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TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
Reader Beware: Consider the Source
The aftermath of last year's presidential elections brought a running conversation on the role played by "fake news" that was largely presented via social media.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
The Manual Resistive Test
Physical examination remains one of the most valuable aspects of assessing the integrity of soft-tissues. While high-tech diagnostic studies can be helpful for examining the structure of various tissues, their usefulness can be limited in numerous conditions where the problem lies more in function of the moving soft-tissues. These high tech diagnostic procedures are not reliable for identifying functional problems in the moving soft-tissues of the body; that is where the physical examination excels.
One of the most important aspects of any physical examination process is the manual resistive test. A manual resistive test (MRT) is used to identify a wide range of pathologies from minor muscle strains to severe neurological dysfunction.
The first step in recognizing the usefulness of this orthopedic testing procedure is to clarify some common misperceptions in terminology. The term muscle testing is often used to describe what is done during a manual resistive test. However, this term has several different meanings and the type of information derived from the test can vary widely. The practice known as "Applied Kinesiology" uses the term muscle testing to describe techniques used to identify a variety of ailments ranging from food allergies to emotional disorders. These problems are evaluated by manually testing the strength of certain muscles while the subject is in contact with some other substance or thought process. There is a great deal of controversy about the validity of this approach, and most research has indicated that the results of "Applied Kinesiology" muscle testing are little better than random chance.1
The term muscle testing is used within the Western-based medical system to indicate the evaluation of muscle function that may be impaired due to neurological disorders. Since our focus in this article is on proper locomotor function, this form of muscle testing is of particular importance and relevance.
The manual resistive test is also used as a means of evaluating structural abnormalities in the muscle/tendon unit. This use of the manual resistive popularized primarily by orthopedic evaluation concepts proposed by James Cyriax.2 This article examines the MRT as both an indicator of neurological dysfunction as well as structural damage in the muscle.
The MRT as an evaluator of structural damage
Perhaps the greatest contribution of Cyriax's system of orthopedic evaluation is the concept of selective tissue tension. In this approach, he suggested that pathologies in certain tissues could be identified by selectively applying stress (usually tensile stress) to those tissues. For example, if there were structural damage to a muscle tendon unit (muscle strain), then tensile stress from a manual resistive test applied to that tissue would reproduce that pain.
A manual resistive test may also produce pain when there is structural damage to tendon fibers. In common tendinosis (most frequently referred to as tendinitis), the tendon becomes painful and dysfunctional due to collagen breakdown within the tendon. Tensile loads on the tendon during an isometric muscle contraction will reproduce pain in this situation. A similar situation exists with tenosynovitis when there is an irritation or inflammation between a tendon and its surrounding synovial sheath. When tensile loads are placed on the tendon with a manual resistive test, the characteristic pain the individual has been feeling will likely be reproduced.
Depending on the severity of the structural damage, pain with a MRT may be anywhere from mild to severe. It is not imperative to have a maximum contraction in order to test for structural damage in the muscle/tendon unit. A moderate degree of contraction will be sufficient to achieve the desired result.
The MRT as an evaluator of neuromuscular dysfunction
The use of the MRT to evaluate neuromuscular activity dates back to the early decades of the 20th century and is generally credited to Wilhelmine Wright, a clinician working with several orthopedic surgeons prior to the emergence of the physical therapy profession.3 Her work was particularly helpful in understanding and evaluating neuromuscular dysfunction as health professionals were grappling with how to treat polio. While this system has been enhanced and refined since that time, the basic principles of muscle evaluation still remain.
Muscular atrophy and weakness are the result of neurological pathology. That pathology could be a neuromuscular disease such as multiple sclerosis or it could be a mechanical impairment of neural function such as the many nerve compression pathologies. Regardless of the cause, if there is impairment of neural signal transmission, one of the likely effects is muscle weakness. This weakness can be evaluated with an MRT.
Keep in mind that when using an MRT for evaluating neurological function, you are looking for the strength of the contraction. In the MRT that is used for structural damage of the muscle, you are mostly looking for a reproduction of pain. In evaluating muscle weakness due to neurological deficit, there is a commonly-used grading scale that goes from 0 to 5. This grading scale is described as:
1 trace activity
0 no activity
However, more commonly a greater degree of variation and description for the different grades is included and the scale can be expanded as the one below.4
5 normal, complete range of motion against gravity with maximal resistance
4 good, complete range of motion against gravity with some (moderate) resistance
3+ fair+, complete range of motion against gravity with minimal resistance
3 fair, complete range of motion against gravity
3- fair-, some but not complete range of motion against gravity
2+ poor+, initiates motion against gravity
2 poor, complete range of motion with gravity eliminated
2- poor-, initiates motion if gravity is eliminated
1 trace, evidence of slight contractility but no joint motion
0 zero, no contraction palpated
The MRT is a very important clinical evaluation procedure for the massage practitioner. It is also essential to understand what kind of information will be derived from performing this test, and how the results of this procedure blend in with other assessment methods.
General Guidelines for performing the MRT
You must first decide which muscle (or muscles) you want to evaluate. Keep in mind that it may be difficult to isolate one single muscle, because most actions in the body are performed by multiple muscles. Once you have determined what muscle action you are trying to test, determine a position that isolates that motion most effectively. An important guideline is not to allow a joint between the hand that is offering resistance and the attachment site of the muscle you are evaluating.
For example, if you are evaluating abduction of the shoulder, place the hand offering resistance on the distal humerus (above the elbow). If resistance is placed on the distal upper extremity (near the wrist) the elbow is between the resistance point (wrist) and the attachment site of the shoulder abductors on the humerus (near the shoulder joint). In this case you will be recruiting the wrist extensor muscles and other compensating muscles around the elbow.
The goal is to have the client use the target muscle or muscles, but not compensate with other muscles. Here is an effective method to reduce additional muscular compensation and make sure that the client is not over-exerting him/herself. Simply place the limb in the ideal test position and then say "hold this here and don't let me move it." As you (the practitioner) initiate the opposite action from the one you are trying to evaluate, the client will attempt to hold the limb still and thereby engage the target muscle. The advantage of this method is that it is the practitioner who determines how much muscular effort the client must resist.
When evaluating for structural damage, the muscle is usually placed in a neutral (not shortened or lengthened) position prior to the engagement of resistance. This is done to decrease the likelihood that any other inert tissues will be stressed and cause pain during the contraction. Therefore, any pain that is produced during the contraction can likely be attributed to the target muscle/tendon unit that is being engaged. It is not necessary to have a maximal contraction, so having the practitioner determine the amount of effort being used is particularly helpful with this procedure.
When testing for neurological dysfunction, the starting position is different. The muscle is usually put at some form of mechanical disadvantage, such as a shortened position for a one-joint muscle. If you are testing a two-joint or multi-articulate muscle, the starting position will be somewhere near mid-range. This starting position is necessary with a multi-articulate muscle because active insufficiency will prevent the contraction from being strong if you start at the fully shortened position even if there is no dysfunction. Remember that when evaluating for structural damage, you are looking for pain reproduction; when evaluating for neurological dysfunction, you are looking for muscle weakness. Incorporating these quick and simple evaluation procedures into your session can greatly enhance you effectiveness and clinical success.