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Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
February, 2016, Vol. 16, Issue 02
A Bridge to Reducing Chronic Anxiety and Panic Attacks
By Dale G. Alexander, LMT, MA, PhD
One of the most important "aha's" in my career was developing an understanding of the paradoxical breathing reflex and discovering that re-calibrating this reflex was an effective therapeutic bridge for reducing the severity and frequency of chronic anxiety and panic attacks.
There are a range of definitions for paradoxical breathing.1 Here, I propose a description that comes from more than 35 years of empirical clinical experience: When the cervical muscles are initiating the breath wave instead of the diaphragm muscle initiating it, one is caught in the reflex of paradoxical breathing. This state of inefficient breathing is characterized by the SCM's and the scalenes unnecessarily lifting the thoracic cage. It is a complete reversal of the typical neuromuscular sequence involved in normal breathing, especially when the body is at rest. This proposed definition fits the description of "labored breathing" in some texts.2
Certainly, other soft tissues can be recruited beyond the SCM's and scalenes as part of a paradoxical breathing pattern. I am referring to this as a reflex because the client is unaware of it and is unable to restore a normal pattern without sensory guidance and tissue re-calibration. You will not find this listed as a reflex in medical textbooks.
Additionally, the reflex of paradoxical breathing has implications for co-perpetuating a plethora of chronic physical complaints such as neck pain, migraines, upper radicular syndromes, TMJ dysfunction and pain, etc. It is a very long list. I am selecting chronic anxiety and panic attacks simply because I have observed that these symptoms are much more common within our client population than many might think and I sense we, as a profession, can assist in resolving this patterned behavior once we comprehend the primary physical variables involved.
The five most common physical correlations to chronic anxiety and panic attacks include:
My experience with clients suggests that those with a history of highly emotionally charged events, whiplash, head trauma, asthma and respiratory allergies, or the many forms of lung dysfunctions or disease complications, most commonly experience physiological states that trip the neurological switch that activates this reflex.
Repeating for emphasis and clarity, the paradoxical breathing reflex is active when the client is initiating their breathing from their neck rather than from the diaphragm muscle. This is observable, yet, if one doesn't know that this reflex exists, it is easily missed amid the vocalized constellation of painful symptoms clients so often present to us. We often are swept up in our sincere desire to help, allowing the client to direct our therapeutic focus to where they hurt rather than to observe and assess them as a whole.
If a client presents with a chronic somatic dysfunction, then I encourage you to include paradoxical breathing as one of the usual suspects in your initial assessment. The first step is to observe the client while breathing as they sit on the side of your table. Observe them from the front and from both sides. If their chest is rising and lowering, up and down with the rhythm of the breath, it is a potential sign of paradoxical breathing. And, if in addition, their belly does not move with their breath, then there is a very high probability that they are experiencing the reflex of paradoxical breathing.
Is the pattern I am calling paradoxical breathing ever normal? Yes, it is! When you exercise and your heart rate rises, your cervical muscles will initiate the breath wave normally to increase the anterior to posterior dimension of your chest in order to increase your oxygen intake. It is characterized by the heavy breathing we all experience after exercising. Speaking of heavy breathing, another time that paradoxically breathing naturally occurs is when one approaches and experiences sexual climax. Then, as our heart rate lowers and our neural system shifts to parasympathetic tone, our breathing initiation returns to the more normal pattern of the inferior descent by the diaphragm creating the space for the lungs to expand. The third most common natural activation of this reflex is in the latter stages of pregnancy. The expansion of the uterus which then occupies so much space within the abdominal-pelvic cavity is the obvious stimulus for this shift of neuromuscular function. My description of this phenomena in an article written in the mid-90‘s, "Freeing the Breath Wave During Pregnancy," is the most often requested article I have written to date.3
Once paradoxical breathing has been assessed, the next step is to assist your client in re-normalizing their breathing pattern. Sit on the table next to them. Request they close their eyes. Place one of your client's hands on your upper abdomen and the other hand on their upper abdomen and request that they breath in tandem with you for 6 to 10 cycles while you embody a normal, diaphragmatically initiated breath pattern.
Then, move their hand from your belly to their upper chest while the other remains on their abdomen. Have them continue normal breathing for another 6 to 10 cycles directing their intention to notice which hand moves first. Even if they are unable to make a complete shift toward a normal pattern, most clients will register the distinction between whether they are initiating from above or from below.
This technique is using the principle of kinesthetic entrainment, and I have found that it is the quickest way to give your client a sensory experience of what is more normal. It also gives them the psychological and physical permission to release the tension of their abdomen.4
As the diaphragm descends, your abdomen will normally expand slightly forward, but many consciously or subconsciously restrict this motion. Yes, this is another reason that perpetuates this reversal of function: People don't want to be perceived as fat. Next, have your client lie supine, placing one hand on their upper chest and the other on their upper abdomen. Request that they intentionally initiate their breathing from their neck muscles for 2 to 3 cycles then switch back to diaphragmatic breathing for 3 to 5 cycles.
The key to this method of recalibrating the paradoxical breathing reflex is to consciously initiate the dysfunctional pattern "on purpose" so the nervous system develops a sensory recognition and discernment between the two. For many, a few rounds of feeling their diaphragmatic breathing restored and then intentionally initiating from their cervical muscles again will be enough to interrupt the reflexive cycle. For others with entrenched physical or psychological trauma, it will take a few or even many sessions to restore the normal neuromuscular sequencing of the breath cycle.
If deprived of air for 3 to 5 minutes, most of us would die. We all know this instinctively, so some breath is better than none, even if it is feeding our chronic anxiety or functions as a pre-disposition to our panic attacks. Most of our clients simply do not understand how their bodies really work. Identifying this dysfunctional pattern is one way that our profession can educate them, serving them at multiple levels with knowledge, touch, and compassion.
One caution: do not focus on the breath re-calibration process for more than about 10 to 12 minutes, especially if a client is not making progress. This doesn't occur very often, yet frustration fatigue can set in quite quickly for any of us. Instead, allow yourself to use other therapeutic tools you already possess to relax the additional structures identified earlier in the article. Or, if your context is principally to give a client a relaxing full body massage, trust that this will assist them. At the end of the session, you can ask them if their breathing feels more normal. You will be surprised just how many will say yes.
In a future article, I will expand on the other physical variables that have shown themselves to be associated with this paradoxical breathing reflex.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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