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Yo San University Receives $1 Million Gift
Long-time Yo San University supporter Thomas S. Blount recently gave a $1 million dollar gift to the University, it's largest charitable gift to date. Mr. Blount was a retired naval officer, aerospace consultant and philanthropist.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Building Community: A New Way to Socialize Your Practice
Social Media can seem like a slippery slope when, in fact, it is fairly easy to understand. With social media platforms, you can connect with current and potential new clients, build strong customer loyalty and increase brand awareness.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Breech Baby: A Scientific Approach
You learned a classic cookbook style treatment strategy in college for treating breech baby presentation. I'm sure you've used it. The main ingredient: moxa at Urinary Bladder 67.
Create Community and Grow Your Practice
Many healthcare providers are fortunate to enjoy the freedom and independence of owning their own businesses. However, the constant demands can lead to a lonely and isolating experience unless you make an effort to get out of your office.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Cold and Flu Season: Expanding the Repertoire
As we move into the winter months, it is important for clinicians to have a solid working knowledge of effective herbal protocols for treating and managing clinical cold and flu presentations.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
When I started to think about what I wanted to do, I toured different schools to choose where to pursue my original chiropractic education.
How to Market to the Medical Profession
The world of health care is changing dramatically. When situations occur that cause expenses to increase, it is time for you to develop strategies that maintain and grow revenue.
Detoxification Demystified and the Crucifers that Help
"Let food be your medicine and medicine be your food," is a quote often attributed to Hippocrates, a philosopher of the 5th century BC.
The 2015 Nobel Prize Shines a Spotlight on TCM Research
Traditional Chinese Medicine continues to make it's presence felt on the world stage as the 2015 Nobel Prize in Physiology or Medicine was jointly awarded to William C. Campbell and Satoshi Omura for their work on combating parasites and YouYou Tu for her discoveries in combating Malaria.
Suffering Makes Us Human
It is possible that suffering, instead of being something negative, can be one of the greatest gifts to bring out one's humanity — if we allow it to be.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
We Have Much to Learn from Current Fascia Research
Fascia is fashionable. Over the past few years, you may have noticed the increase in conferences, congresses, symposia, workshops, online courses, books and articles that contain the word fascia in their title. Fascia was, for many years, seen as a sort of second-class tissue, a form of supportive wrapping, a nuisance during dissection, where it obscured the views of pretty muscles and joints. Fascia's increased visibility, due largely to the series of International Fascia Research Congresses, has attracted publication of a huge number of serious basic science research papers, as well as an avalanche of clinically related, fascia-related articles. These articles range from a focus on the fascial influences of foam-rolling, kinesiotaping, connective tissue massage, muscle-energy and other stretching techniques, myofascial release, a variety of exercise models (with plyometrics taking the lead), as well as a range of new trademarked approaches, led by the Italian export Fascial Manipulation.
One of the surprising features resulting from current fascia research (and there is an awful lot of it) is how little our increased understanding of fascia's functions has changed what manual therapists actually do – or need to do.
Rather, I believe, greater fascial awareness and understanding helps most therapists to do what they already do, more effectively, rather than having to relearn their skills. I have outlined a few examples of this here.
Before looking at examples of how emerging fascial knowledge refines, but doesn't necessarily change, what we do – it's important to establish a basic fact: It is impossible to treat fascia directly (short of actual surgery). In fact, all treatment approaches that target the soft tissues of the body, the muscles, ligaments, tendons and of course the joint-related tissues must involve fascial structures. The key message here is that it is not possible to "treat," - for example, a muscle (in any way whatever), without fascia being a feature of the process.
This elegantly phrased quote, from a research article by Weppler & Magnusson (2010), summarizes this point: "Skeletal muscles comprise contractile tissue intricately woven together by fibrous connective tissue that gradually blends into tendons...made of fibrous connective tissue [that] attach the muscle to bone. Although contractile tissue and tendons are sometimes evaluated separately for research purposes, they cannot be separated during routine clinical testing and stretching procedures, nor during functional activity," nor, of course, during manual treatment.
Five Clinically Relevant Examples
Note: This is not a definitive list. I have selected some key examples, there are many others!
Load transfer via fascia. Load-transfer research demonstrates how force is transmitted from one part of the body to another via fascial connections (described by some as "chains" and others or "trains"). For example, Carvalhais and colleagues (2013) demonstrated how contraction of latissimus dorsi – during adduction of the shoulder - produces external rotation of the contralateral hip via the superficial layer of the thoracolumbar fascia; while Stecco et al., (2013) showed how gluteus maximus contractions directly influence the knee via the iliotibial band. Potentially, therefore left-knee dysfunction could involve right latissimus dorsi behavior. Awareness of such links would not necessarily alter your treatment methods, but might well cause you to look at a wider set of possibilities when seeking causes of knee pain.
Fascia's sliding and gliding fascial functions. The different layers of the body - for example, between muscles or separating dense fascial structures from muscle or from other fascial layers – contain viscous loose connective tissues that allow a gliding, sliding function, protecting sensitive neural structures, as well as facilitating pain-free, efficient movement and force transmission, as described above. Gliding function may be lost because of trauma, inflammation or aging, resulting in fibrosis, thickening, densification. (Pavan et al 2014). Knowledge of the sliding functions of fascial tissues might not change what you do at all, but may help to explain why attention, lightly applied, as in myofascial release, can offer such dramatic benefits.
Mechanotransduction or changing cell behavior: for example, reducing inflammation and speeding healing of damaged tissues. Mechanotransduction describes the many ways in which cells respond to different degrees of load, such as pressure, tension, stretch, friction, etc. Research using important fascial cells (fibroblasts) that are largely responsible for the early stages of healing traumatized tissues, has shown that when these cells have been distressed by many hours of rapid movement, so that they start producing inflammatory chemicals, a brief period (a minute to 90 seconds) during which the cells are "treated" with the equivalent of myofascial release (MFR) or positional release (strain/counterstrain or SCS) – normalizes them. (Standley & Meltzer 2008.)
When MFR methods are applied to fibroblast cells in damaged tissues, a speeding up of the repair process is observed. (Hicks et al 2012). More recently, Cao et al (2015) conducted research on bioengineered tendons that had been artificially injured, to see how different degrees of light load (as in MFR) would effect the healing process. They tested a variety of degrees and durations of light stretching and identified that particular variations. For example, three minutes of stretch using around 6% of stretch, was effective in speeding up repair, while 12% for five minutes slowed it down. These percentages represent the degree of increased length of the tendon induced by stretching.
This remarkable research does not change the way gentle MFR or SCS are applied in manual therapy treatments of injured, painful, irritated, inflamed tissues – but helps explain why stronger degrees of stretch may not be as effective as light load.
Fluid dynamics and pain reduction. Manual methods that use isometric contraction – such as Muscle Energy Techniques (MET) – have the effect of improving fluid movement, particularly involving fascial fibroblast cells. Changes in the hydrostatic pressure in fascial tissues leads to improved drainage, reducing inflammatory chemicals (Langevin et al 2005, Fryer & Fossum 2009).
This is another example of fascial research indicating why (and how) mild stretching methods, particularly those involving isometric contractions, are effective in pain management. The information doesn't change the treatment methods, but it does clarify our understanding of what's happening.
Eccentric MET stretch and fibrosis, post-surgery. Remarkable clinical work in India, by orthopedic surgeons working in rehabilitation of individuals who have had recent hip or knee replacement surgery, or surgical repair of fractures, has demonstrated the value of slowly applied isotonic-eccentric stretching in such cases, thus reducing fibrosis and speeding recovery compared with traditional passive stretching methods. These MET variations have been successfully used for many years, by osteopaths and manual therapists in treatment of musculoskeletal dysfunction and have now been scientifically validated. Although this clinical research adds a wider range of application for MET, it does not change the way many of us already use this valuable method (Parmar, et al 2011).
The Bottom Line
Current fascia research is informing us, refining rather than revolutionizing what we do. Understanding the mechanisms of what we do in practice can help in the choice of what methods are best for particular clinical settings - how to best apply the multiple tools that manual therapists have for the optimal benefit of patients.
You may have noticed that the examples I have given in this article largely focused on biomechanical (and fluid related) effects of manual treatment. Apart from these there are, of course, important neurophysiological effects but that's a whole other story for another time.