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Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
The Aspiration to Prevent Hip, Knee and Shoulder Replacements, Part 2
The extrinsic variables that contribute to hip, knee and shoulder degeneration were outlined in my last column in the November 2014 issue. That article proposed that the hip and shoulder joints have a genetic propensity for subluxations. In the shoulder, this involves its anterior capsule, while for the hip joint this relates to its posterior capsule.
My theory suggests that this propensity comes to us from our primate evolution when our ancestors needed to develop ways to fall (as from trees) and somehow survive. For any who may have experienced a significant fall, our human tendency is to tuck and roll involving a sudden movement forward of one shoulder and a corresponding posterior movement of the opposite sided hip. Another way to appreciate this large body reflex is to reflect on the Olympian springboard and platform divers with their truly awesome ability to harness this capacity for combinations of flips, spins, tucks and rolls.
The second article of this series describes our internal anatomical structures whose cringing, shortening or twisting are proposed to be primary contributors for progressing toward hip subluxations.1,2,3 I theorize that hip subluxation and its accompanying typical soft tissue compensations are principal variables leading to many knee and hip replacement surgeries which are often attributed to the nebulous cause of aging.
To my perception, the primary factor in this all too common degenerative progression is how the femoral head interfaces with its socket, the acetabulum. Specifically, how shifts in each hip bone or, between both and the sacrum, may participate in pre-disposing hip subluxation(s) of the femoral head. Internal influences related to shoulder subluxations and further relationships influencing the knee joint will be addressed in separate articles.
My clinical experiences suggest that the cringing of the peritoneal sac, the shortening of the mesenteric root of the small intestine and the shortening of the tubes that comprise the ascending and the descending colons, are commonly associated with the local influences within the abdominopelvic cavity which can act on the lower spine and pelvis thus pre-disposing the posterior slide of the femoral head.4,5
Specifically, the ascending and descending colons have firm visceral ligamental attachments to the ilia and are incredibly powerful muscles very capable of distorting the acetabulum/femoral relationship. Additionally, the mesenteric root of the small intestine has the capacity to rotate the pelvis by virtue of its attachments to the left side of L2 and to the right sacro-iliac joint.6 Both of these structures are invested within folds of the peritoneal sac whose cringing response to stress or trauma initiates and exaggerates the responses of those previously described.1 Other organ attachments certainly co-participate as variables; yet, working with these three viscera have produced the most favorable outcomes for clients.
Consider the following: should the peritoneal sac, small intestine or large intestine structures contract significantly in response to a virulent digestive flu, food poisoning, extended constipation, infection or amebic dysentery then... "Katie bar the door, "... the relationship between the acetabulum and the proximal femur is rather likely to be affected. Little considered is the possible displacement of the acetabulum/femoral head relationship associated with these small and large bowel episodes. Sometimes everything settles back into dynamic balance yet, many times I propose, it does not.
Additionally, consider the mesenteric root of the small intestine experiencing a similar sequence of events: such a oblique/diagonal contraction between its left side lumbar attachments and its attachment to the right sacro-iliac joint may well induce a torque to the pelvis thus creating the pre-disposition of the femoral head to displace posteriorly, at least on one side.
Let's now consider the typical soft tissue compensations I have clinically experienced. When the femoral head slips posterior, I propose it begins to ride the edge of the acetabulum, thus creating a hip joint instability. The most common compensation pattern involves the gluteus medius and minimus muscles, the tensor fascia lata and its iliotibial band all contracting around the femoral head to prevent its possible dislocation. Ironically, this still allows relatively normal function and range of motion; yet, I propose that this fixes the femoral head against the lip of the acetabulum which over many years grooves a flat spot on the naturally spherical shape of the bone.
Further, I propose that any posterior glide is also accompanied by rotation of the femoral head which translates itself all the way down to its distal condyles creating rotation in the knee joint and contributing to the distortion of how the knee tracks in its normal flexion and extension movement during the walking cycle. Over time, this distortion of knee joint mechanics translates into compression, thus accelerating the wear and tear of its cartilages. It is no accident that roughly twice as many knee replacements occur than hip replacements during each calendar year.7 This is my proposed answer to how hip distortions influences knee degeneration.
Certainly, the iliopsoas is also a significant variable; yet, I suggest not in the manner you might imagine. More commonly, I believe that the psoas is often in spasm because of the posterior and inferior slide of the femoral head rather than the other way around. Its attachment to the lessor trochanter is being stretched by the posterior position of the femoral head. Also, the typical soft tissue compensations (the fixation of the gluteus medius and minimus, tensor fascial lata and the iliotibial band to prevent further displacement) create more inertia for the psoas contraction to overcome while initiating flexion of the femur in relationship to the trunk.
These protective contractions also disrupt the psoas' external rotation function that is essential to coordinating with the distal femoral condyles that participate in unlocking the knee and allowing it to functionally participate in a normal gait pattern.8 This extra effort to overcome the soft tissue protection of the hip joint over time influences the adductors to shorten in order to counterbalance the power of the femur's external rotation by the iliopsoas. This triangular protective shortening of the soft tissues involved in hip motion is part of the reason that clients with hip degeneration so often present with groin pain. With such a wide-ranging compensation pattern the femoral triangle is bound to be affected and vascular congestion will eventually ensue.
Further, it is my interpretation of anatomy that when the psoas tendon is constantly on stretch, its tension contributes to occluding the medial circumflex artery which effectively starves the femoral head. Avascular necrosis is a common diagnosis leading to hip replacements.9,10
The big picture of life is that our bodies consistently trade off "mobility for stability" during the aging process, as well in response to physical traumas of all varieties and intensities. In my view, this construct leads us back to the invisibility of flexor/extensor reflex systems that are a part of the evolutionary momentum which produced more distensibility in the anterior shoulder joint and the same in the posterior hip joint. These were all designed to prevent falling, surviving a significant accident and to prevent one's pre-mature death.
Sadly, the echo of these survival mechanisms has left us a Gordian Knot to unravel in our efforts to assist our clients in maintaining their quality of life.
In truth, my successes with undoing the progression of hip and knee degeneration is much less than I would prefer to report. However, what I have learned from my clients, I do believe can contribute to a foundation for us as a profession to build a commonly accepted model of how this progression occurs and what we might do to stabilize its downward spiral. And, if identified in its early stages, the progression may even be reversed. This understanding also points us as dedicated professionals toward building additional skill sets to address these human difficulties.