Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
December, 2013, Vol. 13, Issue 12
Timing is Everything: Shoulder Instability and Labral Tears
By Debbie Roberts, LMT
The greatest thing about being a massage therapist is you never know who you will help next. One minute, you could be holding the hand of a hospice patient and the next, a strained quadriceps muscle of a 6-year-old.I know all of you understand what I am talking about because, in our field, we have such an opportunity to treat a very diverse clientele. I had the opportunity to help a young football player hold onto his dream of being a quarterback, his future college scholarship and the opportunity for scouts to see him throw. My goal is to help you understand the mechanisms of shoulder instability, how to access for instability and possible tears and most importantly, why your understanding of timing can be critical.
The Shoulder Joint
The shoulder joint often has been referred to as a cup hanging on a saucer or a golf ball on a tee. What this describes is how vulnerable the glenohumeral joint is. The glenohumeral joint has the largest range of motion of any joint in the human body. The shoulder ball (humerus) and socket (glenoid) have little inherent stability. The lack of stability results in a GH joint prone to instability and dislocation.
The labrum, which is a fibrocartilage tissue that forms a ring around the glenoid, adds stability to this inherently unstable joint. The labrum is connected to the capsule that links the socket loosely to the ball. The biceps tendon also attaches to the top of the labrum ring. Together with the muscles of the shoulder, the capsule/labrum complex affords stability to the glenohumeral joint. Any injury to the capsule/labrum complex causes a patient to have shoulder pain and instability (dislocation or subluxation). Damage to the labrum and capsule is a common occurrence as a result of an instability event; the damage causes the labrum to detach from the glenoid and predisposes the shoulder to future events of instability and dislocation.
There are many kinds of labral tears, but this discussion will focus on one of the most common types involving throwing athletes called the SLAP tear: "Superior Labrum Anterior to Posterior." SLAP tears usually develop over time following repetitive use like in some of our golfing clients. But they can also occur when an athlete suffers direct trauma to the shoulder, just like my young quarterback.
He sustained two different tears as a high school quarterback. The first injury sustained was a small labral tear which the doctor told him he could continue to play with. The second tear wasn't yet discovered until his visit with me. Both happened as he was getting ready to release the ball. He described that his arm was externally rotated and raised to 90+/- degrees of abduction in the loaded position of cocking for a throw. Another player tackled him making contact with the arm which forced the arm backwards and further into external rotation. The blow took the glenohumeral joint beyond its normal joint range of motion. This type of impact causes the humerus to sharply rotate within the glenoid stressing tendon and ligament structures beyond their tensile strength. Tensile strength is the maximum stress that a material can withstand while being stretched or pulled before failing or breaking. Tendons have great tensile strength, but are practically inelastic and resistant to stretch. In injuries that involve a severe stretch, the muscle most likely is affected, and sometimes the tendinous attachment to the bone is affected. Tendons can also rupture. An example is when the Achilles tendon ruptures and the Gastrocnemius retracts with the soleus muscles going into spasm and acute pain.
Red Flag On The Play
The first red flag to take notice of is the way the injury happened. Anytime the shoulder is taken beyond its normal range of motion, there is potential for serious musculotendinous junction or ligament damage. I helped this boy's father out with some nagging elbow pain a couple of years ago so when his son was complaining of shoulder pain, he called me. They came into the office and told me he was having pain on certain movements, nagging pain in the back of the shoulder and the chief complaint was instability. He complained he could no longer do a bench press in his workout even when he lowered his weights. (Extra tidbit: A bench press exercise is not a good idea anyway for a valuable throwing shoulder because the bar doesn't allow for the natural rotation of the shoulder joint. The use of free-weights in a dumbbell press accomplishes the same strength goal without the potential risk of damage to the shoulder joint.)
It is always interesting to me the details left out by a client because they don't think it is necessary information to the treatment of massage therapy. He didn't tell me he had a previous tear. It was revealed during the assessments. Based on the red flags the assessments threw up, I asked him if he had ever been diagnosed with a labral issue. He looked at me and said, "yes, last year but the doctor said it was so small I could play. But this feels different and I can't throw as far or as hard (loss of power)."
Second red flag for you to take notice of is that instability is the main complaint and loss of power. This indicates a possible tear of either a muscle or the labrium.
The first assessment I performed was a length test asking him to show me his range of motion in abduction, adduction, flexion, extension, internal rotation and external rotation. I also asked him to stop at any range that caused pain and to point where he felt the pain was coming from. "There isn't any real pain it just feels unstable and aches in the back of my shoulder." I compared his active range of motion with his passive range of motion. On external rotation, he had a clunk and a slippage sensation. This is an orthopedic assessment called the "clunk" test. The third red flag for you to take notice of is a clunk, snap or pop which are signs and symptoms of a possible labral tear.
The second assessment was the use of manual muscle testing examining the strength of the shoulder complex. Manual muscle testing is used to determine the capability of muscles or muscle groups to function in movement and their ability to provide stability and support. I performed manual muscle testing to the shoulder complex of muscles which included supraspinatus, infraspinatus, teres minor/major, anterior deltoid, middle deltoid, posterior deltoid, upper trapezius, middle trapezius, lower trapezius, latissimus dorsi, pec major/minor and serratus.
When you perform manual muscle testing, there should be a definite feeling of a muscle locking into place without quivering. He had a trembling or shuddering feeling against my resistance not a firm locking in of the joint (instability).
The fourth red flag for you to take notice of is that during the manual muscle test, there was not a definite locking in place there was more of a wavering when the muscles were subjected to pressure. This can be an indication of a tear and/or extreme inflammation. For more information on how to perform manual muscle testing, I suggest reading, MUSCLES Testing and Function with Posture and Pain, Fifth Edition, Lippincott Williams & Wilkins, by Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, May McIntyre Rodgers, William Anthony Romani.
I explained to his father and to him the objective findings. I also explained that underneath my scope of practice, I am not allowed to diagnose. The reason for the assessment is to make sure they are a candidate for massage therapy and there are no contraindications to treatment. I explained that based on the instability, the poor muscle function test and his past medical history, I would recommend they go back to their orthopedic surgeon. There is always a possibility he might have done further damage since he received another direct blow to the shoulder. I told him, the sooner you get this taken care of, the faster you will be ready to play football next season and not miss out on your senior year of high school.
I received a phone call a week later from his mother thanking me immensely. She explained the new MRI showed an additional labral tear and a partial supraspinatus tear. She told me he was scheduled to have surgery right away so he would have time to rehabilitate and be able to play in his senior year. They were very grateful because they were hoping for a football scholarship to help out with the college tuition.
Without doing an assessment, you are guessing. Timing and rehabilitation are always critical when it comes to sports. Delaying the surgical intervention would have prolonged the client's recovery and return to play. He may have lost his window of opportunity to earn his chances of an athletic scholarship.
All red flags are contraindications for treatment and are indications for a medical referral. He has completed physical therapy. He is seeing me once a week for maintenance and is leading the way with his high school football team. Everything indicates he will get that college scholarship and who knows what is next. The scouts are looking at him!
Click here for more information about Debbie Roberts, LMT.
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