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End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
February, 2014, Vol. 14, Issue 02
What Does an MRI Tell the Therapist? A Closer Look at Cervical Pain
By Debbie Roberts, LMT
There are more than six million car accidents every year in the United States alone. Worldwide, an estimated 1.2 million people were killed and fifty million injured from a car accident. There is a very big chance you will treat a whiplash injury over the course of your career.It is important not to treat these potentially serious trauma cases blindly. Even if you work in a chiropractic office ask to see their MRI report. The MRI and his prognosis for the case will give you a more precise treatment strategy. This will also help you determine how severe the injury is. You can divide a whiplash prognosis into three categories. Minor whiplash injuries usually resolve within one to two weeks. Moderate whiplash injuries with muscle spasm or ligament strains may take up to four to eight weeks to resolve. Severe whiplash injuries, or those that involve nerve damage or ligament or disc injury to the spine, may result in chronic or permanent disability. These injuries may require more drastic measures to resolve.
How many times has a patient said to you, "I feel like I am crazy?" Massage therapy is sometimes so much more than the physical portion of manual therapy. Massage therapy can be the gap of empathy, education and evaluation between the patient and their physician. Where does the process start? It starts with how well you assess and evaluate the situation. Evaluation takes a level of judgment, necessary to make sense of the clinical findings in order to correlate a relationship between the symptoms and the signs of dysfunction. This kind of thinking takes you away from treating symptom-based massage therapy into cause and affect therapy. Having real tangible evidence helps the therapist decide which techniques are necessary to help the client regain their previous level of health or even a better state of health.
Where is the easiest place to start? Start with the facts and not speculation. If the client has had a MRI, ask them to bring it to their first appointment. If you have never read a MRI report it can look and sound daunting, but it will actually help you make a more sound therapy session. The information this report can lend to you as a therapist is insight into what is really going on with the client. There may be certain range of motion movements you will not want to do with this client knowing their history. Also, now you will have a better idea on what you can expect from your treatment plan.
There are well over 100 types of massage and massage modalities to choose from these days so it is even more important to have a system on which to base the appropriate technique or tool from the tool box. I bring this up to help our community of massage therapists understand that although some techniques such as stretching, elongating fascia and helping with mobilization are good at times, certain directions of movements may not be appropriate after reading the clients MRI report. Holding ourselves accountable for knowing standard orthopedic joint range of motion measurements are critical in making sound stratagem for massage therapy. Just because you learned that a stretch in lateral side bending will lengthen the trapezius muscle, will that technique or modality be appropriate for this cervical patient? And without looking at their MRI report, you are trapped at speculating instead of correlating the facts.
It is not hard to read a MRI report of findings. You simply go to the end of the report and find the word IMPRESSION. This is where the basic conclusion of what the testing results showed. Taking the time to ask for the report and reading the report demonstrates to the patient you have knowledge and understanding as well as empathy. It also demonstrates you really want to know what to do and what not to do during their treatment session. Massage therapists have an opportunity to educate the client by showing charts of the muscles, joints and nerves involved that were indicated in the report. The patient doesn't understand why their muscles are still going into spasms one month, two months, even a year later, but you do. Giving the needed educational and emotional support when someone is in pain can immediately reduce their anxiety which in turn reduces their pain levels and an opportunity for healing can begin. When you take the time yourself to understand what a MRI report is saying, your treatment plan can be much more precise.
Here is the exercise for this article. I am going to give you the subjective information and the results of one of my cervical patients MRI report. Read the report all the way through. Jot down what you understand and then what you don't understand. Google it! Based on the subjective, how would you treat? Now, based on the facts how would you treat? Which technique or modality would you be comfortable using. Is there range of motion movements you would avoid? What muscles would you do manual muscle testing on?
Case Study Subjective
In total tears, over lunch my girlfriend relays she has been in neck and headache pain now for the past six months and can't workout. She had chiropractic care which included adjustments, ultrasound, hot/cold and electric stimulation which offered some relief.
Past Medical History
She had an accident one year prior to this car accident. She fell off of a ladder that tore her ACL, MCL, the medial meniscus and fractured her tibial plateau. She was found on the ground in a pool of blood.
Here is a beginning list of the muscles innervated at the different spinal roots. C5/6 innervate the Deltoid, Teres minor, Biceps, Brachioradialis, Subclavius, C4,5,6 Infraspinatus, Supraspinatus, C6/7 innervate Coracobrachialis, Pronator teres, Flexor Carpi Ulnaris, Triceps, C7 innervate the Latissimus dorsi. Let's look at a few terms that were in the report.
Spinal stenosis is an abnormal narrowing of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. There can be either sensory or muscular weakness. Cervical spinal stenosis is dangerous because it involves compression of the spinal cord.
A bulging disk extends outside the space it should normally occupy. The bulge typically affects a large portion of the disk, so it may look a little like a hamburger that's too big for its bun. The part of the disk that's bulging is typically the tough outer layer of cartilage. Usually bulging is considered part of the normal aging process of the disk and is common to see on MRIs of people in almost every age group.
A herniated disk, on the other hand, results when a crack in the tough outer layer of cartilage allows some of the softer inner cartilage to protrude out of the disk. The protrusion of inner cartilage in a herniated disk usually happens in one distinct area of the disk and not along a large component of the disk, which is more typical of a bulging disk. Herniated disks are also called ruptured disks or slipped disks. A herniated disc is more likely to cause pain.
Relief In The Findings
Because she didn't understand the report of findings, she was not making the necessary adjustments to her lifestyle to help with relief of long term pain and dysfunction. Her neck seems like a train wreck and is the third type of whiplash discussed previously. We treated her with ice and heat, performed soft tissue work to tolerance. No deep tissue was used. She was treated in supine, prone and side lying. Other treatments included some craniosacral therapy, light traction, and no range of motion movements instead the use of isometrics in all directions and again to tolerance. I managed to take her pain level from a 10 down to a 3 with soft tissue work, home contrast therapy, lying down as often as possible during the day while she was working. Also, she made modifications to her workout routine. The focus was not to let the pain cycle get started.
Understanding the MRI helped her make the necessary lifestyle corrections to allow the chiropractic and massage therapy to be successful. Although both kinds of care lowered her pain levels, it still remained a constant nagging dull ache with limitations to her standard of living. On the advisement of her lawyer she sought care from an orthopedist. The orthopedist recommended a series of facet injections to help break her pain cycle and he felt strongly that it would eliminate her pain. The injections were successful and this allowed her to resume closer to her previous way of living and working out. To make sure she doesn't get into that pain cycle again she presently maintains herself on as needed bases of both massage therapy and Chiropractic care.
Because the disc does not always protrude in the same direction in relation to the nerve root there is no way to know for sure which motions or positions will aggravate a nerve root compression. A safe rule of thumb is that if any motion or position or technique further aggravates the client's symptoms, it should be immediately stopped.
Click here for more information about Debbie Roberts, LMT.
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