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Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Learning How to Treat PopeyeI want you to know as massage therapists, some things are just simple, very straight forward and can be helped within one to two visits. I sometimes see massage therapists looking for the more complicated reasons for pain. I have tried to convey in every article that you can save your hands and help more clients by understanding form and function along with simple assessment tools. Treating Popeye is no exception.
After two MRI's (one of the bicep and one of the shoulder), acupuncture, and a failed attempt of physical therapy, this young man found his way into my office to seek help for an unrelenting pain in the bicep. Lucky for me, his Orthopedist had ruled out that there was not a complete tear or a partial tear of the bicep tendon by doing the MRI's. But he wasn't so lucky in the fact he had been suffering with this pain and loss of function for more than six months and no one had any answers. His doctor said, "I don't know why you still have the pain, none of the lab work or the MRI's have a definitive answer. Let's try physical therapy."
I want to explore together controlled micro-tears of fascia, the difference of macro and micro-tears of fascia, how to assess bicep pain and the treatment options of micro-tears. A look into why physicians might miss this critical piece of the pie altogether. Plus, take a walk back in time with me to the beginning of the medical era of fascia reality. Try to guess the year!
I would like to clarify that a Popeye reference to a bicep usually means the client has suffered from a full bicipital tear and is left with a bulging in the center of the upper extremity showing a Popeye like effect from the tear. The look is actually the long head of the bicep hanging there not attached. You won't need many assessment tools for this one just your eyes to see that it is torn and your treatment options are relief of pain symptoms being caused from the tear. The long head of the biceps tendon is more likely to be injured because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears and because of the second attachment, many people can still function and only need simple treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical treatments, or if the client requires complete recovery of strength for a sport or work, surgery to repair the torn tendon might be required.
Can you think of anyone that would want to deliberately do controlled micro-tears to their fascia? The answer is actually everyone that works out. The most known sports would be bodybuilding for the big hypertrophy effect or a power lifter than is going to compete for lifting the most weight in his class. But it is what happens to all muscles that need to build stamina and endurance. Well, after all, Popeye didn't get that big bicep by not doing micro-tears to his fascia.
The effect of training causes micro-tears to the muscles being trained; this is generally known as a micro-trauma. These micro-tears in the muscle contribute to the soreness felt after exercise, called delayed onset muscle soreness. It is the repair to these small micro-traumas that result in muscle growth and development. Normally, this soreness becomes most apparent a day or two after a workout. However, as muscles become adapted to the exercises, soreness tends to decrease. A micro-trauma can be a cumulative effect from simple acts of daily living over a long period of time or playing a leisure sport such as golf that ultimately leads to pain and dysfunction. The extreme micro-tears are called a macro- trauma where the fascia has been injured by a traumatic event such as a car wreck, fall, or a sports injury.
My client worked out with weights and did bodyweight exercises almost every day. He stated he was just trying to maintain his physique and not trying to do anything over the top. Weight training aims to build muscle by prompting two different types of hypertrophy; sarcoplasmic hypertrophy and myofibrillar hypertrophy. Sarcoplasmic hypertrophy leads to larger muscles and so is favored by bodybuilders more than myofibrillar hypertrophy which builds athletic strength. Sarcoplasmic hypertrophy is triggered by increasing repetitions, whereas myofibrillar hypertrophy is triggered by lifting heavier weights. In either case, there is an increase in the size and strength of the muscles, tendons, bones, and ligaments through a process known as remodeling, the breakdown and growth of new tissue. But when tissue or fascia breaks down (catabolic) faster than it can rebuild (anabolic), injuries occur. Exercising or engaging in a physical activity too intensely, too long, and too often does not allow enough time for the remodeling process. This makes the client more susceptible to an injury.
Once fascia is injured either over stretched or torn the microscopic fibers are disrupted. Now, instead of fibers running parallel to each other in an organized fashion with their normal degree of elasticity and flexibility, the fibers now run every possible direction and have an extremely diminished amount of organization. Fascial injuries often heal in this tangle manner with those injured areas being referred to as microscopic scar tissues or microscopic adhesions. Finding and diagnosing these fascial tears with conventional, high-tech tests can be difficult, to the point of usually being virtually impossible. Advanced imaging techniques such as MRI will not show most fascial injuries because the fascia itself is so thin and microscopic. This is why numerous people that suffer with chronic pain syndromes will be run through test after test, with doctors telling them repeatedly, "We cannot find any reason for your pain." In some cases, they are told it is age related and you will just have to live with it.
Here is a fun quick history lesson. There are two people who have made the awareness of fascia prevalent and the first is Dr. Andrew Taylor Still in 1874, when he walked away from modern medicine to create Osteopathic Medicine. Dr. Andrew Taylor Sill saw that modern medicine at the time used harsh methods and harsh drugs that had more ill effects than good. He believed that problems with the fascia were the root of all sickness and disease. The second, Tom Myers, is quoted saying, "Fascia is the missing element in the movement/stability equation. While every anatomy lists around 600 separate muscles, it is more accurate to say that there is one muscle poured into six hundred pockets of the fascial webbing. The illusion of separate muscles is created by the anatomist's scalpel, dividing tissues along the planes of fascia." Medical professionals are still overlooking the importance of fascia to the detriment of their patients by relying on high tech tests for their diagnosis.
In its healthy state, fascia is smooth, supple and slides easily, allowing you to move and stretch to your full length in any direction, always returning back to its normal state. Unfortunately, it's very unlikely that your fascia maintains its optimal flexibility, shape or texture. Lack of activity or over activity will cement the once-supple fibers into place. Chronic stress causes the fibers to thicken and this is where the muscles start moving as a unit or recruiting muscles in a poor firing order. Fascia needs to be moved in all planes of motion in order for it not to form adhesions and become glued down to the muscle. These repetitive movements pull the fascia into ingrained patterns and once they've formed they are hard for the client to get rid of on their own. Foam roll, foam roll, foam roll is what they are told to do. There are two problems with this, one is that clients rarely use a foam roller properly and second, not all adhesions respond to this form of therapy. In addition, it is hard to form roll a bicep.
How do you help Popeye?
That's it; therapy can really be that simple. This client was better in the first visit during the session by 80%, presented on the return visit 90% improved, after the second and final session he was 100%. He thanked me for the education and was extremely grateful.