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News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
December, 2015, Vol. 15, Issue 12
Pain Chasers vs. Pain Solvers
By Debbie Roberts, LMT
In 1995, I took a course taught by a physical therapist on post rehabilitation. It was a four-day course on how important a personal trainer could be after the client was finished with physical therapy.It went over the proper and safe exercises for hip replacements, knee replacements, shoulder surgeries, and more. The entire time I was in the class thinking that thank goodness I am both a massage therapist and personal trainer. The other thing going through my mind was I have to find a way to bridge the gap between massage therapy and exercise.
Functional movement at that time was not being taught in massage school. There was and still is a great need to incorporate the understanding of how the human body moves. It was and still is my goal to elevate the field of massage therapy beyond the Swedish massage taught in schools. I had applied to the state of Florida to teach massage therapist exercise and at the time was turned down. Exercise was not under the scope of our practice, but understanding movement was. So it was born, the course and thought process to teach the world of massage therapists Functional Integrated Massage and Movement Therapy. But this concept is far from new. In 1940, Dr. Ida Rolf developed her system of Structural Integration. Her approach was using manual therapy and sensorimotor education to improve human biomechanical functioning as a whole rather than to treat particular symptoms. The important thing is not to chase the symptoms or the pain, always go after the cause.
Are you a pain chaser? In order to truly know you have to ask yourself a few honest questions. How well do I know how to evaluate a set of symptoms? Am I always looking for new evaluation tools? Am I willing to admit I don't know and seek out education to help me excel in this topic? In this article we are going to apply the concept of Functional Integrated Massage and Movement Therapy to a very stubborn case of Posterior Tibial Tendon dysfunction (PPT). I want to help you become an even better therapist by not falling into the trap of chasing the pain. As massage therapists, we are very sympathetic to someone complaining they are in pain. Our antenna go up and we are on high alert that someone needs our help. With the absolute best intensions, we invite them to lie down on our table and we will repair the problem or at least help dull their current pain level. Let's examine together the importance of understanding how valuable evaluation in gravity before the table time is. Looking before treating is critical to obtain the results both you and the client are expecting to achieve. Having a reliable means of evaluation is vital to therapeutic massage.
With her permission, I am going to tell you about Crazy Mary who originally presented with the diagnosis of Posterior Tibialis dysfunction. She is an above avid group exercise leader with an appetite for moving. She is the best in shape 52-year-old I know. Everyone loves her classes and her enthusiasm is infectious. She has suffered with various structural issues throughout her life stemming from a L1 fracture at age 16. I know you know the client that just won't listen until their pain and wallet start to match. They are spending, spending, and spending. While spinning, spinning, spinning in the same cycle. Well that was Mary. However, not everything was her fault. In physical therapy, they focused on band exercises for her Posterior Tibialis Dysfunction, the massage therapist that had treated her focused on her Posterior Tibialis pain, and her chiropractor focused on adjusting her sacrum that never seemed to stabilize. But no one was addressing her functioning as a whole. I convinced her to let me do a full evaluation before lying down on the table and that is where everything began to change. Matthew 7:7 says, "Ask and it will be given to you; seek and ye shall find; knock and it shall be opened unto you."
Here are the results of my full evaluation:
So what do you think, treat from the top down or the bottom up? Treat the front fascial line or the back facial line? What throws up the red flag for you? The good news in one respect there is no right and there is no wrong way to approach this client as long as all of it gets addressed to eliminate more than the symptoms and return her to a fully functioning human being without pain. The following is how I approached the issue over several visits. As you can see from the evaluation, there were multiple things going on and each with its unique situation and effect on the central nervous system. Your recipe is to develop an effective treatment plan based on your evaluation. So your treatment plan not to chase pain is only as effective as your evaluation.
Function and Treatment
I started at the bottom along the back facial line where the transverse tarsal joint had become very rigid. This joint is composed of the talo-navicular and calcaneal cuboid joint. The transverse tarsal joint relies on normal function of the subtalar joint, in order to move normally. Because the transverse tarsal joint is made of two joints, the transverse tarsal joint can be either loose and floppy (early flatfoot stage) or rigid (late flatfoot and heel rise) at certain points in the walking cycle. As the name suggest, the heel rise phase begins when the heel begins to leave the ground. During this phase, the foot functions as a rigid lever to move the body forward. During this phase of walking, the forces that go through the foot are 2-3x a person's body weight. This is because the foot creates a lever arm (centered on the ankle) which serves to magnify body weight forces. Given these high forces and considering that Mary took much more than the most active person of 10,000 steps per day, it is not surprising that the chronic repetitive stress produced Posterior Tibial tendon dysfunction. I treated each part of the joint separately using isometrics combined with mobilization.
Another contributing factor was Mary loved to use an outdoor elliptical as her mode of transportation, so she was always on the ball of her foot shortening the gastroc-complex and pulling on the calcaneus. The elliptical put her in a forward bent position using her T-12-L1 as a fulcrum point tugging and pulling on the entire back fascial line. This set of problems I treated with client education of how important watching her posture during this activity was and how the body did not load and unload naturally with an elliptical. I suggested limiting the use as a constant mode of transportation.
My overall suggestion to you, the therapist, is to follow the Superficial Back Line in its entirety which I had to do for Mary. The next part that became important to treat was the scar tissue and calcium that had developed around her L1 fracture. This needed to be released to help allow her body to come back into extension and not remain in that C-curve. Treating the QL and releasing the hypertonicity would be part of the solution for her SI joint on the right side to start to close properly. She happily reported that she had been able to taper the amount of chiropractic adjustments.
By releasing the QL's line of pull this allows the hip to come into better joint alignment. The right hip dysfunction and weakness have an opportunity to start to regain strength and communicate with the CNS. By removing the hypertonicity (she was so point tender I had to use a cup) in the gluts her body began to trust the right side again. The foot gets help from hip rotators to pull her out of the pronation during gait thus helping the Posterior Tibialis dysfunction.
The psoas imbalance had to be addressed, a better breathe pattern had to be taught, her overdeveloped quads needed tissue release, finishing this treatment all the way up to her SCM and the cranium. Not every detail of the treatment could be listed here. I suggest looking at the front fascial line.
For an injured muscle to regain strength with ease and balance, the scar tissue needs to become aligned and integrated with the muscle fibers. Even a small muscular injury or in Mary's case a L1 fracture, can lead to developing a chronic pain pattern which persists for months or even years. After 36 years of misalignment, trying to fix just one of the pieces will not work. That would be called chasing the pain. Mary's fascial system and joint centration as a whole needed to be address in all of the planes of motion. Lasting change not temporary change comes with understanding how to perform rehabilitation incorporating the Central Nervous System and the body as a whole. In the words of Ida P. Rolf, "Strength that has effort in it is not what you need; you need the strength that is the result of ease."
Click here for more information about Debbie Roberts, LMT.
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