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Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
March, 2014, Vol. 14, Issue 03
Learning How to Track Anterior Knee Pain
By Whitney Lowe, LMT
How many times have you heard someone say "Oh my aching knees?" It happens with frequency among athletic populations, but just as frequently plagues individuals who are not highly active. Unfortunately, people may have their condition dismissed and told it is just arthritis and they can live with it or perhaps take anti-inflammatory medications.Yet, in many cases, anterior knee pain is a soft-tissue problem that involves complex biomechanics of the knee that are not thoroughly evaluated and could be effectively treated with soft-tissue approaches like massage. A deeper look at these structural and mechanical issues helps in developing a better plan for using massage in addressing anterior knee pain.
There are several key anatomical structures that play a role in anterior knee pain. The quadriceps muscle group has the primary role of producing the power of knee extension for locomotion. Knee pain doesn't usually derive directly from the quadriceps muscle. More often, dysfunction lies in the distal tendon of the quadriceps muscles or the other connective tissues that connect the muscle group to the tibia.
The majority of quadriceps fibers attach to the tibia by way of the patellar tendon. However, the connection of the quadriceps with the tibia is not limited to the patellar tendon alone. The quadriceps retinaculum, also called the extensor retinaculum, has a key role in helping transmit the contraction force of the muscles to the distal tibia (Figure 1). The retinaculum is often overlooked as a pain producing tissue, but it is frequently the cause of anterior knee pain when patellar tracking disorders are present, which are discussed below.
The patella is another structure that is crucial to knee function, but often misunderstood. It is commonly thought that the primary function of the patella is to protect the knee. But that's not really its role. Its primary function is to improve the power of the quadriceps. Because the patella is embedded within the patellar tendon, it acts like a fulcrum to pull the tendon farther away from the joint's axis of rotation making the quadriceps group more powerful (Figure 2).
Biomechanics and Tracking Disorders
The patella has a ridge on the underside of it and this ridge fits in the groove between the two femoral condyles (Figure 3). As the knee moves in flexion and extension the patella tracks in a superior and inferior direction. The ridge of the patella must stay centered between the femoral condyles for proper knee mechanics.
Unfortunately, in many cases the patella does not track straight up and down in the groove. Muscle imbalance and other alignment factors such as a large Q angle can lead to problems in correct patellar tracking. When the patella is tracking incorrectly it is most commonly pulled in a lateral direction. This is called a lateral tracking disorder.
If not corrected, tracking disorders in the patella can cause long-term degeneration of the knee. If the patella is being pulled to one side it causes excess friction between the underside of the patella and the femoral condyles. The excess friction produces a softening and degeneration of the articular cartilage on the underside of the patella, which is a condition called chondromalacia patellae.
Tracking disorders of the patella cause anterior knee pain, but there is still some controversy as to which tissues are the source of the primary pain. For example, it was once thought that tracking disorder pain was caused by the cartilage degeneration of chondromalacia. However, the articular cartilage has very little innervation, so it is unlikely that cartilage degeneration is a primary source of knee pain. The layer of bone just underneath the articular cartilage is called subchondral bone. It is richly innervated and it is likely that tracking disorder pain may result from damage that has extended all the way to the subchondral bone.
There is another likely explanation for anterior knee pain resulting from tracking disorders that does not appear as frequently in much of the orthopedic literature. The patellar retinaculum and other connective tissues that help attach the quadriceps to the tibia are also richly innervated. An imbalance of tensile forces on these retinacular tissues can cause anterior knee pain in the soft tissues.
An effective way to identify if the retinaculum and other extensor mechanism connective tissues are a key factor in the anterior knee pain is to stress these tissues while palpating them. The most effective way to do this is to perform a resisted knee extension and palpate with moderate to deep pressure all of the connective tissue structures around the knee while the contraction is held. This same procedure could be done by engaging an eccentric contraction of the quadriceps muscles while these structures are being palpated. The eccentric contraction has the tissue being lengthened at the same time it is being deeply palpated, which exaggerates the stress on the tissue and makes it easier to identify problem areas.
Many tracking disorders originate from imbalance in the pulling forces between the different quadriceps muscles. Massage can be a highly effective means of helping to restore normal biomechanical balance in the knee. Unfortunately, it is greatly underutilized in the traditional rehabilitation community for addressing this problem. Invasive techniques such as cutting the lateral retinaculum surgically so it doesn't pull the patella so far laterally are often used before all conservative measures been attempted.
Massage treatment can be very helpful in balancing the excess pull from the lateral side of the patella. Once the key areas of tightness and sensitivity have been identified they can be addressed with very specific stripping techniques and those involving active engagement as well. By applying deep specific elongation techniques with a small contact surface like a thumb, fingertip, or pressure tool, the practitioner is able to provide a highly specific treatment strategy that is more focused than many of the other general approaches such as relying only on strengthening techniques to restore balance in the region.
Many practitioners have shown and demonstrated excellent clinical results with soft-tissue treatments for tracking disorders. Now we need to compare those treatments with more traditional methods and see if they are clinically effective across the board. If they are found to be more successful, and it is likely that they would be, there would be a greater body of supporting evidence to encourage a different treatment approach that includes massage.
Click here for more information about Whitney Lowe, LMT.
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