Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
I just got finished with a ...
resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
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.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
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.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
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.
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.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
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.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
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!
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.
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.
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.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
The Strain of Compression
In order to enhance the distribution of strain through the kinetic chain between the foot, ankle, leg, knee, thigh, hip joint and pelvis, imagine the lower extremities as circles and columns that are designed to load share the compression of standing and movements of all kinds. These are concepts that have aided my efforts to assist clients desiring to prevent hip, knee, and shoulder replacements or to improve the quality of their rehabilitation after surgery.
Jon Zahourek, the developer of the Maniken System of Anatomy in Clay, was my inspiration for the circles notion when Lansing Barrett Gresham and I attended a rive-day workshop with him in 1990. During that week, we used clay to form every muscle in the human body and then placed them on a 3 1/2 foot skeleton. It was an amazing experience. However, one might also visualize the lower extremities as composed of articulated column segments. Thousands of clients have been my hands-on teachers guiding me to the experience of how these concepts successfully work to enhance their lives.1,2
What are the proposed circles and columns that may more evenly distribute compression in the lower extremities? Visualize, if you will, the longitudinal and transverse arches of the foot. The space between and including the tibia and fibula. The angular shape of the femur bordered laterally by the iliotibial band and medially by the muscular band of the gracilis and encased in all the soft tissues of the thigh. The ovoid shape of the pelvis itself with the pubic symphysis and the two sacroiliac joints. And, even the circular shape of the acetabula.
Consider directing your hands-on efforts toward creating a more balanced suspension into the center of each circle or column, thus enhancing the load sharing capacity of the lower extremity upward through the kinetic chain from the feet to the pelvis. In my previous articles, I have described the more superior anatomical and physiological elements that may predispose a posterior slide in the femoral head. Of course, these inferior circular and columnar relationships may also influence hip joint deterioration, especially if trauma to any of these lower extremity joints and soft tissues has occurred.
Who among us hasn't sprained an ankle, twisted a knee, or landed rather unceremoniously on our duff, aka, ischial tuberosity, sacrum, or tail bone. And, if one has had a fracture of any of the bones that intersect with these joints, then the resulting compensations may still be skewing the load sharing. Creating expanded, more normalized, more integrated space is our intent to enhancing the function of this system of interrelated circles and columns:
The simple concept to highlight in your awareness is that such trauma injuries (as well as injuries due to repetitive misuse, etc.) may alter the symmetry and structural integrity of these circles and columns and lessen their ability to distribute strain and contribute to the tendency for the femoral head to slip posterior.
Our job is as bodyworkers and massage therapists is to restore the soft tissue balance and suspension of these geometric spatial relationships as best we can. This new perceptual orientation will enhance your ability to mobilize the joints within the feet, ankles, knees, thighs, hips and pelvis.
To aide you in your quest, the golden key is to recognize that by directing your efforts toward mobilizing each of these joints toward their normal range of motion, is the fastest and usually least painful avenue to restore the balance of each circle and column. And, as you facilitate these changes for your clients, visualizing and working from the inside-out is the more natural and effective approach.
To say this another way, realize that soft tissues serve the joints. It is nature's hierarchy. Much of any excessive tension around and between the joints is created because the joint surfaces become stuck in mid-range, prevented from completing their full range of motion and thus are structurally mis-aligned in their proper tracking relationships.3 Restoring appropriate tracking within these joints along with utilizing our additional skill sets for enhancing soft tissue suspension together is a more comprehensive approach for us to aspire toward.
Below, I describe some of the more crucial osseous and soft tissue relationships which are instrumental to the distribution of strain within these circles and columns. Many others are also important; yet, if you master these, your competence to assist your clients will leap forward, as will your income. Increasing your anatomical and physiological knowledge and the depth and breadth of your hands-on skill sets is your best marketing tool. What generates new clients faster than anything else is your clients speaking your name associated with a proclamation that they are feeling and functioning better after working with you!
In the feet, the navicular and cuboid bones counter-rotate in order to unlock the arches during the heel strike and foot flat phases of the walking cycle, thus allowing the foot to adapt to the irregular surfaces of the earth as was necessary before we began to wear shoes. Then they re-rotate to provide a rigid lever during push-off.3,4 Since the line of joints from the navicular to the cuboid is where the longitudinal and transverse arches intersect, this is a key concept to understanding foot function. Often, one or both bones will become stuck in the mid-range of their rotational motion.
In the ankle, the talus bone has no muscular attachments, so it is often vulnerable to displacement. Mobilizing it positionally in relationship to the mortice structure of the malleoli of the tibia and fibula is another important skill to develop. The talus bone frames much of the tarsal tunnel, the opening through which blood, nerve and lymph supply flow in and out of the foot. Mobilizing its position toward a more balanced perch above the calcaneus bone positively affects both proprioceptive stability and neurovascular supply.
Moving upward to the leg and knee, remember two important goals: mobilizing the proximal head of the fibula then diving into and opening the interosseous membrane between the tibia and fibula is the quick path to re-balancing the column of the leg.
Learning to guide the tibial plateau through a figure eight range of motion is an approach that often allows the femoral condyles to naturally reset in relationship to the concave surfaces of the tibial plateau. This change toward greater joint mobility can be a miracle to a client with a chronic knee misalignment. Similar to the foot bones, the knee must twist to open and then flex forward, initiating the walking cycle. Then it needs to twist back to its original position for there to be stability and power during the extension/push off phase of walking.3,4 Again, the femoral condyles in relationship to the tibial plateau often become stuck in the middle of their reciprocal counter-rotations.3
Within the thigh, developing an awareness of the lateral and medial intermuscular septa radiating and spiraling outward from the femur is a core anatomical understanding to creating space within this cylinder/circle. Make it a priority to learn to mobilize the range of motion within the hip joints. Visualize the femoral head moving within the acetabulum. Direct your efforts to increase the roll and spin of the femoral head within the socket itself.
In the pelvis, learning to mobilize the pubic symphysis and the sacroiliac joints are exceptionally useful skills along with learning how to release the attachments of the adductors whose fascia blends with that of the pelvic floor muscles. Finally, to complete this holistic view of the body, we come to the relationship between these circles and columns of the lower extremities and the shoulder girdle, which is so often functionally vulnerable to the distortions in this kinetic chain of support.
Allow me to begin with Dr. Richard MacDonald's articulation from osteopathic theory that there exists a contiguous fascial line from the latissimus attachment to the humeral bone through the fascia associated with the sacroiliac joints, then following the lateral hamstrings and peroneal muscle group downward all the way to the lateral ankle/foot. His stated inference was that distortions could begin from above, and refer downward or from below, and refer upward.5
One of Ida Rolf's most enduring quotes guides our understanding of this dynamic relationship, if the body is not supported from below then it will endeavor to hang from above.6 I believe that the physiological mechanism(s) related to the meaning and understanding of this assertion are principally mediated by the large body reflexes and the flexor/extensor reflex systems, as well as the effects of fascial suspension, vertebral segmental motion, and many other additional variables.
My theory is that the constant activation of these reflexes will invariably distort the smooth range of motion of the shoulder joints adding to the progression of arthritic changes and the deposition of calcium salts. Most clients coming to me considering shoulder joint replacements have complex histories all involving some degree of trauma which most likely initially activated these reflex systems.
As loss of support from below progresses over time, these reflexes begin to insidiously lock the scapulae against the rib cage, often creating some degree of frozen shoulder; while in others, the arms are unconsciously pulled medially against the side of the chest. Both of these actions will add external compression against the expansion of the thorax as a whole, thus also increasing resistance to heart and lung expansion. Then inevitably, the entire general physiology becomes strained without adequate supplies of nutrients, oxygen, and hormones that fresh blood delivers. The elegance of the human design is really all that connected and more.
Please do consider Jon Zahourek's notion of multiple circles and Glenn Gaffney's concept of multi-articulated columns as paradigms for how we may imagine creating a more balanced distribution of strain and load bearing along the kinetic chain of the lower extremities into the pelvis.
Please do consider that mobilizing opposing joints surfaces picks the protective lock of soft tissue spasms. And, yes, many will need a lot of "coaxing to more fully release." Many physiological therapeutic principles and techniques will be needed: fascial spreading and unzippering, muscle energy technique, trigger point therapy, reciprocal inhibition, cross fiber friction, indirect techniques such as strain-counterstrain or its English cousin orthobionomy, and many many others.