The Opioid Crisis Hits Home: An Acupuncturist's Inside Perspective of Addiction Treatment
My husband and I have four grown children, but we still sleep with a phone next to our night stand just in case they need us. But nothing could have prepared us for a 1 a.m.
Power of the Talk: A Simple Way to Attract New Patients
One of the most effective ways to bring patients in predictably, especially if you enjoy teaching, is by doing talks. Talks can also bring in another stream of income beyond just seeing more patients one on one.
Who's the "Father of Corrective Traction" in Chiropractic?
History teaches that a Presbyterian minister, Samuel Weed, coined the name for the profession of chiropractic from the Greek cheir for "hand" and praktos for "done."
How to Reduce Metabolic Endotoxemia
Approximately 50 percent of the Western population suffers from a condition known as metabolic endotoxemia (ME). The condition is characterized by increased serum endotoxin concentration during the first five hours of the post-prandial period.
The Medicine of Peace in a Land of Conflict
We often read about violence, despair, and political stalemate between Israelis and Palestinians. It's easy to feel overwhelmed and pessimistic. And yet there are Israelis and Palestinians working together to transform conflict into cooperation.
Weight Watchers Goes Wellness
Goodbye Weight Watchers, hello "WW." The company has changed its name to reflect its new WW brand not only on its website, but also on every aspect of its public expression, including every studio.
ACA, ICA at Odds Over H.R. 7157
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.
Winter Joint Health: Looking at Seasonal Influences
One of the most common clinical issues I see during the winter season is joint / muscle pain. These issues often appear due to the activities of winter sports or may appear due to seasonal influences on old chronic injuries.
An East & West Perspective on Sleep
You, your patients, and people all over the world are sleeping less. In 1979 a team led by American psychiatrist Daniel Kripke did a large-scale study of over a million people, which indicated that most people slept between 7-8 hours.
Dehydration ... A Commonly Overlooked Etiology
Water covers 71 percent of the earth's surface. It's found in every living organism and is considered the "universal solvent," yet we take it for granted as the foundation for optimal health.
Historic Farm Bill Provisions Legalize Hemp ... and CBD?
Until recently, hemp was classified as a Schedule 1 drug per the federal Controlled Substances Act, putting it in the same class as marijuana (and heroin, by the way).
Electromagnetic Hypersensitivity and the Science of EMFs
Movement of planet Earth's molten iron core generates a weak static geomagnetic field that varies in strength over millennia but currently ranges from 0.25 to 0.65 gauss. This is the native field in which all life has evolved.
3 Tips to Get New Patients After a Talk
One of the most effective ways to bring in new patients predictably, especially when an acupuncturist enjoys teaching, is by doing talks. It can also bring in another stream of income, beyond just seeing more patients one-on-one.
Differentiating Qi Under the Needle (Part 2)
While classic sages have said a lot on this topic, I will share my own experience with the sensations under the needle with you. You, in turn, will also need to gain your own understanding of them through daily clinical observation, thinking, and practice.
Neuroscience 101: Understanding Opioid Addiction and How Chiropractic Can Help
Opioids now account for nearly two-thirds of all overdose-related deaths in the U.S. This insidious bane is no respecter of gender, age, race or ethnicity, with nearly all categories experiencing increases.
Case Study: Forefoot Pain
Patient presents with a history of forefoot pain. Discomfort has become worse in the past six months. He has difficulty completing his four-hour shifts as a part-time hairdresser.
Pain in the Butt (Pt. 1)
Many of my patients (and probably many of yours) come in with pain and/or tenderness in the buttock region. First, I assess where the painful and/or tender spots are located and what these points represent.
Flying Into the Year of the Pig: Making Way for the Impossible
The first of the new year has passed, and some of our New Year's resolutions may have already come and gone. Fortunately, we will celebrate the Chinese New Year this month, and will welcome in the Year of the Pig.
Quickie Seminar Adjustments Have No Place in Chiropractic
Recently, I observed chiropractors treating each other in the vendor area at the annual meeting of a chiropractic association. "Quickie" chiropractic adjustments and other hands-on procedures were administered without appropriate history taking, physical examination, diagnosis or informed consent.
The Role of TCM When Treating Mental Illnesses
Mental illness is common in the U.S., nearly 20 percent of adults live with a mental illness which vary in degree of severity—ranging from mild to moderate, to severe. It is not exaggerated to say that mental illness is an epidemic.
Simple Screening Tests for Stroke and Other Brain Lesions
The drift test, arm rolling and finger rolling are three useful assessments in the identification of upper motor neuron dysfunction.
Top Social Media Do's & Don'ts for Chiropractors
For years, health care practitioners have avoided embarking on the social media highway, primarily due to patient HIPAA privacy issues and the time needed to give the process due diligence.
Outcomes for Any Occasion
Outcome assessment tools (OATs) are a necessary part of documentation and patient care. They are used to show patient progress and help practitioners show changes as a result of their treatment interventions.
Quick Sacroiliac Assessment: Treating Different Types of Pain
The lower back is a generator for a number of types of pain. The lower back involves several different articulations – the lumbar spine with vertebral bodies, discs, and facets – the sacroiliac joints – and the lumbosacral junction.
Know Your Clinical Flags: 5 Different Colors to Consider
In health care, the term red flag is used to describe signs and symptoms that can indicate the presence of serious health conditions. These conditions generally carry an increased likelihood for serious complications, disability or even death.
March, 2006, Vol. 06, Issue 03
Spondylolisthesis: An Elusive Cause of Low Back Pain
By Whitney Lowe, LMTLow back pain (LBP) is one of the most prevalent orthopedic problems in the world. Yet, the cause of much LBP is poorly understood, which sometimes leads to improper treatment. Many times LBP is caused by muscular tightness or myofascial trigger point activity, and is effectively treated with massage. However, serious structural problems can exist in the spine. These conditions need to be referred to a physician for proper evaluation. Spondylolisthesis is just such a problem.
The term spondylolisthesis is derived from the Greek spondylo, meaning "spine," and listhesis, "to slide down an incline." Spondylolisthesis results from a stress fracture in a region of the vertebra called the pars interarticularis (Figure 1). Left untreated, the stress fracture might fully separate, causing one vertebra to slip forward in relation to another (Figure 2). The slippage is most common at the articulation between L5 and S1 junction due to the downward pull of gravity and the anterior and inferior sloping of the L5-S1 junction. If only a stress fracture exists without the vertebral sliding, the condition is called spondylolysis. Because the stress fracture occurs before the forward slippage of the vertebral body, spondylolysis generally is a precursor to spondylolisthesis.
The compressive forces that aggravate the condition are magnified if the individual has an exaggerated lumbar lordosis. When the lumbar lordosis is increased, the posterior vertebral arch bears a greater percentage of the upper body weight.
In addition, the exaggerated lordosis tilts the lower lumbar vertebrae even farther in an anterior and inferior direction, making forward slippage more likely.
Individuals engaged in certain sports or occupations are particularly susceptible to spondylolisthesis, especially if it involves repetitive flexion and extension of the spine. It is common in gymnastics, rowing, diving, swimming (especially the butterfly), tennis, wrestling, weightlifting and football. An increased incidence also has been identified in loggers and soldiers carrying heavy backpacks.1, 2 The condition is prevalent in adolescents due to the extremes of physical exertion in athletics and bones that are not fully formed.3 Females are affected more often than males, possibly due to strength differences in bone structure.
Hamstring tightness is evident in many individuals with spondylolisthesis. The hamstrings tighten in an effort to posteriorly rotate the pelvis. The posterior pelvic rotation decreases the potential for forward slippage of the lower lumbar vertebra and helps stabilize the lumbar region.1
The most common symptom in spondylolisthesis is dull, aching pain in the lower lumbar or upper sacral region. Pain also extends into the buttocks or posterior thigh in some cases. The client generally reports some repetitive flexion or extension activity prior to the onset of symptoms. Consider the client's report of recent activities that might produce aggravating stress on the posterior vertebral arch, especially if there is a corresponding exaggerated lumbar lordosis.
There usually is tenderness in the soft tissues in the lower lumbar and upper sacral region. However, the tenderness usually is not the primary pain-producing sensation of the stress fracture or vertebral slippage. Attempting to palpate tissues in this region also can produce pain because there is anterior pressure being applied to the vertebral structures. The anterior pressure might push the vertebra further into the position of slippage and aggravate the pain. In addition to tenderness, hypertonicity in the lumbar erector spinae, quadratus, lumborum, gluteals and hamstring muscles is likely.
In spondylolisthesis, pain increases with lumbar extension. Flexion decreases the pain, as this motion pushes the vertebra back toward the normal position. Pain might be aggravated during either lateral flexion or rotation, although there is not a clearly established pattern of this pain. Hip flexion with the knee in extension generally is limited due to hamstring tightness.
A special test called the one-leg lumbar extension test might help isolate spondylolysis or spondylolisthesis. To perform this test, the client is standing on one leg and balancing. While in this position, the client attempts to bend backward, thus extending the spine (Figure 3). The test is repeated on the opposite side. If back pain is felt during the spinal extension, there is a strong likelihood of a stress fracture in the pars interarticularis. If the stress fracture is only on one side, standing on the ipsilateral leg produces more pain.
If spondylolisthesis is suspected, the client should be referred to a physician for appropriate evaluation. Forward slippage of the vertebra has to be confirmed by X-ray and is not testable with physical examination alone. Soft-tissue therapies like massage can be helpful in reducing overall muscular hypertonicity associated with spondylolisthesis, but it's important to consult with the client's physician about appropriate treatment goals. For example, working on the hamstrings to relax their hypertonicity actually could be detrimental to the condition because the hamstring tightness is helping reduce forward vertebral slippage. Awareness of conditions such as spondylolisthesis highlights the importance of proper assessment so an appropriate referral and/or treatment approach can be developed.
Click here for more information about Whitney Lowe, LMT.
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