the affected nerve. This goal is the same for Guyon's canal syndrome. However, because the primary cause of nerve compression is extrinsic, massage techniques should not be applied directly to this area as they could cause further compression of the nerve and prolong the pathology.
Massage treatment in other portions of the upper extremity can, however, provide significant benefit. Much has been written in recent years about the key benefits of neural mobility.1 Therefore, working all of the tissues along the path of the ulnar nerve will enhance full neural mobility and give the nerve the best possible environment for healing, which sometimes is lengthy with nerve conditions.
Without knowing and understanding some of these key facets of Guyon's canal syndrome, the practitioner may inadvertently aggravate a nerve compression problem by attempting to work around the wrist and hand for someone experiencing hand pain or weakness. This is a valuable reminder that while massage is highly beneficial in most cases, there are instances in which our intervention could be problematic or cause a condition to get worse if we apply it inappropriately.
Click here for more information about Whitney Lowe, LMT.
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