resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
February, 2016, Vol. 16, Issue 02
Assessing and Treating Golfer's Elbow
By Ben Benjamin, PhD
The term golfer's elbow is a bit misleading, because golfers are only a small segment of the population that suffer from this injury. The muscle-tendon unit involved in this injury is the flexor carpi radialis, the structure used to flex the wrist.Bikers, tennis players, pianists, violinists, painters, construction workers, and individuals who work out using weights all get golfer's elbow fairly frequently. It is also common in those who spend many hours a day at their computer, and is frequently a part of the complex picture referred to as Repetitive Stress Injuries (RSI).
To locate the structures affected in golfer's elbow, press one of your elbows into the side of your body, squeezing it against your ribs as hard as you can. The bony protrusion pressing into your ribs is the medial epicondyle. Golfer's elbow usually occurs right at the medial epicondyle — specifically, at the tenoperiosteal junction of the flexor carpi radialis tendon (the portion of the tendon that is attached to the periosteum, or bone covering, of the medial epicondyle). This is the area of the muscle-tendon unit where the most stress and tension are exerted. If the structure is not rested after an initial strain, the injury may spread to affect the body of the tendon, the muscle belly, or at the distal attachment on the anterior side of the base of the second and third metacarpal bones of the hand. This spreading of the injury occurs if the structure is not rested or treated and worsens over time.
How and Why this Injury Occurs
It's often hard for clients to remember what they did that brought on golfer's elbow. It can be caused by almost any activity that uses a repeated forehand motion — for example, intensive writing or typing, hammering, lifting, or painting , or overdoing wrist curls at the gym — and the pain often starts up to several days after the strain occurs. Often, no pain is felt if the person is warmed up and involved in athletic activity like golf or tennis.
Golfer's elbow can last a week, a month, or a year or two, depending on how well or poorly the strained fibers heal. If the person keeps repeating the activity that caused the strain, adhesive scar tissue may form and prolong the healing time. If the client cannot or does not stop the pain-causing activities, the treatment will take much longer.
Referred pain is minimal in the elbow, but if the injury worsens, the person may experience the pain as radiating from the elbow toward the wrist. In that case, what's actually happening is that the injury is spreading throughout the muscle-tendon unit. Once the tenoperiosteal junction is injured, the whole structure is weakened and more vulnerable to injury. If it is repeatedly put under stress, more and more fibers become strained. As a result, an injury that started at the tendon attachment soon spreads to the tendon body and then the muscle as it tries in vain to do its work.
Increasingly in our society, people are working longer hours, exercising less, and spending more time on their computers for fun after work is over. This causes great strain on the flexor carpi radialis muscle-tendon unit. Whenever people don't exercise to gain and maintain flexibility and strength beyond what they need for their normal daily activities, things can break down quickly. I recently began treating a woman with golfer's elbow who spends most of her day working at a computer, and who hasn't exercised for four years because she is so busy. Her good arm could lift a two-pound weight just 20 times before tiring. Her injured arm could not lift even one pound without discomfort. The flexibility of both wrists was limited to 75 degrees. (A healthy wrist easily moves to 90 degrees of extension and flexion.) This is a case of an injury that was just waiting to happen. Our goal now is to build up flexibility and enough strength in her flexors and extensors that she can easily exercise with ten pounds with her good arm, and eventually (after six to eight weeks of treatment) with her injured arm as well.
Ask the client to hold the injured arm out in front of the body and flex the hand down toward the floor. Place one of your hands on top of the wrist to support it, and wrap the fingers of your other hand around the client's palm. Now, ask the client to hold the hand in this position while you try to pull it forward and up. Hold this isometric position for a few seconds. In a person with golfer's elbow, this action will cause pain at the medial elbow and/or into the forearm.
A combination of the following treatments is generally very effective within four to six weeks. The muscle-tendon unit is easily accessible.
To perform the friction, it's best to have the client's elbow bent at a 90-degree angle and the forearm slightly supinated. Place the tip of your thumb at the edge of the flexor carpi radialis tendon, just inferior to and up against the edge of the medial epicondyle; this is the tenoperiosteal junction. Now press down to compress the tendon, and friction in a medial direction. Continue for five or six minutes, take a break, and repeat, for a total of 10 to 12 minutes of frictioning. Then massage the upper arm and forearm to maximize blood circulation to the tendon.
An important caution when working in this area: The flexor carpi radialis is located right near the ulnar nerve. If your client feels tingling or electric sensations down the arm, that means you've hit the nerve and you need to shift where you're working.
Extend the injured arm in front of you, with the palm facing the ceiling, and you can use your other hand to support the elbow. Then, holding a one- or two-pound weight, curl the hand up in flexion and then slowly lower it to the starting position. Do three sets of 10 repetitions of this exercise, resting for a moment between sets.
Golfer's elbow is a very common condition, for golfers and non-golfers alike. With more and more people working on computers or playing computer games for long periods of time, it will likely become even more prevalent over time. In treating golfer's elbow, friction therapy to reduce and eliminate the adhesive scar tissue — coupled with exercises to increase the flexibility and strength of the flexor carpi radialis — have proved to be extremely effective. No matter what treatment is given, the person should be sure to limit activities, especially those that cause pain, until he or she is completely well. It is often very tempting for clients to resume activities as soon as they begin to feel better; it's easy to lose perspective and resume exercise or work at a level that the body is not yet ready for. A slow, careful build-up of strength and flexibility is the most prudent course of action to ensure a full recovery and minimize the risk for re-injury.
Click here for more information about Ben Benjamin, PhD.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.