resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
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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