resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Recliner Test
"Hi, Bill, how are you?" "Oh, I'm OK, Doc. I've got pain down the leg again, so I thought I would stop by and get you to check it."
News in Brief
In Remembrance: A Moment of Silence for Dr. Dick Versendaal; NYCC Named Chiropractic College of the Year by ACA; National University Partners With Indiana VA Facility.
Enhancing TCM with Enzymes
Herbal formulations are an integral component for most Traditional Chinese Medicine (TCM) practitioners. One of the best ways to enhance their effectiveness is the addition of plant-based enzymes.
Are You Driving Patients Toward Dependence on Big Pharma?
Over the years I have had the opportunity to talk to doctors of chiropractic about health promotion, wellness and preventive care in chiropractic practice.
Alternatives to the Rainy Day Fund: Better Things to Do With Your Money
Google "rainy day fund" and you'll find the predominant and traditional advice given today is that you need to have three months of living expenses saved for an emergency. Some even recommend six months or more.
Chinese Herbs Debut at the Cleveland Clinic
Chinese herbal medicine is now being prescribed at the Cleveland Clinic thanks to a trailblazing team of people.
Making Sense of Chronic Inflammation
Inflammation is big business, evidenced by not only the laundry lists of medications patients bring me aimed at managing inflammation, but also the never-ending stream of advertisements for anti-inflammatory supplements that constantly find their way to my desk.
Revisiting the Neurological Exam
In spinal trauma or disease, the neurological exam chiefly aims to determine whether one (or more) of three basic neurological conditions is present: myelopathy, radiculopathy and peripheral nerve disorder.
Dry Needling is Acupuncture: Anatomy of a Legal Victory in Oregon
On January 23, 2014, the Oregon Court of Appeals overturned the Oregon Board of Chiropractic Examiners "dry needling" administrative rule, which allowed chiropractic physicians to perform acupuncture after only 24 hours of training.
Environmental Toxins: Cause of Modern Illness (Part I)
Environmental toxins have created burdens on the human body that put demands beyond our evolutionary development. Modern diseases that historically did not exist to any great degree have been rising sharply in the last 40 years.
Dietary Supplement Research: Contradictions, Bias, Misinterpretation and Confusion
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
We Get Letters & E-Mail
Shouldn't the Pentagon Know More About Chiropractic Care? Office Flow: Have You Reviewed the Patient Experience Lately? Let's Stop Confusing the Public About Chiropractic; Cutting Down the Cherry Tree.
Colorado to Have the First Acupuncture Medical Reserve Corps in the U.S.
In the summer of 2012, Colorado was on fire. Literally. Many acupuncturists from around the state, especially those who had received disaster response training through AWB, wanted to help those affected by the fires as well as the first responders and tireless state and local officials, with the healing and stress-relief of acupuncture.
Evaluating Prenatal and Pediatric Automobile Injuries
Often in a family practice, one of your patients or an entire family is in an automobile accident and you are sought out to provide care for their soft-tissue injuries.
AAAOM: Facing An Ultimatum
On the heels of the growing discontent with leaders of the AAAOM, the Council of State Associations (CSA) recently took it upon themselves to present the organization with an ultimatum: for all board members to resign from the board and turn the organization over to the CSA or they will proceed on their own to become the primary representative of the AOM profession.
How Much is Enough?
One of the primary arguments used against acupuncture care is the overuse of treatment. Some people say, "once you go, you have to go forever."
Arch Height and Running Shoes: The Best Advice to Give Patients
Because runners with different arch heights are prone to different injuries, running shoe manufacturers have developed motion-control, stability and cushion running shoes for low-, neutral- and high-arched runners, respectively.
Chiropractic Management of Sports-Related Tendinopathy
Tendinopathy is increasing in prevalence and accounts for a substantial percentage of sports injuries. Despite the magnitude of the disorder, research on chiropractic treatment is limited.
Through the Eyes of a Child
Once upon a time there was a girl name Lucy. Lucy had cancer, but she had a heart filled with love and compassion. Please come along to hear this story of an amazing child, her tenacity and her dream to help other children.
Anti-Aging: Educating Your Patients About The Skin
We know that cosmetic acupuncture works but what then? Education is a key part to the practice of Chinese medicine and when you practice cosmetic acupuncture, facial rejuvenation, etc., it is time talk about skin with your patients.
Your Chance to Go Back to High School
As the father of a student who recently entered high-school sports (soccer), I have come to recognize an untapped opportunity for the chiropractic profession.
San Zhen Protocols Part II: Case Studies
In my last article, I presented a collection of three-point acupuncture combinations which can provide effective clinical results.
Socializing In My Slippers
When I graduated college, I had grandiose dreams of becoming an amazing acupuncturist. I wanted to build a great practice and make a good living. For four years, 13 semesters to be exact, I had a spreadsheet.
The Right Idea at the Right Time
On Feb. 28, 2014, Virginia Governor Terry McAuliffe appointed David Brown, DC, as new director of the Virginia Department of Health Professions.
Shoulder Strategies: Reduce Pain, Improve Function With Proper Taping
Shoulder pain / dysfunction is a common problem for chiropractic patients. Clinicians who utilize elastic therapeutic taping as part of their treatment approach know it can be effective for a variety of shoulder problems.
The "Sacs and Tubes Theory of Stress"
In 1996, while considering the treatment principles I had accumulated from many advanced trainings throughout my clinical career and the results they had produced for my clients, a deeply intuitive experience of anatomical understanding inspired me to conceive of the human body as composed of mostly sacs and tubes:
Integrating this personal epiphany with an understanding of Han Selye's General Adaptive Syndrome, my clinical thesis became clear: in response to "stress," the sacs around organs "cringe," while the tubes within them and between them "shorten and narrow and often twist." The intensity, duration and repetition of the stressor(s) are all relevant variables which may be reflected in the "degree" of these internal responses.1,2
As most body tubes are comprised of longitudinal and circular fibers, this notion of shortening and narrowing was not such a big theoretical leap.3 The notion of the "cringing of the sacs" was initially a "felt sense" of my own body's responses to positive as well as negative anticipation. Yet, supporting anecdotal evidence emerged recently when a client who had been a biology teacher for 35 years reminded me that during dissections of live frogs, the frog's heart would swell to twice its size when the pericardial sac was retracted.4
What are some of the possible effects of this proposed cringing, narrowing and shortening? To my perception, this clinical insight provides a credible explanation for the downward and forward pull of the head upon the neck, so often referred to in our profession's literature as forward head position. Let's take a look inside the body to appreciate just how many structures, especially viscera, are suspended from the anterior portion of the axial skeleton and have specific, palpable soft tissue linkages back to the cervical spine.
My understanding of the following anatomical references are based on seven years of study with Dr. Jean Pierre Barral DO, developer of the Visceral Manipulation approach to bodywork. I do wish to again gratefully acknowledge his dedication to articulating precise anatomical landmarks from his work with cadaver dissections and his ongoing exceptional teaching to the breadth of all professions that comprise the manual therapy field.5 His therapeutic ideas and anatomical assertions have been core to what has assisted me to help so many.
During embryological development, the heart and diaphragm muscle descend from C2 and remnant fibers to this origin remain throughout our lives. Less appreciated is that the heart and the diaphragm muscle are like siamese twins, conjoined at the inferior pericardium and central tendon of the diaphragm, meaning that one would have to cut them apart to separate them. The heart and lungs are suspended down and forward from the anterior surfaces of C4 - C6 by an overlapping system of suspensory visceral ligaments.
The liver is suspended down from the caudal surface of the diaphragm muscle via the coronary ligament which as noted above is related to C-2. In women, the uterus receives suspensory support from the contiguous relationship between the falciform ligament of the liver and the round ligament, which is composed of the obliterated umbilical arteries and veins.5 From C2 and from C4, 5 and 6 and all the way to the pelvic floor in women, any one of these relationships is symptomatically and therapeutically significant and when one considers that these viscera may become increasingly immobile and congested due to trauma or disease, they can become essentially "dead weight" pulling downward and forward on the cervical spine.
And, if this wasn't significant enough, my clinical work with clients suggested there was another anatomical linkage that can literally pull the "head down upon the neck" and that is the length and tension of the esophagus which is moored from the basilar portion of the occipital bone and then descends down and forward through the mediastinum and esophageal hiatus of the diaphragm becoming the stomach.6,7
The esophagus is a muscular tube composed of circular and longitudinal fibers. Imagine its fibers shortening and narrowing. Given its superior mooring from the cranium might esophageal tensions relate to clients presenting with recurrent headache patterns, neck pain and upper back symptoms?
Just stop for a moment and remember the last time you were highly nervous or anxious. For many of us, this provokes tension within our stomachs. What hasn't been considered is that a contracted esophagus may communicate this tension all the way up to the base of our craniums.
How might these combined vectors of compression affect the delicate nerve fibers exiting the brain, especially the vagus nerves and the superior origins of the sympathetic chain ganglia? How might the jaw respond to such a downward and forward pull? How might such compression rippling down the length of the human spine contribute to how easily our bodies congest fluids?
I perceive all of these anatomical actors flow from one to the other influencing our bodies' strain patterns that are reflected in our clients' presenting chronic symptomatic profiles. Now, also please consider that the right crus of the diaphragm literally wraps around the esophagus. Netter's anatomy plate #253 clearly shows this. What is not so commonly appreciated is that this aspect of the right sided diaphragmatic crus is contiguous with the ligament of Treitz which superiorly adds support to the 20 -25 feet of the small intestine by hooking around the douodenal-jejunal flexure.8,5
Might cringing of the peritoneal sac, the shortening and narrowing of the small intestine and the tension of the longitudinal fibers within the esophagus itself in combination be related to the incomplete closure of the cardiac sphincter more commonly known gastroesophageal reflux disease or GERD?7
Next, consider the mesenteric root of the small intestine which is moored down, forward and diagonally from the left anterior face of L2 all the way to the right sacroiliac joint.9 Given the diagonal element of this anatomical relationship, might the compressive force of chronic stress be a co-conspirator in chronic low back dysfunction and pain and be related to torsional elements so often found when one assesses the osseous landmarks of the pelvis?
The connections of the mesenteric root includes the same douodenal-jejunal flexure noted earlier so we actually have a proposed anatomical routing of manipulable soft tissue from the sacrum to the cranium in both genders. Little wonder the head is pulled down and forward for so many of us in response to how our "innards" react to stress.
We need to additionally appreciate the role of the flexor-extensor reflex systems in chronic somatic dysfunction. The downward and forward pull of the above described anatomical relationships will eventually and inevitably activate their respective reflex systems constantly. These reflex systems are governed by subcortical elements of our nervous system and, as such, we do not register their activation consciously or proprioceptively until something within the kinetic chain of the axial skeleton becomes dysfunctional. Once this occurs, whatever the reason, it is the job of the soft tissues to protect the joint or joints in distress usually by contracting along a continuum until they spasm, which really gets the person's attention.10
It is my assertion that the described anatomical relationships and the constantly activated flexor-extensor reflex system when viewed as a dynamic whole are prime contributors to the progression of osteoarthritis and joint degeneration in both the axial and appendicular skeleton.
These relationships allow us a novel view of our internal architecture. They also allow us in particular to re-consider the means by which progressions of dysfunction toward pathology may proceed. Principle among these stealth physiological progressions that underlie many chronic somatic problems are cardiovascular disease, cervical stenosis and gall bladder dysfunction/disease.
Compression, congestion and coordination or, more precisely, dis-coordination are a simple way to conceive of the downward spiral in the quality of our lives as we age and, how such progressions are related to "chronic stress."
Stress provokes cringing, shortening, narrowing and twisting functionally, "inside of our bodies." The soft tissues of the body support whatever comes to be the new normal. We can get used to damn near anything as human beings. That's the good news and is testimony to our species' adaptive capacities. The bad news is that once we do adapt, our bodies reflexively resist a return toward normal function.
As massage therapists who have a desire to assist clients to resolve their chronic somatic dysfunctions, it is our task to learn how to relieve these intrinsic forces of compression and to facilitate the movement of bodily fluids to redistribute areas of stagnant congestion. We can learn to assist the nervous system to re-coordinate its nerve and blood supply to include all the body tissues again and assist it to re-coordinate the movement of our body parts. When these skill sets expand, wondrous possibilities for healing emerge. I have seen this thousands of times. It is an amazingly satisfying experience.