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Is It Time for a Popeye Moment? The Flaw in Recommending Chiropractic as a Career.
Step by Step: Long-Term Treatment of Soft-Tissue Injuries Combines Skill and Care
Treating soft-tissue injuries with long-lasting results starts the moment an individual enters the office. When it comes to pain, the only thing that matters to the patient is relief.
Chronic heightened emotional states create a perfect breeding ground for illness. Through my practice I noted the increasingly obvious relationship between one's mental focus on negative thinking, emotions, resistance to experiencing feelings and disease.
Five Element Acupuncture Can Enhance Your Practice
For eight years I have been teaching and supervising TCM students at an acupuncture college in Colorado, in Five Element acupuncture.
Treating Chronic Depression with Acupressure
In Traditional Chinese Medicine there already exists a comprehensive theory linking the body and mind.
The Acupuncture Now Foundation: What Our Profession Needs
Although acupuncture is growing in popularity it continues to be underutilized due to misunderstandings about its true potential. Only a fraction of those who could be helped by acupuncture know enough to seek it out.
Are You Ready for the 2016 Patient?
In October, Apple released its iOS 8 operating system for the iPhone and iPad. The new system includes Health, a new app that will interface with an ever-growing number of other apps.
Peer Points: Promoting TCM Knowledge
When Elaine Wolf Komarow, LAc, received her first acupuncture treatment in 1989, she said it changed her life. "I felt more aware, calmer, and happier. I was so fascinated by the changes that I began to learn everything I could about the underlying philosophy of Chinese medicine," said Komarow.
It Pays to be a Foodie
If there is an inner foodie in you, just waiting to burst out—this article is for you! Do you want to know how I know? I'm that girl. My middle name might as well be "Foodie." I love food! And if my patients are any indication, many of them do as well.
Foundation for Chiropractic Progress Announces First Group Member
The Michigan Association of Chiropractors has joined the Foundation for Chiropractic Progress as its first group member.
Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
Avoiding "Just a Pop Doc" Syndrome
Yes, it's harsh. Patients don't like to admit it. They have an unspoken plan when they first visit you: to come one time, get rid of their pain and then get rid of you. They know it's unrealistic, but they'd like to pay nothing for this service.
News in Brief
Life to Open Branch Campus in Italy; Northwestern Research Arm Benefits From Big Donation.
Capturing the Essence of Tai Chi
Over the last 12 years, I have been working on one of the few documentaries about Tai Chi. It's called The Professor: Tai Chi's Journey West and it's about Cheng Man-Ching who moved to New York in the 1960s.
Acupuncture Detox as Part of Drug Rehabilitation
In the U.S., more than 2,000 alcohol and drug rehabilitation programs have added ear acupuncture to their practice. The development of the protocol was determined by Lincoln Hospital as it delivered 100 acupuncture treatments daily.
Chinese Medicine: The Natural Way to Children's Wellness
As a child, I did not like going to the doctor. For the most part, when I had to go I wasn't feeling good to begin with, and I was heading into a sterile environment to be awkwardly probed by a man in a white coat for a very short, impersonal period of time.
Inspire Your Patients to Make Healthy Choices
Have you tried to get your patients to change their eating habits or their diet and couldn't get them to succeed? Were they confused and unsure of what the right thing was to eat? You are not alone!
Why Drugs and Supplements Can't Cure Disease
Chronic diseases are the outcome of disease-promoting, goal-oriented behaviors. So, the notion that diseases can be cured with drugs or supplements should be abandoned. Hypertension is the best example of this.
Home Safety: Help Families Avoid Common Injury Hazards at Home
These days, many parents childproof their homes before a baby is even mobile. You will see an array of electrical outlet covers, bumpers on the corners of the coffee table and safety latches on the cupboards.
Following the Thinking of the Classics
I have heard about the "best time of day" to carry out certain examinations or therapies. For example, I remember making a note years ago that early morning is the best time to take someone's pulses.
Solving the Pain Puzzle
Legendary former New York Yankees baseball player Yogi Berra once said, "You can observe a lot just by watching." He would have been a great chiropractor. We are trained to become experts with our hands: palpation, adjusting, soft-tissue release, etc.
The Death of the Travel Card
As long as I have been in practice, the travel card has stood as the primary style of documentation for chiropractic. It is quick, simple and direct. Unfortunately, the rules have changed.
Treating Acute and Chronic Neck Pain With Ischemic Compression and Exercise
There are many reasons not to manipulate the neck with cavitation: the patient is too old, their neck is too tight, etc. But the most common reason is that plenty of patients are afraid of "the crack," mostly because of the bad publicity about that procedure.
Micro-Needle Dermal Roller Use in the Treatment Room
Recently micro-needle dermal rollers have been getting a lot of media attention. As a practitioner who specializes in acupuncture facial rejuvenation, I know that skin needling with a dermal roller (also known as collagen induction therapy), promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter.
Are You Ignoring the 10,000-Hour Rule?
Having trained interns and mentored new practitioners, it has been my observation that their No. 1 clinical concern is adjusting skills. Their second clinical concern is their ability to read X-rays. Physical diagnostic skills are a distant third.
The Power of Mu Xiang to Treat Irritable Bowel Disease
Bloating and gas pain is something that everyone has had to deal with at one point or another; however, that's usually reserved for holiday dinners and other large gatherings.
Introduce Your Patients to Collagen Induction Therapy
Cutaneous (skin) aging generally occurs from either intrinsic or extrinsic processes. Intrinsic aging results from natural skin tissue damage and degeneration.
Implications of Section 2706: The Non-Discrimination Provision Survey
In late April 2014, NCCAOM diplomates received an email survey with the subject line: "End discrimination against acupuncturists" polling CAM practitioners for a Request for Information from the Department of Health and Human Services, released in mid-March.
Make Low-Level Laser Therapy Part of Your Evidence-Based Practice
Low-level laser therapy (LLLT), also referred to as photobiomodulation, has been increasingly utilized in the clinical setting over the past decade.
The Aspiration to Prevent Hip, Knee and Shoulder Replacements
In 1983, my right hip was fractured in a head on automobile accident with a drunk driver. The hip joint was so severely shattered that the acetabulum appeared as potato chips in the x-ray. The tibial plateau and ankle were fractured as well. The very good news was that I was only 30 years old and, after a month in traction and through the assistance of skilled soft tissue practitioners, chiropractic care and exceptional yoga teachers, I was able to rehabilitate to functional capacity over the next year.1 The other good news is I was very lucky. The car burned completely within 3 minutes. An unidentified motorist saved both my step-son and myself.
Soon thereafter, clients with varying degrees of hip degeneration started showing up at my office. I have been able to assist many, yet the first theme of this article is the most important: we all need to become part of our clients' early detection team. This article will also propose some innovative relationships between the hip, knee and shoulder joints. I pray they will intrigue and pique your interest and motivate you to further explore them. These are anatomical interpretations that can positively influence your clients' range of function and their quality of life. Satisfied customers are how you grow your practice and prosper.
As massage therapists and frontline health care providers, we have an opportunity to incite curiosity and realistic hope into our nation's aging population. The progressions of hip, knee and shoulder degeneration are encroaching upon the quality of life of so many that the general public is beginning to reach out to our profession to assist them. No one wants the painful and life-disrupting experience of intrusive surgery and recovery; yet, many will still endure them in large measure because early detection and competent preventative care has been missing.
Certainly, many clients come to us with pain and reduced range of motion associated with these joints. According to the physician who reviewed this article, his clinical experience suggests that his patients present with the early signs of these degenerations as young as their early 40‘s.2 The important question is whether each of us has the skill sets to screen for early indicators that these joints may be progressing toward degeneration. The following are my time tested screenings for the shoulder, hip and knee. Other tests certainly do exist.
For the shoulder, with the client seated, passively move the arm and shoulder into abduction guiding their arm over their head, feeling for ease, or lack thereof, for the humeral head gliding under the acromial shelf. If the range feels restricted, tremors or locks out (abruptly stops), this may be an indication that a degenerative process has begun. Yes, we may do much to mobilize the shoulder, yet planting a seed that more formal orthopedic evaluation and a MRI review may be useful to your client is a really good idea with all significant joint problems.
For the hip, have the client lie on their side with their bottom leg and thigh extended. Place your foot on the table with your knee bent to 90 degrees and lift their top thigh and leg, balancing it on your thigh. Grasping just above the ankle, passively lift the leg into abduction, while palpating at the femoral trochanter and feeling for the range and quality of the movement through both of your hands as you guide the hip joint into internal rotation. Most commonly within my experience, if someone's hip joint has started down the path of degeneration, you will feel not just a restriction to motion, but rather an abrupt stop to the motion. This lack of internal rotation has been my most reliable indicator that degeneration is progressing, especially if my best efforts to mobilize the joint are minimally effective.
Evaluating knees is trickier because degeneration can create either an advancing immobility to flexing and extending normally or the joint can become destabilized to the point where a client suggests that it feels as if their knee is going to give out on them with increasing regularity. Again, our refrain needs to be encouragement to seek further medical evaluation.
Functioning as part of your clients' early detection team is a golden key to preserving their quality of life even if you typically see most of your clients only once. You touched them, you cared enough to express concern, trust that the seed was planted. This will serve us as a profession to do so.
Let's now explore the relationships between the hip, knee and shoulder. Based on my clinical experience and research, the foundation to understanding the hip joint is that "roll and spin" is what characterizes its ongoing capacity for proper function. This relates to the ability of the femoral head within the hip socket to spin during internal and external rotation as well as to roll forward and backward during the flexion and extension phases of the walking cycle.3
What I have deduced over many years is that when clients present with chronic somatic hip pain and restriction, the femoral head has slipped posterior and has begun to ride the edge of of the hip socket. Of course, over time, the related soft tissues, especially the gluteus medius and minimus, the iliopsoas, the tensor fascia lata and its iliotibial band all shorten to protect and stabilize the femoral head as do other pelvic soft tissue structures.
The net effect is that hip range of motion is reduced and altered from its normal tracking. I hypothesize that the hip's blood supply is reduced both due to the shift of the femoral head and as a result of protective spasm of the relevant soft tissues. To fully comprehend the essential anatomical nature of the femur, it is important to recognize that there is a tri-angular relationship between the proximal femoral head, its lateral projection - the trochanter - and its distal femoral condyles. These distal condyles interface with the depressions of the tibial plateau to form the knee joint.
A factor that I believe has been overlooked is that even a small chronic rotation and posterior shift of the femoral head and trochanter may be communicated down the shaft of the femur in such a way that the "tracking" of the knee between the femoral condyles and the depressions of the tibia are influenced. You may observe this twist by noticing the relative position of the patella usually lateral to center, or with your client prone, noticing the angle of the posterior knee crease as more diagonal than horizontal. Sometimes, the twist into the knee is so obvious that the lower leg, ankle and foot are externally rotated relative to the knee joint by 25 degrees or more.
So to be clear, I am proposing that often in the progression of hip degeneration a posterior shift of the femoral head occurs and that the femur as a whole becomes fixed in a slightly rotated position, thereby communicating this torque into the functional articulations of the femoral condyles, altering proper knee tracking and support function.
The progression of degeneration is proposed to loop between both ends of the femur. Which joint degenerates more quickly is influenced by many variables, yet the number of knee replacement surgeries is approximately double that of the number of hip replacements.4 Might these relationships be a factor in chronic low back dysfunction and pain? In my clinical experience, the answer is a resounding "Yes."5
Very early in my career, one of my instructors stated that knee problems usually begin as hip troubles, yet did not describe "how."6 From experiences with tens of thousands of clients, I now believe a posterior shift of the femoral head coupled with this angular relationship between the two ends of the femur is at least part of the answer. Further, with the associated tracking relationship of the knee being strained, I theorize that the increased friction between the opposing joint surfaces contributes to knee degeneration over years of misaligned compression.
I further propose that the degeneration of the hip, knee and shoulder may have an evolutionary linkage. My conjecture is that their inherent weaknesses come to us as an evolutionary pre-disposition from our time as primates living in trees. A fall from a height all too often led to an immediate or eventually related death. Those dead primates' genes were not passed on. As a result, I propose that nature selected for a more flexible anterior shoulder capsule and a more distensible posterior hip capsule to assist the capacity to "tuck and roll" during a sudden fall.
Take a moment to consider: Aren't all falls sudden? Remember for yourself a time when you had a sudden, unexpected fall. Did you not endeavor to twist while going down? One may not have been successful, but the automatic response to do so was there. It is a good thing we have these reflexes to assist us.
Typically, after a fall or significant impact, these reflexes lock into the nervous system shortening one entire side of the body. Thomas Hanna referred to this as a Lateral Trauma Reflex. Might such an ipsilateral shortening be a variable that could contribute to the degeneration of the joints being discussed? Over 25 years of my clinical experience with clients supports this assertion.7
Additionally, it is an osteopathic construct that the fascial elements from the latissimus dorsi's attachment to the humerus relate downward throughout the torso via the sacroiliac joints, blending into the lateral hamstrings, then descending further along the peroneal muscle group to the lateral ankle and foot.8 This one construct gives us a fascial linkage between the joints that need to be most commonly replaced. I don't think that is a coincidence, do you?
Most importantly, as massage therapists, it suggests that we may be able to provide preventative assistance if clients come to us earlier in the progression of their joint degenerations. For those of us in our profession who feel the call to learn more of how to assist clients with these progressions of degeneration, this is the time. Those who are aging and desire to be active throughout the span of their lives need you. This is a call to action, our nation needs you.
My next article will explore the more intrinsic relationships of anatomy and physiology that I have clinically correlated to be contributing variables to the progression of degeneration within these joints. Reflect for a moment, our quality of life really does depend upon the normal functioning of our hips, knees and shoulders.