resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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!
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.
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.
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?
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 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.
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.
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.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
"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.
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.
April, 2013, Vol. 13, Issue 04
Reclaiming Functional Feet: The Janda Short Foot Exercise
By Nicole Nelson
The plantar intrinsic foot muscles might be the most underestimated players in the quest for optimizing posture and ideal function. These muscles are instrumental in controlling the dissipation of ground forces and stabilizing the foot during impact.Likewise, afferent inputs from the sole of the foot are believed to affect postural awareness and gait. It stands to reason that improving the function of the intrinsic foot muscles may be one of the best ways to promote ideal stabilization and motor control throughout the entire body. The following is a review of the basics of the intrinsic foot muscles (IFM), the implications of imbalance in the IFM and a discussion of Janda's short foot exercise.
Anatomy and Function
The plantar IFM are arranged in four layers, all of which are innervated by the plantar branches of the tibial nerve. The first layer consists of the abductor hallucis (often celebrated as the captain of the IFM), flexor digitorum brevis and the abductor digiti minimi. The second layer includes the quadratus plantae and the lumbricals; the third layer includes the adductor hallucis transverse, adductor hallucis oblique, flexor hallucis brevis and flexor digiti minimi brevis. The fourth layer includes the interossei muscles. The plantar IFM differ from their more extrinsic foot counterparts in that they strictly span the foot and do not cross the ankle. Their primary function is to provide dynamic support of the medial longitudinal arch (MLA) of the foot and to control forces that act to excessively spread the arch while walking, running or jumping.
The MLA consists of the calcaneus, talus, navicular, cuboid, three cuneiforms and the first three metatarsals. Many conceptualize these bones as fixed; however, there should be a fair amount of rotation, flexion and extension occurring between these structures during impact and push off phases of gait, as this mobility is necessary for additional shock absorption and force generation. While many foot structures contribute to the static and dynamic control of the MLA, the intrinsic foot muscles may be the most important. A study by Fiolkowski et al 2003, discovered a significant navicular drop (the keystone of the MLA) after administering a nerve block in order to de-activate the intrinsic muscles in study participants. Another study by Headlee et al 2008, induced fatigue to the IFM and also discovered a significant navicular drop. Both of these studies indicate the essential role of the IFM in supporting the MLA and suggests that IFM weakness can contribute to an unstable, poorly functioning foot.
IFM Imbalance Implications
Although difficult to isolate the IFM during testing, weakness in these muscles have been associated with many foot and ankle problems including plantar fasciitis, lesser toe deformities and bunions. Weakness of the intrinsic foot muscles is considered a risk factor for plantar ulcerations in individuals suffering from diabetes. This is likely due to the altered foot rollover during gait and ineffective plantar load distribution. Imbalance in these muscles is not simply a local issue, as faulty foot mechanics are known to cause compensations up the kinetic chain leading to knee, hip, low back and cervical issues.
How about just going for a barefoot run to train the IFM? I'm often asked if minimalist footwear or going sans shoes is a good way to correct poorly functioning feet. As Gray Cook would probably say,"don't add strength to dysfunction." The problem I have with our clients ditching their clunky running shoes is that their feet are not prepared for the demands of their body weight meeting the ground without a nice cushioned buffer. It is my opinion that some feet just don't have the potential to go completely naked; those that do will need to improve the function of the intrinsic foot muscles and progressively strengthen the musculature before they begin wearing the minimalist footwear or going barefoot for extended periods of time. In other words, running barefoot or wearing minimalist shoes are the end game, not the place to start. Janda believed that the proprioceptors on the sole of the foot need to be stimulated and a balance of activity among the intrinsic and extrinsic muscles of the foot needs to be established in order for lasting positive change can occur. So our "restore the foot project" should begin with a combination of appropriate soft tissue work and sensory motor retraining and maybe somewhere down the road, our clients can let their feet run naked. As always, consider the entire body when doing your evaluation and assessments.
As much as I like simple assessments, the old "wet foot test" probably doesn't reveal all that much in terms of what we need to do to help our clients reclaim functional feet. Although many would say the SFE is well suited to the flat foot (pes planus), those with high arches (pes cavus) and neutral arches can collapse just as much as the structurally flat foot during dynamic foot movements. Along these same lines, all arch sizes are subject to issues such as plantar fasciitis, achilles tendonopathy, tibialis anterior and posterior overuse syndromes, stress fractures, etc. This has led many researchers and clinicians to suggest that these commonly seen overuse pathologies may be a result of the client lacking the ability to control the arch upon landing and pushing off rather than just having a puny arch. So, if our goal is to improve the ability of these muscles to dynamically control the MLA, we need to see the client's feet in action. I use two dynamic assessments, which are not meant to take the place of a thorough exam by a foot specialist, but it will give you an idea of if the IFM are adequately controlling the MLA.
Walking test. Without the client's knowledge, observe the way they walk toward you (you will get a more accurate impression of their foot control if they don't know you are critically assessing them). A few things you want to look out for:
Single leg test. Have the client stand facing a wall, with the feet and knees shoulder width apart, with the knees slightly flexed. The client should place their finger tips on the wall for a bit of balance help. Instruct the client to gently supinate the feet by lifting their toes (this will wind the plantar fascia and create an arch), then slowly drop the toes but try to maintain the arch that was created. If they can't do this on their own, you can help by placing your hands on their foot and actively shortening their foot for them. While holding the MLA, have the client lift one foot and stand on one leg for 30 sec. Note the steadiness of the client and watch for any reduction in the MLA. Keep a look out for excessive toe grabbing; this is considered faulty patterning and demonstrates a dominance of the more extrinsic muscles of the foot and ankle. Have them perform the same test on the other foot.
If you observed any the faulty patterns mentioned above, the SFE is likely a good corrective exercise for them.
Towel Grab vs. Short Foot Exercise
I admit, I used to love the towel grabbing exercise for my weak footed clients; as it turns out, it may not have been the best IFM strategy. Recent research pitted the towel grab exercise against the SFE with the researchers concluding that the SFE is more effective at recruiting the IFM. Despite these results, don't ditch your towels, just save them for the clients with weak, unstable ankles.
I find the best time to work the SFE into a session is after bodywork. Specifically after I've done some big toe mobilization and myofascial work on the feet. When your clients first attempt the SFE, they will likely have no sense of how to turn on these intrinsic muscles, this will be seen by the client grabbing the ground with the toes. This lack of motor control will require your assistance to model what the foot should do. With your client seated, place one of your hands on the back of the client's heel, while the other hand should cup the forefoot. Gently squeeze the 1st and 5th metatarsals together while creating a supportive pressure to the back of the heel. Your intention is to condense their foot, which should create a neutral arch for them. Ask your client to feel what is happening to their foot and to try and appreciate the energy it would take to hold this foot posture.
With your hands on the client's foot, have them actively hold the arch, assist them with some tactile support when you note a failure of proper foot activation. Cue the client to narrow the forefoot and pull the front of the foot toward the heel. They should be able to create an arch while the toes and heels remain flat on the floor and the toes are not excessively grabbing the floor. Once the client has developed a feel of what the short foot feels like, keep them seated but wean them from your help by taking your hands away and have them hold the short foot for 10 seconds followed by a short rest, then repeat 4-5 times. The next progression is to perform the SFE while standing, once again challenging them to hold the short foot for 10 sec and then resting and repeating 4-5 times.
As these muscles get stronger and more adept at firing, have them hold the short foot for longer intervals. Eventually have the client integrate their new and improved "short foot" to more functional activities such as performing a squat-single leg standing while touching a wall for support (single leg standing without the wall) performing a lunge, etc.
The SFE may be one of the best ways to re-establish control of the intrinsic foot muscles. These muscles are known to have a positive influence on posture and gait, yet are often times "out to lunch" regardless of foot type. Soft tissue work in addition to improving motor control of the foot will go a long way to restoring muscular balance, optimizing posture and preventing injury.
Nicole Nelson a licensed massage therapist in Jacksonville, Fla. She has a masters degree in Health Science from the University of North Florida and is a certified Advanced Health and Fitness Specialist through ACE.
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