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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.
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."
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
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.
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.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
January, 2016, Vol. 16, Issue 01
Positional Release Techniques: What are the Mechanisms?
By Leon Chaitow, ND, DO
At its simplest, positional release techniques as used in manual therapy settings, involve the unloading of tissues, placing them into less-stressed, "ease" positions. In such a comfort state, a number of beneficial changes may emerge including reduced pain perception and reduced inflammation,15 greater local muscular strength, reduced fascial stiffness,1,2 reduced pain-medication use and number of days of hospitalization, as well as enhanced peripheral circulation, post-surgically.11
There are four main forms of PRT methods:3
The benefits of reduced stimulation, applied to the whole body may help us to understand the effects of PRT. For example, time spent in a flotation tank, immersed in neutral temperature water, of high salt concentration to increase buoyancy - described as Restricted Environmental Stimulation Technique (REST) – reduces anxiety, depression and pain in individuals suffering chronic pain.
In 2001, Kjellgren et al, described 37 patients suffering from chronic pain who were randomly assigned to either a control group (17) or an experimental group (20) who received nine REST treatments over a 3-week period. The most severe pain intensity was significantly reduced, but low perceived pain intensity was not influenced. REST treatment elevated optimism, reduced the degree of anxiety or depression, and improved sleep.
In another study, Edebol et al (2008) reported the benefits of the REST method in the management of the chronic effects of whiplash injuries. And of course, relaxation, mindfulness, meditation approaches – are all known to be useful as means of reducing general over-sensitive states, whether mental, or physical. Here are some suggested mechanisms for manually induced stimulus reduction.
Neurolophysiological changes might involve muscle, fascial and joint mechanoreceptors (e.g. Ruffini corpuscles, Golgi tendon organs, muscle spindles),10 as well as pain receptors. To explore the role of muscle spindles, and the hypothesis that sensitivity of the deep tendon stretch reflex contributes to range-of-motion restrictions, Howell et al. (2006) measured stretch and H-reflex latency and amplitude before and after strain counterstrain treatment. The results suggest that SCS affected the sensitivity of the muscle spindle, thought to be heightened by the existence of tendonitis.
Proprioceptive theory is probably the most commonly discussed explanation for the efficacy of SCS. It is suggested that when a disturbed relationship exists between muscles and their antagonists, following strain, the positioning of these tissues into an unloaded, ease, position, may allow spindle resetting and partial or total resolution of inappropriate motor impairment.9
Mechanotransduction: Altered fibroblast responses resulting from changes in the shape and architecture of cells through mechanotransduction can be anti-inflammatory. Meltzer et al.14, observed that traumatized fascia disrupts the normal functions of the body, causing myofascial pain and reducing ranges of motion. Resulting inflammatory responses - involving fibroblasts - can be reversed in as little as 60 seconds by changes in load on the tissues, delivered either by counterstrain or myofascial release. In 2007, Standley & Meltzer observed that "fibroblast proliferation and expression/secretion of pro-inflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques..." such as SCS. Standley and Meltzer (2008) also reported that "it is clear that strain direction, frequency and duration, impact important fibroblast physiological functions known to mediate pain, inflammation and range of motion."
Ligamentous reflexes: Solomonow13 identified the sensory potential and major ligamento-muscular reflexes that have inhibitory effects on associated muscles. He states, "If you apply only 60 to 90 seconds of relaxing compression on a joint... an hour+ of relaxation of muscles may result. This may come not only from ligaments, but also from capsules and tendon" (personal communication 2009). A possible clinical application of this ligamentous feature may be seen when joint "crowding" is induced as part of Facilitated Positional Release and/or SCS protocols. Such effects would be temporary – 20 to 30 minutes – but this would be sufficient time to allow an enhanced ability to mobilize or exercise previously restricted structures.
Wong16 summarizes current thinking regarding ligamento-muscular reflexes and SCS: Ligamentous strain inhibits muscle contractions that increase strain, or stimulates muscles that reduce strain, to protect the ligament.7 For instance, anterior cruciate ligament strain inhibits quadriceps and stimulates hamstring contractions to reduce anterior tibial distraction.7
Hydration: Crowding (compression) of soft tissues – as used in SCS and Facilitated Positional Release (FPR), has an effect on the water content of fascia, leading to temporary (20 to 30 minutes) of reduced stiffness of fascial structures – with the potential for enhanced mobility during that period. This window of opportunity can be usefully employed to enhance function and for the individual to experience less painful movement.
Hysteresis: In a study at the Philadelphia College of Osteopathic Medicine (Barnes 2012), 240 subjects were palpated for cervical articular somatic dysfunction. This was followed by use of a durometer to objectively measure soft-tissues overlying each cervical segment pre- and post-intervention, using a single consistent piezoelectric impulse, quantifying hysteresis (tissue stiffness/densification). Various soft-tissue techniques, including SCS, myofascial release, muscle energy technique and high velocity manipulation were tested. The results showed that all methods - but not the sham intervention - improved symptoms and stiffness of tissues but that SCS resulted in the most significant beneficil changes.
To what degree all, or any, of these mechanisms are operating during application of PRT in general, and StrainCounterstrain (SCS) in particular, remains to be more definitively established. Meanwhile positional release methods are among the safest and most effective ways of easing painful symptoms and inducing a healing response.3
Click here for more information about Leon Chaitow, ND, DO.
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