Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Ink, Art and Healing
I can assure you they didn't use this as a case history when I was in school. One of the reasons would be it was not very popular to get a tattoo or have permanent make up done in 1988, but the celebrities that we see in the movies and on television have changed all of that.
Demand for permanent make-up has grown exponentially over the past few years thanks to the trend for bold, statement eyebrows like those of Duchess of Cambridge or model-of-the-moment Cara Delevingne. The reason a person may give when warning against a tattoo is exactly the reason many people get one: "it's permanent." Just look at celebrity Johnny Depp. His first tattoo was a Cherokee Indian chief for his ancestral heritage-on his right biceps. He now has 32 tattoos.
My goal here is to bring awareness to this artistry and a field that is growing with enormous numbers and a field that will need our help to restore their postural imbalances to save careers. We will take a very close look at their posturing and how the imbalance happens,learn how to assess the problem, and delve into the education of pain referral patterns with nerve entrapment.
First, let's look at the staggering numbers from the Statistic Brain Research Institute regarding the amount of traditional tattoos performed in the United States:
Let's explore the client that presented in my office with the chief complaint of numbness and tingling into her thumb and first two digits with no neck or shoulder pain. This client has been a permanent make-up artist for 31 years. She first sought out help through chiropractic care. The physician diagnosed her with carpal tunnel syndrome from a left over car accident that happened in her early 20s. She received treatment for her neck three times a week for more than 36 visits, with a cost of $4,000. She said, "Nothing changed. In fact, the symptoms were worse." Without reading further, how would you assess this client? Go ahead and write down the things you would check. At the end, we will discuss the assessment and treatment plan and see if you might do the same.
To understand the posture, we have to understand the profession. What is permanent makeup and how is it performed? It is a cosmetic technique which employs tattoos (permanent pigmentation of the dermis) as a means of producing designs that resemble make up, such as eye lining and other permanent enhancing colors to the skin of the face, lips, and eyelids. Unlike most artists who can step back from their canvas and take a break, a tattoo artist's canvas is another person. They clamp their arm tight to their side to steady their hand. The clamping motion is so they can rely on stabilizing themselves because the client could flinch or move at any given moment, unlike a stationary canvas. Needless to say, they work in a very poor anterior posture position for hours at a time. Like this client said to me, "I am next to someone's eye, I can't make a mistake." Their work also includes producing artificial eyebrows for people who have lost them as a consequence of old age, disease, such as alopecia totalis, or chemotherapy. She relayed to me she covers unwanted scars like the ones that can be left from a face lift and restores the breast's areola after breast surgery.
First, I looked at range of motion of the neck and asked in each position did anything refer down the arm and into the fingers. Although her neck range of motion wasn't good in any position, nothing reproduced her symptoms. Next, I palpated the forearm tissue and did manual muscle testing to see if anything in the flexors would reproduce her symptoms and the answer was, no. So my next thought was it must be between the neck and forearm which lead me to pectoralis minor, anterior scalene, and the first rib. There the symptoms were reproduced, with abduction of the arm out to the side she experienced the numbness and tingling into the fingers. She then relayed she had noticed it had become increasing impossible to hold her shoulder back in a good postural position. Now we have our starting point to be able to reassess during the treatment.
Let's look at pectoralis minor function and entrapment pattern. The pectoralis minor draws the scapula forward, downward and inward at nearly equal angles. Depression of the shoulder by this muscle stabilizes the scapula when the arm exerts downward pressure against resistance. Since the inward force component is blocked by the clavicle when this muscle contracts, the resultant force draws the glenoid fossa of the scapula obliquely down and forward. At the same time, this force tends to lift its medial border and inferior angle away from the ribs causing winging of the scapula.
This winging is an indication that the antagonist muscle to pectoralis minor which is the lower trapezius is weak and inhibited. This is why she could no longer hold her shoulder back in an anatomical position because of the muscular imbalance that had been produced over the years of performing her craft. The pectoralis minor tension increases the entrapment potential of the C7 and C8 roots that hook over the first rib. Kendal, et al., have described in detail this entrapment of muscular origin noting that pectoralis minor shortening is the most likely cause, aggravated by tension in the biceps brachii and coracobrachialis, and by weakness (or inhibition) of the lower trapezius muscle.
The treatment session started with the client in a side lying position to release pectoralis minor, pectoralis major, upper trapezius, levator, anterior, and middle scalenes. Additional muscles were also treated such as latissimus and subscapularis that help produce internal rotation of the humerus.
Treatment tools: I performed isometrics by cupping the client's anterior shoulder into my hand and having her roll the shoulder forward at a 15% resistance holding the contraction for 8-10 seconds and then having her take a deep diaphramic breath and imagine the shoulder going limp six times through. I did not stretch the shoulder during the relaxation phase after the isometric because it would reproduce her symptoms. I used myofascial release techniques to help with the fascial tension both to the front and the back of the shoulder girdle.
The next part was having her in a supine position with heat on the chest muscles while working on her neck muscles, helping to restore balance and relieve the upward pull on the first rib and scapula. I also used a small device underneath her at each level of her T-spine to help produce thoracic extension and more opening for the chest. I alternated each tool and position of the client three times during the treatment session. There was an immediate difference in her symptoms at the end of the session. She was instructed to do the same techniques at home with the heat, isometrics, something rolled between the shoulder blades to allow the shoulders to fall backwards, and the use of breath and visualization. I asked her to examine what she could change in her work station and habits for better ergonomics. In addition to her homework at work, she needed to take posture breaks after each client, not just when she noticed the numbness and tingling starting to increase.
The use of isometrics in this case was a very important aspect. As stated by Liebenson (1996) in Leon Chaitow's Muscle Energy Techniques book pages 5 and 6, "the benefits of, and the mechanisms involved in, use of muscle energy technique (which he terms ‘manual resistance techniques', or MRT): Two aspects to MRT [i.e. MET by another name] are their ability to relax an overactive muscle and enhance the stretch of a shortened muscle and its associated fascia. There are two fundamental neurophysiological principles that account for the neuromuscular inhibition that occurs during the application of these techniques. The first is post contraction inhibition [also known as post isometric relaxation or PIR], which state that after a muscle is contracted, it is automatically in a relaxed state for a brief, latent, period. The second is reciprocal inhibition (RI) which states that when one muscle is contracted its antagonist is automatically inhibited."
I love the application of isometrics because it seemingly just helps melt any over contracted muscle. It is one of my standard tools in my tool box. Tattoo artists are not alone in this "bent over, curved position" staring at clients all day. There are nail techs, office workers, orthodontics, and of course, massage therapists just to name a few, who are probably experiencing the same kind of discomfort from their working posture. So to all of the above, I recommend seeking the appropriate treatment to help correct postural imbalances and most important, change your habits both during and after working to eliminate the anterior forward roll of the shoulder and possible entrapment by a known villain pectoralis minor.