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MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
September, 2013, Vol. 13, Issue 09
Rehabilitation Associated with Low Back Pain
By Don McCann, MA, LMT, LMHC, CSETT
Decades of published research on low back pain almost always includes a short leg as part of the functional/structural cause of distortions in the spine and pelvis leading to low back pain.There is much debate over this and no one has provided a universally acceptable answer for this structural imbalance. Various studies evaluate the ilium/sacrum relationship from either a standing position (front, back or side) or lying supine or prone. Consequently, what was already a confusing issue becomes even more confusing, as there is no one standard for this evaluation.
P.J.R. Nichols, DM, specialist in physical medicine and a member of the Royal Air Force states, "the recorded incidence of leg length will depend on the method of assessment and the selection of the subjects. The smaller the unit of measurements, the greater will be the incidents and the larger the unit of measurement the greater will be the agreement between the observers." This raises some very significant questions as to assessment and interpretation as seen in the results of the work of Denslow and Chase in their measurement of leg length discrepancy which found a 66% incidence of short right leg, and in the work of John H. Juhl, DO. who found a 68% incidence of the right leg being short. The difference in the way they are assessed and interpreted makes even these figures questionable. The one constant with the majority of people with low back pain symptoms seems to be that a short leg syndrome is present.
From my 38 years of evaluation and practice, I have noticed that there is an observable anterior/posterior rotation of the iliums which tends to create a functional short leg on the side of the posterior rotation. With this ilium rotation, the sacrum is tipped, creating increased curvatures throughout the spine. We call this the core distortion since the structural core of the body from the pelvis through the spine is distorted in direct correlation to the degree of the rotation of the iliums and tippage of the sacrum.
In this core distortion, the left ilium is rotated anteriorly and the right ilium is rotated posteriorly. This is easily observed when viewed from behind. Also, when viewed from the left side, the ASIS of left ilium is rotated counterclockwise downward and forward and from the right side, the PSIS of the right ilium is rotated counterclockwise downward and back. If using functional kinesiology, the client is supine and asked to raise the right leg 10" off the table. When the right leg is pressed down toward the table, there is significant strength. The same test done with the left leg will show significant weakness, even in a weight lifter who can squat 400 lbs. The rectus femoris is a powerful extensor of the knee but is weak when the hip is flexed along with the other hip flexors. The anterior rotation of the left ilium (flexion) prevents the rectus femoris and the other hip flexors from being functionally strong. This is a consistent finding in clients with the core distortion and is just one of many functional tests that verify the structural imbalance in the pelvis that is a major part of the core distortion found in the body.
The rotation of the iliums creates a long leg/short leg, a tippage of the sacrum and a stretching of the connective tissue between the sacrum and ilium. When moving the iliums back into support using classic manipulation or deep soft tissue therapy there is some improvement, but this improvement will not be maintained when under a weight bearing load because of the stretched ligaments and fascia associated with the sacrum, ilium and the position of the legs. Even after a significant number of treatments, when a client is weight bearing, the iliums will again rotate and the weight bearing separation will reappear along with the tippage of the sacrum. This is extremely important because if the sacrum cannot be level enough to support the spine, the exaggerated curvatures of the spine which put pressure on the discs and cause spasms or contraction of soft tissue cannot be brought into long term balance and support for long term pain relief.
The relationship of the movement of the cranial bones to the rotation of the iliums provides a tool for bringing the structure at the pelvis into weight bearing support. The wings of the sphenoid have a direct relationship to the ASIS of the iliums and the ridge of the occiput relates to the PSIS. When the cranium is moving in its cranial motion of flexion/extension, 8 to 12 cycles per minute, the cranial motion moves off a fulcrum of the SBS where the sphenoid and occiput meet. The wings of the sphenoid and the ridge of the occiput display a distortion in this motion. The left wing of the sphenoid moves easily downward into flexion, but is restricted in going into extension. The right ridge of the occiput moves easily downward into flexion, but is restricted in moving upward into extension. This creates a distortion that is identical to what is happening with the iliums.
The application of the Cranial/Structural Core Distortion Releases (CSCDR) address this imbalance in the cranial motion using specialized soft tissue releases to bring the cranial motion into balance by releasing the soft tissue restrictions that govern the distorted cranial motion. There is an immediate observable improvement in the pelvis where the anterior rotation of the left ilium is lessened and the posterior rotation of the right ilium is lessened. The result is a leveling of the sacrum and an immediate weight bearing support for the spine.
After the CSCDR, I reapply the functional left leg test discussed previously and the left leg will now test strong showing no inherent weakness. This is just one of many tests that show improvement in strength and indicate a balancing of the iliums. The obvious improved balance of the iliums results in a lessening of the leg length difference. The myofascial planes that have been holding the compensation for this core distortion which includes the long leg/short leg start unwinding to the degree that the fascia and other connective tissue can release.
I have been working since 1985 with the CSCDR to bring the pelvis back into weight bearing support and balance and have found these results to not only be consistent with every client, but remarkable in achieving long term recovery. Clients with back pain now have a weight bearing functional structure that supports the pelvis and spine more evenly lessening the curvatures. This results in an immediate reduction in the cause of degenerative disc disease and nearly every spinal condition starts to show improvement.
Using this new paradigm, treatment for low back pain begins with a structural evaluation with the client standing, followed by applied and functional kinesiological evaluation with client supine. Over the years, every client with back pain has tested positive for the core distortion in this initial evaluation. The core distortion is then released with the application of the CSCDR which can take 15 to 45 minutes. After the CSCDR, kinesiology tests show significant strengthening throughout the body as the pelvis moves into balance. When clients stand after the CSCDR they generally report feeling their legs more directly underneath them with more support from the feet all the way up their structure. Measurements taken before and after using a level measuring tool indicates an average of a quarter to a half inch gain in height. Many clients also report a significant reduction in the amount of pain and discomfort.
Once the CSCDR is applied, the body structure begins moving back into balance with support for the sacrum and spine. The myofascial holding patterns start to unwind to the degree they can, but the extent of this unwinding is limited by the complications from injuries and degeneration of discs and joints from imbalances and weaknesses of the core distortion. At this point, specific soft tissue myofascial work is applied to assist the unwinding of the chronically tightened old holding patterns to move the body into maximum balance. This totally changes the way the soft tissue responds to the myofascial work. Instead of resisting and trying to maintain an old pattern it is now actively unwinding into balance and support from the very first session without resisting the myofascial work. Everyone with back pain has a different degree of distortion, degeneration, damage, spasm and pain. Consequently the number of sessions varies, but each individual is treated until the pain disappears and function is restored. Thus, applying the CSCDR before soft tissue therapy initiates the unwinding of the core distortion to provide weight bearing support at the pelvis making the full treatment10 times more effective.
Clients treated with the CSCDR 25 years ago are still maintaining their structural improvements pain free. The weight bearing support that was previously unattainable successfully rehabilitates severe disc herniation, bulging discs, stenosis, spondylolisthesis, spina bifida, scoliosis, sciatica and simple lumbosacral sprain/strain long term. The missing link was not treating the cranial core distortion to bring the sacrum/ilium relationship into weight bearing support. The Cranial/Structural Core Distortion Release technique integrated with specialized myofascial techniques can be used as a basis for bringing long term support to the pelvis. This has opened an exciting new frontier in the effectiveness of treating low back pain with long term results.
Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.
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