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Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
June, 2013, Vol. 13, Issue 06
Adventitious Tissue Structures of Elevated Tissue Density
By Linda LePelley, RN, NMT
A 12-year-old boy was brought into my clinic complaining of pain in his right heel, which impaired his ability to participate in sports, even to walk normally. His doctor, having x-rayed it, diagnosed a bone spur, explaining that the pain may or may not resolve on its own and it could be surgically removed if it continued to bother him.The boy's mother had heard I'd helped a friend with a similar problem so she wanted to see if I could help her son with the pain until something could be done about the bone spur. A hard nodule the size of a pea was palpable on his right heel.
A mechanic came in complaining of right-sided upper back pain, with trouble raising his right arm. I found a large mass of dense tissue, approximately 9 cm long, 4-5 cm wide, with an approximate depth from 1 cm at the outer borders, to 3 cm deep at its center. Its presence, at the medial border of the scapula, involved all of the musculature at that region, and prevented full range of motion. Palpation indicated it was ensconced all the way through to the bones of the ribs.
A 65-year-old woman presented with severe low back pain. She stated that she had never had any problems with her back until several days earlier. She had driven for 6 hours to visit her daughter, stopping only for fuel and then going directly to bed once she had reached her destination. The following morning she awoke to find herself barely able to walk without grimacing and crying out in extreme pain. Upon palpation, I found a large, rubbery, firm area the approximate size and shape of a 5 x 3 cm oblong pancake, 2 cm deep, engulfing her right sciatic nerve and the tissues around it.
A friend showed me her left wrist where, over the period of just a few months, a knot had formed on the radius, proximal to the scaphoid bone. Her doctor had told her it was arthritis, and her sister told her that she had suffered the same thing on her wrist, and had it surgically removed – suggesting my friend should do the same. My friend was no longer able to wear her watch, due to tightness and irritation. The knot felt just as if it was solid bone.
What these seemingly unrelated conditions have in common with each other is that they all involve the formation of a new tissue structure. I refer to these tissue structures as "Adventitious" because they are extraneous and they do not belong where they occur. And while they are likely the result of a body's attempt to maintain homeostasis; their development often results in pain and dysfunction. In my previous article, "Tissue Density's Relationship to Pain and Dysfunction", from the April 2012 issue, I wrote as follows: "My thoughts regarding the etiology of elevated TD involve the lipid-rich components of our extracellular fluids, which I believe are attracted to the bio-polymeric nature of our cartilaginous tissues. This attraction, combined with a variety of dynamic factors, including body heat, compressive force, overuse, injury, hypo-hydration, torsion, sheer force, tensile force, inertia, chemical environment and fluid viscosity may cause the extracellular fluid to accumulate, thicken and eventually precipitate into gelatinous plaque. Over time, I believe that these plaques harden and become mineralized, turning into the rubbery nodules or bone-like overgrowth of arthritic joints, as well as contributing to many other conditions. The plaque may be as thin as a sheet of a single layer of fascia cells or it can form a large area of many tissue layers sandwiched together, such as those found over arthritic hip joints and the thick, tender pads which so often develop at the medial aspect of knees." (I suspect that the main component of this conglomeration is cholesterol.)
Elevated Tissue Density (TD) is, in my opinion, the first sign of adventitious tissue structure formation. It seems to continue to increase in size and hardness over time. I wouldn't characterize it as "growth," but as an accumulation. Tissue Density Restoration (TDR) massage is an effective way to prevent and reverse this condition. In most of the examples above, the structures were stable, easy to isolate, and not too difficult to resolve.
In the case of the mother who spent several hours driving, the problem was a little more complex. An adventitious tissue structure had formed and become dense at her sciatic nerve area. Because it had not impeded movement or caused her pain, she was unaware of its existence. Over time, it continued to accumulate and condense, holding the nerve firmly in place until, that is, it shifted. When my client spent several hours driving, with her right leg extended to the gas pedal, enough heat was created in the affected area to slightly melt the outer layer of the adventitious structure. She then went to bed, sleeping in a side-lying position. During the night, her tissues resumed their normal temperature and the structure re-hardened, but now it was in a slightly different position. While the structure maintained its solid grip on the nerve, it had shifted, pulling the sciatic nerve painfully out of place.
Adventitious tissue structures can form sharp points, such as the bone spur on the young man's heel; large, immobile, lumpy barriers to free movement, as found in the mechanic's back; unstable, shifting bodies such as the one experienced by the traveling mother; and some so smooth and solid one would easily believe that it was simply a large, bony prominence. Fortunately, these affected tissues can often be restored to normal density and function through the proper application of TDR massage, as happened with each of the examples listed above.
A client who has rheumatoid arthritis complained of pain in her right ankle, stating that she had erosion in an ankle bone, as explained to her by her physician, and evidenced by x-ray. She brought her x-ray in. It occurred to me that perhaps the eroded area might actually be an adventitious tissue structure, formed over the bone, which had then melted in one spot (due to the heat of RA inflammation), leaving the appearance of erosion. I applied TDR massage, relieving her pain. Our hope was to then have the ankle x-rayed again for comparison; however the health care provider was not interested in exploring the matter. Whatever the actual etiology may have been, almost a year later, the client has not suffered pain in that ankle since.
I surmise that the reason elevated TD and these adventitious tissue formations have been overlooked, is due to the fact that they are largely invisible to diagnostic imaging. They are, however, palpable and once located, treatable through the proper application of massage. Massage therapists have the ability to resolve a great deal of human suffering, literally, within their grasp.
Click here for more information about Linda LePelley, RN, NMT.
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