A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
September, 2001, Vol. 01, Issue 09
Common Structural Oddities in the Human Body
By Neal Cross, PhD, NCTMB
There are a number of common anatomic variations and developmental changes related to aging. Some of these structural "oddities" can be mistakenly interpreted as abnormalities, or worse, a neoplastic disease of some sort.Usually these anatomic variations are nothing more than the result of normal developmental changes, daily activity patterns, or some genetic-based multivariate characteristic. Examples of each of these will now be discussed.
One common phenomenon is the presence of "extra" muscles or absence of common muscles. Perhaps the most well-known variation in this category is the palmaris longus in the anterior compartment of the forearm. This muscle lies superficial to the flexor digitorum superficialis and is roughly in the exact center of the forearm. Its tendon is long and thin and travels over the carpal tunnel to blend with the palmar fascia. You can easily determine if you have one or both muscles by flexing your wrist against resistance and looking for the prominent centrally located tendon.
This muscle is absent about 11 % of the time either bilaterally or unilaterally. More interesting for our purposes here is the fact that the position of the muscle belly can vary quite dramatically. The small muscle belly is usually situated proximally along with the muscle mass of the common forearm and digital flexors. Occasionally, however, the muscle belly of palmaris longus is situated distally just proximal to the flexor retinaculum. In this position it can be confusing. No muscle should be there -- what is wrong with this person? Nothing's wrong; these are just thoughts that might run through the mind of the naïve examiner.
Another similar example is the peroneus (fibularis) tertius. This muscle is commonly present but very variable in its presentation. Arising from the extensor digitorum longus, it runs to the lateral aspect of the ankle and foot and attaches at any number of places, usually including the fifth metatarsal. Palpation in this region of the foot will lead one to discover nothing; a rather dramatic muscle mass; and everything else in between. Unless these sorts of variations are accompanied by other clinically significant findings, they are usually just the result of normal anatomic variation.
Recently in a palpatory anatomy course I teach, one of the students became concerned because of a large and significant bulge right in the middle of her fellow student's popliteal fossa. She called me over, and I examined the young healthy male. My first impulse was correct. After asking a number of questions related to his medical history, I learned that he had a third head of gastrocnemius. This is often referred to as the gastrocnemius tertius. It was particularly prominent in this muscular young male.
Just yesterday in my medical gross anatomy course, I had two students approach me somewhat concerned about unusual muscle masses in the anterior forearms. In the first case, a young healthy male showed me large bilateral masses just medial to the tendon of the palmaris longus and three fingerbreadths proximal to the flexor retinaculum. They certainly did not look pathological at all. I simply asked what he did that might lead to this dramatic hypertrophy of the medial sides of both the flexor digitorum superficialis and the flexor digitorum profundus. At first, he couldn't think of anything; then suddenly he said, "Lacrosse -- I played lacrosse." The repetition of "twirling" the stick led to the muscular hypertrophy we were observing.
Not 10 minutes later, a young woman approached me and showed me the exact same situation, only just on her right forearm. I jokingly asked if she played lacrosse with one arm. She looked puzzled. Then I explained the situation with her classmate; she then saw the humor. I asked her if there was anything unusual about daily activities. She immediately put together her "anomaly" with the fact that her job as a pharmacy technician required her to inject solutions out of a 30ml syringe into a container. This was done hours on end and resulted in the observed muscular hypertrophy. I have found that many if not most of the muscle "abnormalities" I have witnessed over the last 25 years are in this category.
Of course, not all palpatory findings that might concern someone involve muscles. Another very common tissue that can fool us is lymph nodes. Normally lymph nodes are very difficult to palpate unless they are inflamed or the site of neoplastic disease. There are some exceptions to this, however. The superficial inguinal nodes lying along the inguinal ligament and surrounding the cribrifrom fascia in the femoral triangle can sometimes be very large. I distinctly remember a young female student in palpatory anatomy who had herself and her fellow students in a fit over her lymph nodes. Not only were they readily palpable, they were visible! After calming the group down, I discussed variability of lymph nodes with them. It turns out that her inguinal nodes were the largest I had ever seen in a healthy individual, but as the conversation continued, the "patient" described an interesting situation. She had been concerned about these "bumps" for several years, but was too scared to have a physician check them out. Had they been pathological, this could have been a terrible mistake. Palpable nodes can sometimes be felt in the axilla. A physician should always check these in female patients, but by far the most common nodes I have palpated are associated with nearby insect bites (we do have plenty of mosquitoes in Maine) or a recent cold.
As an example of a dramatic developmental change that can lead to unnecessary concern, let us consider the xiphoid process. This structure is found at the inferior end of the sternum. It begins as a pliable cartilage structure with an osseous core. Upon palpation in the epigastric fossa, one can feel the xiphoid give against digital pressure. However, as we age, the bony core enlarges at the expense of the cartilage. This can lead to a structure that feels like a bone growth -- which it is -- but it is part of the normal aging process. I always try to remember to tell the students in my palpatory anatomy class to be wary of such changes in their more mature classmates.
I never tire of the rich variation I experience in the cadaver lab or in the palpation lab. I always try to pass on this experience to my students and clients.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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