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Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
A New Human Organ, the Mesentery Reclassified: What This Means for You
Anatomist Jean Francois Fernel, who invented the word physiology, wrote in 1542: "Anatomy is to physiology as geography is to history; it describes the theatre of events." What is the mesentery? "It's a double fold of peritoneum — the lining of the abdominal cavity — that attaches our intestine to the wall of our abdomen, and keeps everything locked in place." It keeps the small and large bowel from falling into the pelvic floor.2, 3 For over 100 years the mesentery was thought to be made up of fragmented, separate connective tissue elements; but, recent groundbreaking research has shown that it is actually one, continuous organ.
This important discovery is credited to J Calvin Coffey, a researcher from the University Hospital Limerick in Ireland. The evidence for the organ's reclassification was published in The Lancet Gastroenterology & Hepatology.2, 4 This update in anatomical understanding is truly significant because the revelation that the mesentery is one continuous organ implies that the small and large bowel, the rectal region, even the pelvic floor are suspended from the lumbar spine.4
Consider the compression to the lumbar vertebrae when these tubular organs approximating in combination, 28 feet, shorten and narrow and may even twist in response to stress, trauma, bacterial, viral, or parasite influences. This is what I proposed in a previous article "Sacs and Tubes Theory of Stress."5 Now consider the congestion of venous blood and lymph that inevitably ensues when internal structures contract or spasm. Congestion adds weight to this suspension from the lumbar spine, which adds even more compression to the lumbar discs. No wonder that low back dysfunction is the number one reason for missed days at work in our country.
My clinical experience suggests that the far reaching connections of the mesentery is a central player in the frequency of these lost days of productivity. Also, to my perception, what is under-appreciated is that until old blood moves out, new blood filled with oxygen, nutrients, and hormones is reduced in its capacity to feed and heal the tissues and cells that desperately need a fresh supply of resources.
Contraction or spasm of the mesentery promotes varying degrees of ischemia both within the organs and the soft tissues associated with the extensor myofascial structures that brace in response to the forward and downward strain placed upon the anterior lumbar spine. Might this compression and congestion figure into chronic sciatic syndromes and spinal stenosis at L4-5-S1?
What This Means for You
The Lancet article doesn't refer to these structural and functional implications because this is not how medical thinking is focused and prioritized. However, as manual therapy practitioners, I believe it is crucial that ours does. All of us would truly like to understand the origins of our client's dysfunctions and pain. This anatomical update points us in a direction that I invite all teachers in our collective profession(s) to explore and disseminate to participants in their courses.
Coffey and O'Leary's article does not articulate the attachments of the mesentery's root as precisely as the Wikipedia reference (updated February 6, 2017), or as "Gray's Anatomy" has historically described, so I am cautious in stating these elements as facts. Wikipedia did note that "Gray's Anatomy" was being updated in light of this anatomical reclassification. Previously in Gray's and still currently in Wikipedia's, the attachments of the mesenteric root are described to span from the left transverse process of L2 down to the right sacroiliac joint and/or to the ileocecal valve.3, 6, 7
This is a diagonal line from the body's upper lumbar left side to the right side of the pelvic floor. Compress this diagonal in the center of the human bilateral structure and a torque or twisting of the ilia or hip bones will result. Some call this pelvic obliquity, or torsion, and relate it to a long leg on one side and a short leg on the other.
I concluded 25 years ago that this commonly observed torsion was the result of the mesenteric root's attachments and a shortening of the mesentery as a whole. The updated acceptance of the mesentery as a contiguous organ merely confirms what was once intuitive anatomical interpretation. In my clinical experience the implications for viewing the mesentery as the central linkage between the abdomen and the pelvis reach much farther than simply its relationship to the low back.
Any contraction or spasm of the gut tube pulls down upon the moorings of the viscera's suspensory ligaments extending up through the thoracic cavity to both the anterior cervical spine and from the cranium itself.8, 9 This new conception of the mesentery clearly supports a core ingredient of "The Body's Core Line and Central Linkage" and "A New Model for Low Back Dysfunction & Pain" that I published previously and have been teaching for the past few years.
It also has a primary relevance to my more recent published series, "The Aspiration to Prevent Hip, Knee, and Shoulder Replacements." All credit is given to Dr. Jean-Pierre Barral DO, the developer of Visceral Manipulation, for his introduction to the importance of the mesentery and the techniques he taught to normalize its tensions. The potential possibilities of this new discovery go beyond what I can distill within a single article. Others surely will follow.
Congratulations to Coffey and his team of researchers for bringing to light what many of us in the manual therapy field had intuited — that the mesentery is an integral whole, which links many of the organs within the abdomen and pelvis. Also, in my clinical experience the mesentery influences the posture and function of our entire human structure especially as it relates to chronic somatic dysfunction and pain.