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Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
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.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
The Importance of Dosage in Manual Therapy
Research is slowly beginning to reveal the importance of optimal dosage in manual and movement therapies and it may surprise you (as it did me) to learn that very small variations in applied load (compression, stretch, etc.) can make the difference between a positive and a negative therapeutic outcome.
Recent studies have shown that variations in the:
This list should include other variables, such as whether a particular method is used alone, or in combination with others (say, stretching as well as effleurage) – and when employed with other methods - and in what sequence. In other words - how much is too much, and how much is too little?
Evidence is also emerging that the unique characteristics of the client/patient who is receiving treatment - the gender, age, past and present medical conditions, degree of physical fitness etc - are all factors capable of modifying the responses to manual treatment. (Dennenmoser, et al, 2016)
The following examples, taken from recent research studies by hand surgeons, offers us glimpses of the emerging evidence. Wang & Guo (2012) showed that quite different effects emerge when damaged tendons are mechanically loaded, for example, involving stretching. When 4% of tendon stretch was used, there was a reduction of collagen production and tensile strength of the tendon but an increase in catabolic (break-down) of tissues, slowing healing after trauma or surgery. However, 8% of tendon stretch increased collagen production (essential in the repair process) and the tendon's tensile strength, plus differentiation into tenocytes (needed for creation of new tendon tissue), while reducing formation of adhesions and inflammation. This encouraged more rapid healing after trauma or surgery. In contrast, a 12% stretch reduced collagen production and organization, while increasing inflammation, edema and tenocyte differentiation, slowing down healing after trauma or surgery.
That's the basic science, but it leaves a major (as yet unanswered) question: How are you to know the difference between loading tendons to match the ideal (8%), while avoiding the less effective degrees of load (4%, 12%) in practice, in a clinical setting?
Other examples of the clinical challenge of achieving an ideal degree of load during treatment emerge from another basic science study by Zein-Hamoud & Standley(2015). They report that, "The key components of the response to mechanical forces are fibroblasts, which [tend to] respond to different types of strain by secreting anti-inflammatory chemicals and growth factors, thus improving wound healing and muscle repair processes." They also note that, "Heterobiaxial, but not equibiaxial, strain affects fibroblast morphology - [likely due to]- actin, which mediates strain-induced cellular Ca++ release."
In their study involving fibroblast behavior during the repair of a damaged bioengineered tendon, these innovative scientists identified that:
The question arises again: How is a practitioner/therapist to know the difference between loading soft-tissues with the beneficial degree of force, approximately 6% compared with the less helpful 3% or 12% , in order to match these findings? Clearly many therapists get this right, and my personal experience and opinion is that methods that meet tissue resistance and engage restriction barriers heterobiaxially and non-forcefully (as for example in Myofascial Release, or gentle Muscle Energy Technique application), are closer to achieving the ideal, than those that employ more aggressive forms of load.
Of course, the examples described above only highlight the treatment part of the equation. There is of course another element; the nature of who and what is being treated. Dennenmoser et al, (2016), explain the results of research involving applied mechanical friction: "Electrical impedance...can be used to determine the amount of water within human tissue and to differentiate between intracellular and extracellular water. Ultrasound elasticity imaging directly reveals the physical property of fascial tissues and makes it possible to quantify changes in tissue thickness as well as stiffness before and after [treatment]." Their results revealed that the tissue (muscle and fascia) responses will be quite different depending on numerous features that are only partially related to the way treatment is applied. "Besides the expected softening-effects on the lumbar region, both kinds of tissue, musculature and fascia, react differently depending on the sex, age, pain-history and activity-level of the person"
Dosage in manual therapy is an area that is both under-researched and "under-translated" into practice, and all manual professions need to focus on ways of teaching and training that encourage optimal delivery of therapeutic load. Additionally, attention the nature of the individual and the tissues being treated presents a further educational challenge that requires our attention.