Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
May, 2013, Vol. 13, Issue 05
Technique Synergy: Blending Unique Combinations for Success
By Whitney Lowe, LMT
Specific techniques and modalities are the key tools of our profession. But as any artisan or craftsmen will tell you, each tool is only as good as the person using it. Sometimes, we may look to one specific assessment or treatment technique to give us the key results we are looking for.Yet, in reality, the most effective approach might be a unique combination of different methods—technique synergy.
Synergy can be defined as the interaction of elements that, when combined, produce a total effect that is greater than the sum of the individual elements by themselves. So, how do you know which different techniques to combine together for the greatest effect? The key lies in understanding the physiological effects of your treatment or assessment techniques so you can choose the most effective approach. Let's look at an example of how several different assessment strategies were combined together to produce more effective evaluation methods for identifying carpal tunnel syndrome.
Variation on Common CTS Evaluation Procedures
Carpal tunnel syndrome (CTS) is the most common median nerve pathology. Yet, there are still challenges in recognizing it, especially in the early stages before symptoms are prominent. Nerve evaluation tests need to be more sensitive to identify the problem at different stages of severity. The sensitivity of the test refers to how accurate it is at identifying the problem when it is present. Below are several variations on standard carpal tunnel syndrome assessment tests that make them more sensitive, and consequently more able to identify a problem before it is severe. These descriptions are excerpted from an article originally published in the Journal of Bodywork & Movement Therapies.1
Massage therapists routinely treat clients with carpal tunnel syndrome. Yet, they do not have the high-tech diagnostic procedures like nerve conduction tests available for identifying possible median nerve involvement. Therefore, the reliance on physical examination to support (or replace) findings from nerve conduction studies is very important. When performing any of these procedures, the practitioner should remember that exaggerated neural sensations may be indicative not only of mechanical compression neuropathy, but of a host of disorders that cause increased neural sensitivity. Appropriate contraindications for proper treatment should be carefully weighed after gathering evaluation information.
Phalen's Test is the most common special orthopedic test for evaluating carpal tunnel syndrome. To perform this test, the client presses the back of the hands together so the wrists are flexed close to 900 (Figure 1). If the sensory symptoms of pain, paresthesia or numbness in the median nerve distribution are reproduced within about 60 seconds, the test is considered positive for median nerve compression in the carpal tunnel.
When this test is performed, the wrist is in flexion, which decreases tension on the median nerve. If there is increased tension on the median nerve, there is a greater degree of sensitivity in the evaluation procedure and it could therefore pick up less severe conditions.2 Greater sensitivity would therefore result if the wrist was held in flexion (Phalen's test position) while the upper extremity was held in a position that increases neural tension on the remainder of the median nerve. An upper extremity position that would increase tensile stress on the median nerve, while compressing it at the carpal tunnel region, would include lateral flexion of the neck to the opposite side, shoulder abduction, elbow extension, and wrist flexion (Figure 2). This test would be performed unilaterally, unlike the standard Phalen's test, which is performed on both sides at the same time. Make sure the cervical region is laterally flexed away from the side that is being tested.
Another relatively new evaluation procedure that has demonstrated greater accuracy than the Phalen's test is the hand elevation test. In this procedure the client holds the hand as high as comfortably possible overhead (Figure 3). If neurological symptoms in the median nerve distribution of the hand are reproduced within one minute, the test is considered positive.3 Neural tension in the median nerve could be added to the hand elevation test to make it more sensitive. With the arm held overhead, the neck is laterally flexed to the opposite side. Additional tension on the median nerve is added by putting the wrist in extension (Figure 4). Another variation would be keeping the wrist in flexion (as in the Phalen's test wrist position).
Increased neural tension is already a component of this test. The wrist is held in extension and supination. While in this position, the index finger is pulled into hyperextension as far as motion allows (Figure 5). The finger movement can be performed by the practitioner or by the client.4 If neurological symptoms are felt within about one minute, the test is considered positive. As with several CTS tests, this test is considered more accurate when combined with other procedures to produce a comprehensive clinical picture.5
The tethered median nerve stress test already involves tension on the median nerve at the wrist. Additional neural tension can be added to the proximal upper extremity to make this procedure more sensitive. Positions to add include lateral neck flexion to the opposite side, shoulder abduction, elbow extension and forearm supination. Note that not all of these motions need to be added. In some cases symptoms will be exacerbated with addition of just one position.
Accurate evaluation of soft tissue pathologies is an essential element of effective treatment. No diagnostic procedures have proven to be the gold standard for accurately identifying carpal tunnel syndrome. Electrodiagonstic testing, which is commonly used by medical professionals, has demonstrated limited effectiveness. It is also not available to most manual therapy practitioners. There is, therefore, a need for alternative accurate physical examination procedures for CTS. Common physical examination procedures are not always sensitive enough to identify the pathology when it exists. Some of the variations described in this article could prove to be useful adjunctive evaluation procedures that help the manual therapist gather more precise information about their client's soft-tissue pathology so that appropriate treatment or referral may result. These variations on standard CTS evaluation tests show that applying biomechanical principles to various assessment procedures allows us to combine the different strategies together for more accurate results. And that is the key benefit of technique synergy.
Click here for more information about Whitney Lowe, LMT.
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