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Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Business Building: What's Your Strategy?
I know some in our profession love to debate about whether or not spinal curvatures change as a result of our chiropractic adjustment, but I have a question that hits a little more close to the belt than that: Are chiropractors capable of change?
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
Telecommuting and Technology: Ergonomic and Worker's Comp Considerations
As our world becomes more and more reliant on technology, equipment becomes more dependable and we become increasingly more comfortable with e-mail, the fax machine, the Internet and the smartphone, it is becoming easier and easier to work away from the office.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
The Pallof Press for Core Stability Evaluation
Many people become injured because of instability, weakness and poor neural-sequencing patterns in the core. Lack of bracing and support from the inner core cylinder during coronal and transverse movements makes the body vulnerable to compensation injuries.
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
Chiropractic Research: A Moral Issue
This year I've had the opportunity to go to three great chiropractic research conferences; the ACC-RAC, the Fédération Internationale de Chiropratique du Sport (FICS) Congress and the World Federation of Chiropractic Congress.
Calcium Supplements and Mortality
When the National Institutes of Health's AARP Diet and Health Study reported that men who took calcium supplements had a higher risk of dying from cardiovascular disease compared those who didn't, it was the third large cohort in six months with alarming findings regarding calcium supplements.
Medical Payola (Part 2)
Not only has Medtronic made billions selling expensive screws and hardware for highly controversial spine fusions, but a Senate investigation also found Medtronic felt compelled to write and edit medical journal articles attributed to outside physicians that downplayed the risks of the company's best-selling bone graft, Infuse.
Exercises for Back Pain: Low-Compression Training Program
This program is intended for two groups of people: 1) those who want to engage in resistance exercises for the major regions of their body without developing back pain in the process; and 2) those who already have back pain and want to do resistance exercises, but consistently re-irritate their back when trying to do so.
In a previous column, I discussed the history and definition of evidence-based practice (EBP), and expressed concerns with how the concept has been narrowly construed by some academics and payers.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Wisconsin Exam in the Spotlight
You've passed your national boards with flying colors, including Part IV, the practical examination, at a combined cost of more than $3,000.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
History Repeating Itself in Wisconsin?
Thirteen years ago, the Wisconsin Chiropractic Association (WCA) "agreed to settle Federal Trade Commission allegations that [the association] orchestrated a conspiracy among WCA members to increase prices for chiropractic services and to boycott third-party payers to obtain higher reimbursement rates."
Spinal-Cord Injuries: Saying No to Steroids
With steroids, epidural and otherwise, in the news lately for their overuse when treating back pain (and their danger when tainted by fungal meningitis), it was high time for a policy change, and we've got one, from the Congress of Neurological Surgeons and the American Association of Neurological Surgeons.
News in Brief
Cancer Treatment Centers of America Continues Support of Chiropractic; ACBOH Announces 2013 Practical, Written Exam Dates; PCORI Approves Funding for Research on Spinal Stenosis; Macquarie University to Cease Offering Chiropractic Program.
Repeating Bone-Density Tests
The U.S. Preventive Services Task Force recommends that women older than age 65 undergo bone-density testing. However, organizations in general have not stated when repeat bone-density testing should be done.
Technique Synergy: Blending Unique Combinations for Success
Specific techniques and modalities are the key tools of our profession. But as any artisan or craftsmen will tell you, each tool is only as good as the person using it. Sometimes, we may look to one specific assessment or treatment technique to give us the key results we are looking for. Yet, in reality, the most effective approach might be a unique combination of different methods—technique synergy.
Synergy can be defined as the interaction of elements that, when combined, produce a total effect that is greater than the sum of the individual elements by themselves. So, how do you know which different techniques to combine together for the greatest effect? The key lies in understanding the physiological effects of your treatment or assessment techniques so you can choose the most effective approach. Let's look at an example of how several different assessment strategies were combined together to produce more effective evaluation methods for identifying carpal tunnel syndrome.
Variation on Common CTS Evaluation Procedures
Carpal tunnel syndrome (CTS) is the most common median nerve pathology. Yet, there are still challenges in recognizing it, especially in the early stages before symptoms are prominent. Nerve evaluation tests need to be more sensitive to identify the problem at different stages of severity. The sensitivity of the test refers to how accurate it is at identifying the problem when it is present. Below are several variations on standard carpal tunnel syndrome assessment tests that make them more sensitive, and consequently more able to identify a problem before it is severe. These descriptions are excerpted from an article originally published in the Journal of Bodywork & Movement Therapies.1
Massage therapists routinely treat clients with carpal tunnel syndrome. Yet, they do not have the high-tech diagnostic procedures like nerve conduction tests available for identifying possible median nerve involvement. Therefore, the reliance on physical examination to support (or replace) findings from nerve conduction studies is very important. When performing any of these procedures, the practitioner should remember that exaggerated neural sensations may be indicative not only of mechanical compression neuropathy, but of a host of disorders that cause increased neural sensitivity. Appropriate contraindications for proper treatment should be carefully weighed after gathering evaluation information.
Phalen's Test is the most common special orthopedic test for evaluating carpal tunnel syndrome. To perform this test, the client presses the back of the hands together so the wrists are flexed close to 900 (Figure 1). If the sensory symptoms of pain, paresthesia or numbness in the median nerve distribution are reproduced within about 60 seconds, the test is considered positive for median nerve compression in the carpal tunnel.
When this test is performed, the wrist is in flexion, which decreases tension on the median nerve. If there is increased tension on the median nerve, there is a greater degree of sensitivity in the evaluation procedure and it could therefore pick up less severe conditions.2 Greater sensitivity would therefore result if the wrist was held in flexion (Phalen's test position) while the upper extremity was held in a position that increases neural tension on the remainder of the median nerve. An upper extremity position that would increase tensile stress on the median nerve, while compressing it at the carpal tunnel region, would include lateral flexion of the neck to the opposite side, shoulder abduction, elbow extension, and wrist flexion (Figure 2). This test would be performed unilaterally, unlike the standard Phalen's test, which is performed on both sides at the same time. Make sure the cervical region is laterally flexed away from the side that is being tested.
Another relatively new evaluation procedure that has demonstrated greater accuracy than the Phalen's test is the hand elevation test. In this procedure the client holds the hand as high as comfortably possible overhead (Figure 3). If neurological symptoms in the median nerve distribution of the hand are reproduced within one minute, the test is considered positive.3 Neural tension in the median nerve could be added to the hand elevation test to make it more sensitive. With the arm held overhead, the neck is laterally flexed to the opposite side. Additional tension on the median nerve is added by putting the wrist in extension (Figure 4). Another variation would be keeping the wrist in flexion (as in the Phalen's test wrist position).
Increased neural tension is already a component of this test. The wrist is held in extension and supination. While in this position, the index finger is pulled into hyperextension as far as motion allows (Figure 5). The finger movement can be performed by the practitioner or by the client.4 If neurological symptoms are felt within about one minute, the test is considered positive. As with several CTS tests, this test is considered more accurate when combined with other procedures to produce a comprehensive clinical picture.5
The tethered median nerve stress test already involves tension on the median nerve at the wrist. Additional neural tension can be added to the proximal upper extremity to make this procedure more sensitive. Positions to add include lateral neck flexion to the opposite side, shoulder abduction, elbow extension and forearm supination. Note that not all of these motions need to be added. In some cases symptoms will be exacerbated with addition of just one position.
Accurate evaluation of soft tissue pathologies is an essential element of effective treatment. No diagnostic procedures have proven to be the gold standard for accurately identifying carpal tunnel syndrome. Electrodiagonstic testing, which is commonly used by medical professionals, has demonstrated limited effectiveness. It is also not available to most manual therapy practitioners. There is, therefore, a need for alternative accurate physical examination procedures for CTS. Common physical examination procedures are not always sensitive enough to identify the pathology when it exists. Some of the variations described in this article could prove to be useful adjunctive evaluation procedures that help the manual therapist gather more precise information about their client's soft-tissue pathology so that appropriate treatment or referral may result. These variations on standard CTS evaluation tests show that applying biomechanical principles to various assessment procedures allows us to combine the different strategies together for more accurate results. And that is the key benefit of technique synergy.