resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Challenging the Traditional Diagnosis of Carpal Tunnel Syndrome
In the light of clinical studies, and research available today, this article will take a close look at common forearm, wrist and hand problems that often seem to be diagnosed and treated incorrectly. This article is based on a true case study of a client from one of my seminars in Boston. This particular client had recently undergone surgery at both his wrist and elbow. Both surgical procedures were attempts to release the pressure on his median nerve, to treat carpal tunnel syndrome. Unfortunately, the actual nerve compression problem was actually in his neck and shoulder before the nerves ever branched off to become the median nerve at the elbow and wrist. Once we treated the tight muscle groups such as his SCMs, anterior and posterior scalenes, and his pectoralis minor, the numbness, tingling and parasthesia that surgery did not correct in his arm and hand went away.
The term multiple crush phenomenon refers to a condition when there is more than one compression on a nerve trunk. Sections of the nerve distal to the first site of compression become nutritionally deficient because of axoplasmic flow blockage. Consequently, these distal areas are more susceptible to irritation from even a minor degree of compression (i.e. becoming the second or third site of the crush).
If you look at a classic postural distortion pattern of someone talking on the phone, it is clear to see that poor work ergonomics can shorten muscle groups in the neck, shoulder, elbow, forearm, wrist and hand. (Figure 1 ) When muscles like the SCMs, anterior and posterior scalenes, and pectoralis minor shorten, the brachial plexus of nerves get compressed under the clavicle. (Figure 2)
This is often compounded with cervical nerve compression problems. So the nerves are compressed twice already. Then at the elbow, the median nerve runs through the bicipital apeneurosis, and again through the pronator teres. (Figure 3) If there is tension or damage to the bicipital apeneurosis or teres minor, the nerves are now compressed four times before they ever reach the carpal tunnel.
Therefore, when a client complains of clinical symptoms such as parasthesia, numbness, and pins and needle sensations in their hands, the manual therapist should look at all areas of nerve compression between the brain and the fingertips. In my opinion, the assessment should start in neck and shoulder, progress to the elbow, and then end at the wrist. This approach to treatment would address what Dr. Erik Dalton refers to as descending syndromes.
Based on the photo of the woman on the telephone, let's look at a simple road map. This assumes that posturology has addressed a true leg length discrepancy, and myoskeletal alignment techniques have facilitated alignment of the bones in the cervical spine.
Step 1. Release the tight SCMs, and anterior and posterior scalenes.
This should start with myofascial release, followed by treating active and latent muscle belly myofascial trigger points, and stretching those muscles that often pull the first rib up onto the clavicle to compress the brachial plexus of nerves. (Figure 4)
Step 2. Release the pectorals major and minor muscles.
After doing myofascial release to the pectorals major (Figure 5), treat trigger points in the pectorals minor (Figure 6), and stretch the pectoralis major and minor muscles. Make sure to treat a muscle strain in the pectorals minor, if found, and address capsular adhesions of the shoulder if there is a bone on bone like end feel when stretching the pecs.
Step 3. Release the biceps (taking tension of bicipital apeneurosis). (Figure 7) If there is a strain in the bicipital apeneurosis treat that after releasing the biceps muscle belly. The median nerve will be scarred down by scar tissue in the bicipital apeneurosis if that is strained.
Step 4. Release the pronator teres. (Figure 8)
Keep in mind the median nerve passes through this muscle. In people that work on the computer, this is a posturally short muscle that often gets neglected in clients diagnosed with carpal tunnel problems.
Step 5. Release the wrist and hand flexors. (Figure 9) There are nine tendons that pass from these muscles under the flexor retinacculum. Tension in the wrist flexors cause overdevelopment of their tendons, and can compress the median nerve under the tight flexor retinaculum leading to "true" carpal tunnel syndrome.
Step 6. Free up the flexor retinaculum, and release individual tendon adhesions in the carpal tunnel. Active myofascial release is done by having the client spread and extend the fingers to help release the flexor retinaculum and flexor tendons in the tunnel. (Figure 10)
This should be followed with the client stretching those same muscles as part of client self care. Ergonomics of the work station would also be addressed. This article will flow into a series of articles, starting with complicated forearm, wrist and hand conditions, to take a more detailed clinical look at conditions like "true carpal tunnel syndrome" and the significant difference between tendinitis, tendinosis and tenosynovitis conditions. The treatment by the manual therapist cannot get optimal results if we do not understand the different pathologies of these very different basic clinical conditions of the forearm, wrist and hand. Manual therapists will get their best results with complicated clinical conditions when they learn to match the appropriate modality or manual therapy discipline to each specific underlying pathology. Our industry also needs to also take a closer look at things like multiple crush phenomenon to eliminate multiple causes of conditions such as carpal tunnel syndrome.
Editor's Note: Art images and case study information were taken from James Waslaski's new book with Pearson Publishing, Clinical Massage Therapy: A Structural Approach to Pain Management.