resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
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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