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Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
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.