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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.
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).
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.
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.
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?'
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.
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.
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.
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.
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.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
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.
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.
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.
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.
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.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
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.
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.
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.
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.
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