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A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
January, 2016, Vol. 16, Issue 01
Congestion is What Steals Our Quality of Life
By Dale G. Alexander, LMT, MA, PhD
All of us have experienced the sponginess of edema in a client's ankle or foot. All of us have felt the extra weight of a client's cranium who comes in with sinus troubles or chronic headache patterns.All of us have noticed the difference between the heaviness of one extremity vs. the other. These are "hands on" examples of congestion.
This article begins to describes how, in 35 years of clinical practice, I have come to understand and experience my clients' varying states of "congestion" and why I believe that addressing it is such a key concern in assisting clients with chronic somatic dysfunction to regain their functional capacity and vitality for life. The focus here will include my anatomical interpretations of congestion which occurs below the diaphragm and to some degree within the thorax.
In an previous article, I identified that a conceptual triad of compression, congestion, and dis-coordination of the nervous system provides us with simple specific language to describe the intention and beneficial outcomes of therapeutic massage and bodywork.1 I now see that being able understand and describe the far ranging effects of congestion and how it occurs furthers this ability and conveys your competence as a practitioner.
Describing the "Sacs and Tubes Theory of Stress" is a useful construct to set the stage for prospective clients. Our human physiological response to stress can be described as a process in which the internal "sacs around our major organs cringe, while the tubes which comprise our visceral organs and the tubes between them shorten, narrow, and sometimes even twist."2
Imagine the human body as a whole experiencing significant stress: cringing, shortening, narrowing toward the center and even sometimes twisting, thus producing enormous contraction of the external somatic tissues, pushing juxtaposed bones to the limits of their normal range within their joint capsules and potentiating the protective response that our soft tissues are dedicated to - protecting our joints. Internally, this cringing, shortening, narrowing and twisting adds resistance to the delivery and return of the blood supply. Together, these internal and external effects of stress are the causative factors of congestion and the predominant reasons that clients seek us out.
My definition of congestion is the slowed, sluggish, or stopped movement of blood toward its normal outflows. Places of congestion in our bodies are where I believe toxins accumulate. Places where their pressures build. Congestion is the source of much of our somatic pain as inflammatory cycles are spawned as vessels become distended. And, congestion is definitely a primary co-conspirator in the perpetuation of chronic somatic difficulties.
To better comprehend how congestion occurs, let's build a simple model of our vast and complex vascular system. The heart is responsible for pumping our blood, filled with oxygen, nutrients, and hormones, across an enormous journey of 60,000 miles. Wow! That estimated distance alone, over two times around the equator, from leaving the heart to returning to the heart/lung complex is truly astounding!3
Previously, I have proposed that the autonomic nervous system has three cards to play to assist this arterial flow when impeded: make the heart work harder, narrow the vessels of the arterial and venous system, or simply divert blood flow, thereby increasing it to certain areas while decreasing it to others.4 Is this allocation of resources truly equal, or is there an innate hierarchy that the body follows in which some tissues get more increased blood flow and other tissues less?
I propose that when we reduce the degree to which the body is congested, we are assisting the body to more effectively reallocate its most precious healing resource: blood. Working with this proposition has stimulated the understanding and experience of my newest clinical axiom, "for a part of the body to heal, the system as a whole must function more efficiently." This translates into assisting the flow of both the arterial and the venous and lymphatic return systems.
So, how do we as massage therapists, go about relieving congestion and increasing systemic function? By reducing resistances to heart and the lungs expansion. Throughout my career, enhancing the capacity and efficiency of cardiac output has been my Number One priority in each session with every client. This is at the center of how we may assist our clients to reduce congestion and regain and maintain their quality of life.
I believe that increasing and enhancing the flow of raw blood products back to the heart/lung complex is also a necessary component of how cardiac output efficiency is maintained. It is an equally compelling priority of physiology. It is my perception that one cannot really separate these two priorities. In common sense there needs to be the timely volume of returned/used blood and lymph available in order for newly generated blood to be pumped out.
This leads us to the logical, but unanswered question of what happens when raw blood products are lagging in the timeliness of their return? Does the body ramp up additional red cell production in the marrow of the ribs or does it tap the reserves within the spleen? Two simple and logical possibilities have occurred to me. Other possibilities, I pray, exist. I recently asked this question of an exceptionally gifted cardiologist and they encouraged me to seek the answer from a hematologist.
We have created endless theories of how supply and demand function in the external and financial worlds yet, this simple construct of fluid dynamics is missing in how it applies within our biology as viewed by current medical science. This lack of consideration to the importance of return blood flow to cardiac health leaves several critical questions unanswered: How may it influence our systemic health as we age or, how is it a probable stepping stone in progression toward the tipping point of where stress related dysfunctions becomes disease? This is what makes understanding the many dimensions of congestion of our bodily fluids so crucial to improving the systemic health of our clients.
Another interesting and important anatomical feature relating to fluid congestion: I find the fact that the heart and diaphragm are Siamese twins, meaning that they would literally have to be cut apart to be completely separate anatomical entities. It is not an accident that during the time of their embryological development they begin together at C2.
The primary pump of arterial blood, the heart, sits directly upon the primary pump of the venous and lymphatic fluids, the diaphragm. Is there a kinesthetic feedback mechanism between them? Might there be a way that their congenital organization serves us we have yet to discover?
The heart beats 100,000 time a day while the inferior movement of the diaphragm occurs 25,000 to 27,000 times a day. I sense an inherent rhythm between these numbers, approximately a 1:4 ratio, that is not an accident. What happens to one's systemic health when this ratio becomes skewed or is disrupted over time or, even for a short time? Might this be related to anxiety or panic attacks?
What we do know for certain is that the inferior and caudal movements of the diaphragm during respiratory inhalation is what creates the primary diffusion gradient that draws raw blood products back into the heart. It is my postulation that the diaphragm cannot, and does not, do the job all by itself. The body has multiple pumps and inherent relationships innately designed to assist the heart and the diaphragm in this very important return flow process.
An Osteopathic construct introduced to me by Dr. Richard MacDonald in 1988, postulates that the foot/ankle complex functions as the body's second heart.5 That the combined actions of dorsiflexion and plantar flexion initiated by the powerful gastrocnemius and soleus muscles with each and every step we take is what creates the seminal push that provides the momentum of flow upward against gravity, and in coordination with the intrinsic flipper valves within the veinous and lymph vessels, is the process which propels these fluids to at least reach the pelvic floor, or further proximally.
Does this underscore the importance of exercise, walking, Ti Chi or Yoga as health enhancing? I certainly believe so! The vascular system's efficiency is obviously dependent upon movement. And/or in the face of being unable to ambulate some additional means of manually or mechanically pumping these fluids is really important to substitute.
Now, what happens once these fluids reach the pelvic floor? Are we to imagine that the diaphragm's earlier described movements and the pressure gradient it stimulates are enough to draw these fluids further upward and to complete the journey back to the heart or are there other factors at work to assist their flow?
In 1986, Dr. Jean Pierre Barral, DO, galvanized my thinking about how the human body really works in this regard when he stated simply, "that, normal circulation is dependent upon the pressure within the thoracic cavity being ‘less' than that of either the abdominal pelvic cavity, or that of the cranial cavity."6 This leads us to many significant therapeutic implications regarding how this pressure differential becomes skewed and how we might restore this relationship. Yet, the first step is to recognize just how important this idea is to our work with clients. Fluids do freely move from an area of higher concentration to one of a lower concentration naturally when they are not restricted or blocked from doing so.
What I have discovered is that as one reduces the resistances to the heart and lungs expansion you get a "two for one effect" because these same intentions are achieved by whatever means of technique, reduces the pressure within the chest cavity consistently. And, one can kinesthetically verify this by feeling the pressure within the chest decrease as the tissues become softer and more distensible. A therapeutic response is indicated when the thorax depresses more easily when we compress it after treatment.
It has taken me decades to fully comprehend the implications of how frequent it is for raw blood products to build up within the abdomen and pelvis and how this relates to so many of the somatic complaints of our clients. Low back pain is just the tip of the iceberg, yet it is the most frequent complaint registered above all others and the reason for the most days of lost work in our society.7 I have never read in any scientific journal that congestion is a primary variable in its perpetuation; yet, deductive reasoning suggests that it is.
What are the most common areas where congestion occurs? Image the vascular tree descending below the diaphragm. Conceive of it as two rivers, one flowing inferiorly from the heart while the other flows superiorly back to the heart/lung complex. My experience has been that congestion builds in either or both of these rivers within the abdomen, pelvis, and within the thorax.
The naturally low pressure systems of the venous and lymphatic vessels are acutely vulnerable to their rate of flow being slowed by cringing of the peritoneal sac and by the shortening, narrowing, and twisting tendencies of the small and large bowel within the abdomen. The same tendency to restrict venous and lymphatic flow is caused by the shortening and narrowing of the esophagus and the cringing of the pericardium and pleural sacs in the thorax.
The internal arrangement of our organs is exceptionally compact. Any shift from normal positioning may encroach upon these vascular rivers, thus negatively affecting their rate of flow. Whether venous or arterial, we take it for granted that both sides flow without difficulty but, in fact, their respective flow is often impeded. My experience is that when we are able to restore the sliding and gliding between the sacs and tubes, thus re-establishing the normal spatial relationships within the abdomen, pelvis and thoracic cavity, the body as a whole begins to function more efficiently. Scar tissue and adhesions from a host of possible sources are probable co-conspirators here.
What my clients have taught me is that the body's most common plumbing problem occurs where the common bile duct enters into the small intestine through the Sphincter of Oddi. When the fluids of bile, pancreatic enzymes and juices do not reach the duodenum, then resistance to the flow of these fluids often provokes inflammation within the pancreas, gall bladder or liver.
All of these organs sit directly on top of the inferior vena cava and the collecting duct for the lymph, the Cisterni Chyli. Within the small intestine, if these fluids designed to help break down what we eat are insufficient in quantity, the small intestine's only recourse is to swell, thus using surface area as its last resort toward completing its task of absorption. The common result is the experience of gas and bloating so many of our clients report to us.8
Another location of frequent congestion is within the chest. The thoracic duct which carries the lymph further upward against gravity to its outflow into the left subclavian vein is often challenged as well. In a peculiar inelegance of design, this duct crosses from right to left across the front of the spine leaving itself that much more vulnerable to the cringing of the pericardium and the pleural sacs, as well as the shortening and narrowing of the esophagus.
When clients present with pain between their scapulae, it is the congestion of this duct that is often at the root of their problem. And allow me to hastily add that often a vertebra or rib head will often have subluxed as well. Ostensibly this subluxation is the first layer of what has provoked their pain; yet, beneath it is the congestion within the thoracic duct that is the real culprit. I suspect that persistent congestion here in such close proximity to the heart/lung complex may contribute to the progression of cardiovascular disease.
As soft tissue therapists, we are initially trained to feel tension in the superficial tissues. We are rarely educated as to how this reflects internal states of congestion. I respectfully propose that our initial orientation to how the body really works was simply incomplete. Consider that from this moment forward when you feel tension in tissues that it infers congestion, whether local or systemic, and it may also infer joint subluxation... another causative factor in stimulating congestion and another subject for future exploration in this column.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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