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Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Key to Rehab Back Pain
It is universally acknowledged that there is a spiral twist in the body that goes from head to foot, and therefore, it is considered normal. I call it the core distortion, and have discovered that when it is reduced, painful symptoms begin to disappear. If massage therapists are able to understand how this core distortion causes pain and dysfunction, their treatments will be more effective. The entire spine is involved in the spiral twist (core distortion) and is the focus of this article.
The support at the base of the spine is the first and most important aspect to examine. The core distortion causes an anteriorly rotated left ilium and a posteriorly rotated right ilium. This distortion is observable in the cranial motion – the left wing of the sphenoid is restricted down which relates to the ASIS, the right posterior ridge of the occiput is restricted down which relates to the PSIS. With the anterior/posterior rotation of the iliums the sacrum tips and rotates as follows: the left superior articular facet rotates anteriorly, medially and slips down, the right superior articular facet of the sacrum rotates posteriorly and slightly up, and the apex of the sacrum and the coccyx tilts to the right. The greater the anterior rotation of the left ilium, the greater the tippage of the sacrum, which creates less weight bearing support for the sacrum and causes overstretching of the supporting ligaments between the sacrum and ilium. The base of the sacrum, the support for the spine, is tipped and rotated down and to the left. This results in an uneven weight bearing base for the spinal vertebrae producing exaggerated curvatures in the spine.
As the degree of rotation of the iliums and tippage of the sacrum increases, the degree of the spinal curvatures also increases. These larger spinal curvatures become areas where problems develop such as subluxations of the vertebrae or uneven pressure on the discs putting the spine in a deteriorating condition commonly described as degenerative disc disease. The exaggerated curvatures caused by the core distortion put uneven pressure and stress on the discs and vertebrae. In the body's struggle to maintain structural support, it creates lipping, spurring and arthritis on the vertebral edges where the excess pressure and irritation is taking place. The over compressed discs begin a long-term thinning process creating a weakening of the disc sac resulting in bulging, herniations, or even ruptures. It is extremely rare to find herniated and ruptured discs where there is not a significant imbalance and curvature in the spine. Also, there is a greater chance of stenosis due to the curvatures and pressure on the vertebrae.
Soft tissue also plays a significant role. Restrictions in the soft tissue of the cranium create restrictions in the cranial motion. As in any joint of the body, the range of motion is defined by the degree of soft tissue restriction, and an imbalance of tension in the soft tissue creates an imbalanced range of motion at any joint including the cranial sutures affecting the cranial motion. So, observing the core distortion with its imbalances of the anterior/posterior rotation of the iliums and tippage of the sacrum provides information for possible solutions for rehabilitating spinal conditions. According to Dr. Terry Yokum, the normal rotation of the iliums is greater than 22 degrees.
Consistent with kinesiological information, a rotation of more than 15 degrees in any joint will dramatically weaken associated muscle strength and function. Thus, in the core distortion, the spinal muscles and major support muscles for the pelvis are significantly weakened, proven by kinesiological testing. This explains how, over time, the core distortion worsens with increasing degrees of rotation and spinal curvatures due to the inability of the muscles and connective tissue to support the spine, and why severe soft tissue injuries can occur in the supporting spinal muscles.
The good news – the core distortion offers a direction for rehabilitation. By significantly lessening the degree of the core distortion which includes bringing the rotation of the iliums to less than 15 degrees and lessening the entire spinal curvatures, the cause of most spinal pain and dysfunction can be rehabilitated.
Casey, a 43-year-old business owner and downhill skier, came for treatment for neck and back pain and brought MRI's and x-rays. The MRI showed disc herniation between C3-C4 and bulging discs between L4-L5 and C6-C7, thinning of discs throughout her lumbar region, and lipping and spurring in the lumbar, thoracic and cervical vertebrae. She saw a chiropractor, physical therapist and orthopedic surgeon, and the diagnosis was degenerative disc disease. Neither the chiropractic treatment which included massage, nor the physical therapist relieved her pain. The neurosurgeon basically said her downhill skiing was over and she needed surgery.
Postural evaluation revealed a rotation of the iliums, thoracic curvatures, and the head and neck tipped forward and to the right (classic core distortion). Applied and functional kinesiology verified the structural imbalances and significant weakness in the associated muscles and soft tissue.
The Cranial/Structural Core Distortion Releases (CSCDR) were applied in the initial treatment to release the soft tissue restrictions in the cranium that held the cranial imbalance, a significant player in the core distortion. This also reduced the rotation of the iliums and brought the sacrum into weight bearing support and more level. Decreasing the tippage of the sacrum resulted in greater support for the spine leading to a significant decrease in the curvatures of the entire spine. Kinesiological testing showed an increase in strength in all the muscles associated with the pelvis and spine. This provided support for her body to maintain the changes.
Then soft tissue protocols were applied to release the tension, imbalances, adhesions and scar tissue that were maintaining the old structural limitations of the core distortion. Each weekly session focused on specific areas of the structure based on pain or degree of structural imbalance. After 10 sessions, the neurosurgeon took another set of MRI's which showed a dramatic decrease in the curvatures of her spine, and the lumbar bulging disc had completely diminished. Her low back pain was gone and she had full range of motion. Her neck was only painful when she turned her head to the right putting pressure on the herniated disc. The x-ray showed that the herniated disc was reduced and no longer pressing into her spinal column and the bulging disc was much smaller. After five more treatments in three months, Casey was pain free and decided to return to the slopes to resume downhill skiing.
Casey's chiropractor and physical therapist were not successful because they didn't address the major components of the core distortion. Once the CSCDR was applied, there was a level foundation for her spine which reduced the degrees of spinal curvatures, relieved the disc compressions, and strengthened the supporting muscles that could not be fully functional. This strength and structural support allowed her body to maintain the changes. The soft tissue therapy reorganized the myofascial holding patterns which allowed additional unwinding of the spinal curvatures resulting in structural improvement.