Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
May, 2007, Vol. 07, Issue 05
Pronator Teres Syndrome
By Whitney Lowe, LMT
Upper extremity nerve entrapments are a common cause of pain and disability. The increase in repetitive motions associated with occupational and recreational environments usually is singled out as the primary cause of these problems.Many individuals with nerve entrapment symptoms will seek the care of a massage practitioner.
If a client comes to you with an upper extremity pain condition, you want to accurately identify that problem so you can determine if it warrants massage treatment or referral to another health professional. In some cases, a condition might have symptoms that very closely mimic a different pathology. If you don't identify the condition correctly, your treatment is not going to be as effective.
The symptoms of pronator teres syndrome (PTS) can be identical to those of carpal tunnel syndrome because they both involve compression of the median nerve. PTS may be underdiagnosed by medical professionals because its symptoms are so closely related to carpal tunnel syndrome, which is a much more well-known condition.1
PTS develops from compression of the median nerve by the pronator teres muscle, and is sometimes referred to as pronator syndrome. The term pronator syndrome also can include median nerve compression by other structures in the elbow, such as the ligament of Struthers or the bicipital aponeurosis (lacertus fibrosus).2
As the median nerve passes the elbow, it runs between the two heads of the pronator teres muscle, where the nerve may be compressed (Figure 1). Compression can be due to muscle hypertonicity or fibrous bands within the muscle pressing on the nerve.3 In some cases, pressure is placed on the nerve by anatomical anomalies, such as the nerve traveling deep to both heads of the pronator teres.4 In this situation, the nerve might be compressed against the ulna by the pronator teres muscle itself.
PTS results from repetitive motions that cause hypertonicity in the pronator teres. Occupational activities such as hammering, cleaning fish, or performing any activity that requires continual manipulation of tools can cause overuse of the pronator teres. The hypertonicity then causes nerve compression, and the symptoms are felt in the anterior forearm and the median nerve distribution in the hand (Figure 2). Women are affected more than men, although the reason for this is not clear.
Most symptoms of nerve compression radiate distal to the site of compression. Aching forearm pain and paresthesia, along with pain in the median nerve distribution in the hand, are likely to be PTS and should not be assumed to indicate carpal tunnel syndrome.
While PTS and carpal tunnel syndrome both affect the median nerve and have similar symptoms, there are distinct differences. PTS pain is exacerbated by repetitive elbow flexion, and symptoms arise in the forearm as well as the hand. Carpal tunnel syndrome is aggravated by wrist movements, and pain is not experienced as much in the forearm. In both cases, atrophy is possible in the thenar muscles of the hand, which are innervated by branches from the median nerve.
There are several other ways to identify PTS and distinguish it from carpal tunnel syndrome. Clients with carpal tunnel syndrome frequently report night pain, while individuals with PTS generally do not.1 Prolonged wrist flexion during sleep aggravates carpal tunnel syndrome because it decreases the space in the carpal tunnel and presses on the median nerve. Because wrist flexion does not affect the pronator teres muscle, this wrist position does not increase nerve compression symptoms in PTS.
An evaluation procedure called the pronator teres test also is helpful in identifying the condition. The client stands with the elbow in 90 degrees of flexion. The practitioner then places one hand on the client's elbow for stabilization and the other hand grasps the client's hand in a handshake position. The client holds this position as the practitioner attempts to supinate the client's forearm (forcing the client to contract the pronator muscles). While holding the resistance against pronation, the practitioner extends the client's elbow (Figure 3). If the client's pain or discomfort is reproduced, there is a good chance of median nerve compression by the pronator teres. The client should keep the elbow relaxed during the test, because holding the elbow firmly in flexion will not allow elbow extension.
Pronator teres syndrome is most commonly caused by muscular compression of the median nerve. Therefore, it is a condition that is effectively treated with massage. However, it is important that the practitioner accurately identify the problem so treatment can be directed to the proper region of the upper extremity.
Author's note: The content of this article is excerpted from: Lowe W. Orthopedic Assessment in Massage Therapy. Sisters, OR: Daviau-Scott; 2006.
Click here for more information about Whitney Lowe, LMT.
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