resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
August, 2013, Vol. 13, Issue 08
A New Model for Low Back Pain and Dysfunction
By Dale G. Alexander, LMT, MA, PhD
In my 33 years of clinical experience, it has been my observation that chronic low back pain and spinal dysfunction are one of the most prevalent contributors to human suffering and reduced quality of life. I was truly surprised when my research discovered that 95% of all spinal surgeries occur at L4-5 and L5-S1.1
So, how might we enhance our capacity as massage therapists and bodyworkers to assist people with these ailments? One way is to have an expanded and clearer understanding of the anatomical variables that have clinically shown themselves to be related to the persistence of these problems. Let's explore a few of the anatomical relationships that are structurally and physiologically related to low back function. The understanding of these relationships have assisted me in helping many.
In 1987, Dr. Jean-Pierre Barral, DO and Frank Lowen, LMT, an amazing anatomical artist, detailed that the mesenteric root suspends the small intestine from two lumbar vertebrae: the anterior bodies of L2, the disc between and L3.2 If the balanced suspension of the small intestine is spasmed, might this mean that the 20 to 25 feet of the small intestine could be a variable influencing the chronic nature of low back dysfunction?
A year earlier, in my first muscle energy technique course with Dr. Richard MacDonald, DO, he proposed two exceptionally useful concepts of how biomechanics function in the human body. First, that the feet, ankles, knees and hips are all designed to carry weight. Secondly, that from the SI joints on up through the kinetic chain of the axial skeleton, the transfer of weight is designed to go through the joint spaces of the respective facet joints in the cross-crawl pattern of walking, "without loading the bones or their discs." Thus, these facet joints were theorized to function as a relay team, passing the baton of force through their respective joints spaces, thereby creating momentum and decreasing effort after the first few steps of forward motion.
However, in the presence of spinal motion dysfunctions affecting this baton hand-off, the forces of standing and movement shift from being channeled through the joint spaces and instead become "load bearing" especially to the lumbar vertebrae and the sacrum. This osteopathic theory also suggests that such shifts add compression to the discs and distorts the motions of the facet relationships, often compressing the exiting spinal nerves. Could this be a factor in the frequency of sciatica with its nerve roots beginning at L3 with contributions from L4, 5 and S1?
Over the course of my early clinical practice, the understanding and practical application of these concepts had served me very well for many years. Then, another important clinical discovery occurred that broadened the scope and depth of my understanding of how low back dysfunction occurs and so often becomes a chronic problem.
One day in 1996, an 11-month-old infant was brought to the physical therapy clinic where I was working in Eastern Ohio. The presenting problem was that an infant was developmentally beyond the time when humans naturally begin to crawl. As the infant had a deformed head, neurological reasons were suspected as the reason. After a thorough examination by the head PT, I was asked to evaluate the infant boy and after checking his GI track and palpating his iliopsoas muscles, I was holding his knees and feeling through his femurs into his hip sockets and suddenly there was an audible sound that was a cross between serial clicks and multiple soft pops. My brain flashed an amazing number of sensory pictures through my hands into my visual cortex and I turned to the head PT and softly said, "I wonder if this little boy's femoral heads just recaptured their sockets?"
Three days later, his mother called the office with great excitement that her son was crawling "up a storm" and was actually trying to walk. My subsequent clinical experience has correlated the prevalence of posterior subluxation(s) of the hip and the anterior subluxation of the shoulder joints. A recent article in my Massage Today column describes these in more detail.3 However, in summary, the principle is that when one or both hips sublux, the weight bearing and the transfer of the forces of standing and movement are shifted to the SI joints and the lower lumbar segments.
My clinical experience suggests that low back pain and dysfunction often follow. Shoulder subluxations may also participate in perpetuating such dysfunctions via the latissimus dorsi myofascial fibers.4 Now consider that the mesenteric root of the small intestine has become taut for many possible gastrointestinal reasons including chronic stress. Further, consider that the ability of L3 and then L2 is unable to make the baton pass of the forces of standing and movement up the kinetic chain. Which lumbar segments are going to carry the load? The answer is almost invariably L3, L4, 5 and S1. Maybe it is not a surprise that the discs of these segments and especially that of L4-5 and L5-S1 discs so frequently bulges or herniates.
Another revealing anatomical caveat from Dr. MacDonald's functional anatomy courses was that for women, the iliolumbar ligament extends from the posterior superior iliac spine (PSIS) to L5 and L4 whereas, for most men, it connects only to L5. You can reflect on the clinical frequency of occurrence between men and women presenting with an obvious low back side shear pattern. My experience is clearly more males than females.
So, please stop and consider how often this pattern may have exhibited itself in your clients. Unstable support from below... and a blocked ability to distribute the forces of standing and movement along the full length of the axial skeleton... concentrates these forces to bounce back down toward the most common segments associated in low back pain and dysfunction episodes... L3-4-5-S1.
A key concept of the Inside-Out Paradigm is that distribution of forces is an essential component of understanding how the body balances itself in response to traumatic mechanical distortions and in response to neurological viscero-somatic reflex arcs which use the spinal cord to express their distress and/or the onset of pathological changes. Many models of evaluation and treatment imagine that the human body is a system of guy-wires. My clinical experience suggests that many more variables need to be considered as outlined in this article. No model is complete, including this one.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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