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How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
August, 2014, Vol. 14, Issue 08
A Look at Compression, Congestion and Dis-Coordination
By Dale G. Alexander, LMT, MA, PhD
I want to propose that compression, congestion and dis-coordination are the cornerstones of the physiological processes which perpetuate chronic somatic dysfunction. Understanding this triad of dysfunction will allow you to describe the sources of the problems that many of your clients who are struggling to regain their function and quality of life are facing on a daily basis.
I have previously noted the importance of having clear and simple ways to describe the intentions of clinical massage therapy and bodywork to prospective clients, and to the public in general. Learning to describe this triad will greatly assist you in this pursuit. What prospective clients really want is an indication of the depth of your competence and your comprehensive understanding of how the human body really works.
Compression within our human structure, congestion of our bodily fluids and dis-coordination of our nervous system are inevitable outcomes of long-term, repetitious and intense periods of stress. These same variables are at play in response to trauma, extended illness, pathology and the aging process. Accompanying these variables, there may also be elements of scar tissue formation, derangement of joint structures and soft tissue compensations from impacts, falling or surgical interventions. Any of these may trigger the influence of the righting reflexes.1
In my January article, "The Sacs & Tubes Theory of Stress," I proposed that the sacs around organs, the menninges, pleurae, pericardium, peritoneum "cringe" in response to stress while the tubes within and between organs "shorten, narrow and twist." That old colloquial phrase of "feeling twisted up inside," has more reality to it than those who have used it realize.2
The very organization of the major internal viscera being slung "down and forward" from both the cranium and the anterior neck are suggestive to how and why so many clients present with posterior chronic symptoms related to their neck, upper, middle and lower back.2 As well as, how and why clients are challenged with postural dilemmas when faced with the progression of osteoporosis as they age.
Cringing, shortening, narrowing, and twisting of the structural elements related to the heart/lung complex, the diaphragm muscle, the liver, the uterus, the esophagus and the small and large intestines all activate "a war between the flexor and the extensor reflexes" to my sensibilities. The intrinsic visceral connections that activate this war between reflexes exist between the occiput and the anterior neck all the way to the sacrum.2
Consider that this resulting tension between the reflex systems is communicated down the length of the axial spine. Also, let us remember that these reflexes are governed by subcortical structures within the spinal cord and brain stem.1 As human beings, whether client or practitioner, we do not conceive of these reflexes, let alone are aware of their effects upon our moment to moment complex movement patterns. Most have never heard of them. We may notice the slump in our posture. And, we really notice when an involved joint goes "tweak" and the soft tissues dedicated to protect it reflexively spasm. That is the one positive function of pain, to get our attention. Understanding how this process happens so frequently is what this article is describing.
Congestion of the body's fluids is an inevitable result of compression within the human structure. The transverse diaphragm's at C0-C1(occipital /cranial base), C7-T1,T2 (thoracic inlet), T12-L1 (respiratory diaphragm), L5-S4-coccyx (pelvic diaphragm) are actually designed to distribute these strains yet, these same areas are where the flow of fluids and nerve transitions between body cavities and structures are most vulnerable.3
Using the C0-C1 junction as an example, consider the impact of compression upon the delivery of arterial blood to the brain, as well as its influence to slow the venting of venous blood and lymphatic fluids from the cranial vault. One theory of migraine headaches suggests just this juxtaposition of reduced arterial flow and inhibited venous return from the brain.3
Dis-coordination within the human nervous system may occur in many ways and places yet, the superior sympathetic ganglion located lateral to the uppermost cervical spine is easiest to reference as any downward and forward pull to the cranium and neck will add distortion to the occiput, atlas and axis resulting in many forms of autonomic confusion which usually results in disruption of blood supply.4 Dis-coordination within the sensory-motor systems usually relates to spinal cord compression, also known as stenosis.5
Stimulating blood toward a particular portion of anatomy is easily accomplished by all forms of touch therapies whereas stimulating the system as a whole to re-distribute blood and nerve flow within the entire body typically requires additional skill sets.
One such orientation to systemic re-distribution that has shown promise in my clinical experience was described in the last article of this column in which the body's central linkage was described from occiput to sacrum and the crucial role of the ankle/foot complex was emphasized in propelling blood and lymph back to the heart/lung complex.6 Many additional therapeutic perspectives are possible.
The crucial factor is that the body needs freshly oxygenated and nutritious blood containing the necessary hormones and effective nerve supply to all tissue structures to heal and to balance its healthy function. As the nerves hitch a ride on the arteries and arterioles, this therapeutic goal is one and the same though techniques differ in their orientation to stimulate circulation or neural expression.7
Compression relates to any structure which has a superior to inferior attachments. Compression eventually interferes with both blood and nerve supply to all body tissues.
Congestion infers that the body's fluids are impeded from flowing to their natural outlets, primarily back the the heart/lung complex. Congestion adds pressure to delicate peripheral nerves exiting the the spinal cord from the occiput to the sacrum.
Dis-coordination occurs both within the neuro-circulatory matrix of autonomic reflexes which direct blood supply and between the sensory-motor divisions of the central nervous system which coordinates gross and fine motor movements through its peripheral nerves to the extremities.
In summary for now, allow these ideas to distill through your own clinical experiences with clients. Consider the triad of compression, congestion and dis-coordination. Create your own synthesis for how the body heals. Create your own description of how it progresses into physiological difficulty and pathology. The ability to verbally articulate these processes is more important than any marketing tool. Re-emphasizing what was stated earlier in this article, "What prospective clients really want is an indication of the depth of your competence and your comprehensive understanding of how the human body really works."
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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