resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
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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