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Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
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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