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Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Fish Oil: A Key Component to 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?
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
August, 2013, Vol. 13, Issue 08
The Theory of Orthopedic Massage, Part 1
By Ben Benjamin, PhD
Orthopedic massage is an extension of orthopedic medicine, a field that originated in the early 20th century with the work of Dr. James Cyriax. Dr. Cyriax developed a system of precise methods for assessing and treating soft-tissue injuries that do not require surgery.The term orthopedic massage was first coined by Whitney Lowe, a leading massage therapy educator (and Massage Today columnist). This modality has several distinguishing features that set it apart from other forms of massage. They fall into three major categories: theory, assessment and treatment. Here, we'll focus on the theory, and in part 2, I'll cover assessment and treatment.
To practice orthopedic massage effectively, therapists must possess a thorough background understanding of anatomy, physiology, kinesiology and body mechanics. They must also understand a variety of additional core concepts, including five I'll discuss here: adhesive scar tissue, myofascial restrictions, ligament laxity, direct vs. indirect causes of pain and referred pain.
Adhesive Scar Tissue
Many people don't realize that the cause of most chronic pain in muscles, tendons, ligaments, fascia and joints is the poor healing and repeated tearing of adhesive scar tissue. A little bit of scar tissue, located in the right places, is a normal part of healing. It acts as the glue holding torn fibers together. But when tissues heal by forming a random, jumbled matrix of adhesions, constant re-tearing and pain usually follow.
When we use an injured part of the body and experience pain, it is often a sign that we are re-tearing malformed scar tissue, which then stimulates the formation of additional scar tissue. The secret of effective therapeutic treatment is breaking this cycle of tearing and re-tearing. In addition to removing any adhesive scar tissue that has already formed, we must prevent the formation of future adhesions by ensuring that healing takes place in the presence of a full range of movement.
Every cell, every muscle spindle, every muscle, every tendon and every ligament is wrapped in fascia. Myofascial restrictions result from every injury, as well as from poor posture or movement habits, and they predispose a person to suffering from more pain and injury problems in the future. Therefore, the ability to identify and effectively treat fascial restrictions is important for any orthopedic massage practitioner.
Ligaments are supposed to be tight in order to hold our bones together in the proper alignment and limit movements in directions that would hurt us. There should be a little bit of flexibility in these structures, but not much. When ligaments are abnormally loose, we lose the integrity of our joints. The bones they hold together rock around and make us unstable, making us more vulnerable to injuries. Ligaments may be lax due to hereditary factors; they may become lax suddenly as the result of an accident; or they may distend slowly over time through poor posture and the stretching of old adhesive scar tissue from previous injuries.
When ligament laxity is due to hereditary factors, a skilled practitioner will advise the client to avoid hyperextending their joints, to work on developing and maintaining good skeletal alignment and posture, and to keep their body physically strong. When the laxity is due to adhesive scar tissue resulting from an accident or injury, the therapist will work to locate this tissue and suggest treatment to eliminate or diminish it so that further injury can be avoided. Such treatment might include friction therapy, myofascial work, stretching, fitness training, massage, injection therapy and so forth.
Direct vs. Indirect Causes of Pain
A comprehensive plan of treatment must address not only the direct cause of a client's pain, but also any indirect causes. Direct causes of pain are physical injuries, such as strained fibers of a tendon, an inflammation of the bursa, a disc compressing a nerve and so on. When you relieve that problem, the pain disappears. Indirect causes of pain are the contributing factors that predisposed the person to become injured. For example, an exaggerated kyphosis in the thoracic spine makes it difficult to raise the arm overhead without some strain; the last 15 degrees of this movement occurs in the thorax. In a person with a thoracic kyphosis, this condition might be an indirect cause of a shoulder tendon strain. Similarly, poor knee and foot alignment in a young athlete might be the indirect cause of a sprained ankle. Simply improving the person's alignment would not make the injury go away; however, following successful treatment of the ankle, it would help prevent future injuries from occurring.
Referred pain is pain felt at a distance from the source — for instance, pain from a neck injury that is felt in the shoulder or all the way from the shoulder to the hand, or pain from a low back injury that is experienced only in the thigh or low leg. We learn from orthopedic medicine that no matter where referred pain originates, it follows four basic guidelines:
Referred pain creates confusion for many healthcare practitioners. However, once you learn about the specific patterns in which particular injuries refer pain, the confusion quickly diminishes. For example, the sacrotuberous ligament in the pelvis refers pain down the back of the thigh and calf and into the heel, the gluteus medius muscle refers pain to the lateral calf, and the TP7 ligament (intertransverse ligament at C7) refers pain down one side of the lower neck to the medial border of the scapula.
Together, these five core principles guide both assessment and treatment in an orthopedic massage practice. Stay tuned for my next article, when I'll discuss these topics in detail.
Click here for more information about Ben Benjamin, PhD.
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