Trending: CBD / Hemp Oil
A recent survey of DCs regarding cannabidiol (CBD) / hemp oil provides food for thought as to the viability of CBD-based products as a component of chiropractic patient care. Here are some observations from the executive summary of the survey:
Confessions of a Former Drug Rep: Statins Are Endangering Your Overweight Patients
As I sit at my desk on the sixth anniversary of my successful liver transplant, I can't help but reflect on what caused that life-threatening ordeal. Looking back on my personal situation, I want to offer my insight into what is happening routinely to many patients.
NCCAOM: A Route to National Certification
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is offering a route to achieve national certification—without having to take any of the NCCAOM exams. This is specifically for California licensed acupuncturists that meet the eligibility requirements.
A Resting of the Soul
In my pursuit of being a skilled health care provider, I focus on reading journals, attending classes, staying current on medicinal research, and choosing the correct billing codes. However, most of us would never have started down this career path if there wasn't something more.
Autoimmunity, Gut Health and Diet: Connect the Dots
According to the National Institute of Health (NIH), autoimmune disease is recognized in approximately 24 million individuals in the U.S., consisting of more than 80 various disorders that contribute to the top 10 causes of death in female children and women of all age groups.
Facebook Marketing 101
Many of the health care practitioners we work with have smaller practices. The provider tends to wear many hats – office manager, salesperson and healer.
The Secondary Insurance Plan
I have a patient that has Medicare, but also has a secondary insurance plan that does cover acupuncture. How do I bill Medicare to get a denial so that I may bill this secondary payer?
News in Brief
WFC Among Founding Members of Global Rehab Alliance; HealthSource Selects GoChiroTV as Exclusive Digital Signage Partner; Western States' Online Degree Programs Among Best in the Nation; Logan University, University of Missouri-St. Louis Forge Partnership.
Vaccines & Autism (Part 1)
It turns out chronic inflammation is the driver of autism expression. Unfortunately, those who emotionally embrace the vaccine issue rarely, if ever, consider this relationship, which hinders a rational view of the vaccine issue.
Art of the Associateship: It's OK to Trust, But Verify
Trust is a valuable part of any business relationship. It serves as the foundation for all business operations and ultimately long-term success for owners, employees and customers. This is especially true in the world of health care.
#TechPain: Causes, Solutions
For the past several decades, the science of ergonomics has blossomed. The workplace is much safer and life is generally more pleasant thanks to the application of ergonomic principles.
The Certified Practitioner
Certified Chinese herb practitioners often identify themselves with the credentials "LAc" (Licensed acupuncturist).
Why the Automatic Denials for Modifiers 25 and 59?
Your experience is one shared by many chiropractic providers who bill through those plans. It appears to be the national trend, but by far is more prominent in Texas and Illinois.
A Bold Strategy to Take Chiropractic to New Heights
Building public awareness of an entire profession requires strategic planning – especially when it pertains to the exploration of ground-breaking marketing tactics that target new audiences with key messaging about the value of chiropractic care.
Reducing Hip, Knee & Shoulder Replacements (Part 2)
In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation.
UnitedHealthcare Can't Seem to Keep Chiropractic Down
AA decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven.
The Classical Texts & Integrative Medicine
The acupuncture profession has been undergoing many changes in the past years. There has been a shift towards a more integrative approach to medicine as more hospitals include integrative departments.
The Hidden Hip in LBP: Critical Screening Tests
In 1998, Harvey used this test on 117 elite athletes and found excellent interrater reliability to differentially assess iliopsoas, quadriceps or TFL/ITB tightness.
Blockchain Health Records?
Keeping data secure has become a nightmare for the average consumer. Just consider general user account hacks on Yahoo (3 billion records compromised), eBay (145 million records compromised) and Facebook (87 million records compromised), to health record breaches involving Anthem Blue Cross (78 million records compromised) and TRICARE (almost 5 million records compromised).
It's All About That Ki
As an industry are we shifting too much toward a Western mind set? We strive to understand how acupuncture works using imaging and extensive studies. We spend numerous hours of our training learning Western medicine and learning to speak their language. What happened to our core though?
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
Treating Pain With Nutrition
Back in 1910, when D.D. Palmer published The Chiropractor's Adjuster and introduced the world to what he called the "triad of health" – thoughts, trauma and toxins – he explained that the body can only be made optimally healthy if all three aspects of health are addressed.
Why Take X-Rays When You Already Have an MRI?
Let's clear up the issue regarding the efficacy of plain-film studies when an MRI study has already been performed. I review imaging studies primarily for chiropractors, and often their patients have been to other health care providers before finding their way to a DC.
Help Shape the New Neck Pain Best Practices Guideline
The Clinical Compass (originally the Council on Guidelines and Practice Parameters – CCGPP) has issued a call for interested chiropractic clinicians to help shape a new best practices guideline for chiropractic care of neck pain.
Doc, Are You a Social Media Holdout? Your Future Is Now
Whether you like it or not, to compete in any business, even chiropractic, you really should know and consider using social media. It is no longer a small, sleepy, local world we live in; it has become a far-reaching community.
Valuable Adjunctive Therapies
Based on the latest CDC statistics, more than 795,000 Americans have strokes per year, 140,000 of which are lethal. Approximately 87 percent of all strokes are ischemic with an estimated health care and missed work cost of $34 billion annually.1
CBD for Athletes: The Advantages of Cannibidiol
For athletes, pain is often part of their sport or activity. And to a certain extent, it is to be expected. However, after pushing themselves to the limit, soreness and fatigue set in, hampering their ability to perform and recover.
End of Life Treatment
TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
November, 2008, Vol. 08, Issue 11
The Pressurestat Model Explains the Craniosacral Rhythm
By John Rollinson, D. Eu, CST-D; guest author for John Upledger, DO, OMM
The Pressurestat Model illustrates the mechanism behind the circulation of cerebrospinal fluid through the semi-closed, hydraulic craniosacral system.Originally defined by Dr. John Upledger and a team of researchers at Michigan State University in the 1970s, the model explains the palpable, rhythmic expansion and contraction of the craniosacral system.
The brain and spinal cord are surrounded by cerebrospinal fluid (CSF). This fluid transports nutrients, hormones and peptides. It removes metabolic waste and toxic substances. It serves as a shock absorber, floating the brain to counteract gravity. It even influences respiration and cerebral blood flow, among its many functions. Given all this, it's easy to see how essential it is for CSF to flow unimpaired. If an area of brain tissue is even partially deprived of optimal CSF motion and flow, that area will be forced into some degree of functional compromise.1
Cerebrospinal fluid is held within the dural membrane that surrounds the brain and spinal cord. This tough, watertight sac takes the shape of the interior of the cranium and intervertebral canal. Though dura mater doesn't stretch much, this fluid container is flexible and allows for CSF pressure changes. When pressure increases, the dural membrane expands, and the bones of the cranium and sacrum move along with it. When pressure decreases, the reverse occurs.
This filling of the craniosacral system is known as flexion, and the emptying is known as extension. During flexion, the head becomes wider transversely and shorter in its anterior-posterior dimension. The whole body externally rotates and widens. After flexion, this motion passes through a neutral zone on its way into extension, during which the head narrows and elongates and the whole body internally rotates.
Under normal circumstances, the craniosacral system proceeds cyclically through flexion and extension at a rate of about six to 12 cycles per minute. We can feel this rhythm at various places on the body because "this whole-body response is probably due to the pumping effect of the cerebrospinal fluid upon the motor system ... which causes a rhythmical tonification and detonification of the myofascial system in response to rhythmically fluctuating nerve signals."2
Tracing the Flow of Cerebrospinal Fluid Through the Craniosacral System
So, we have a hydraulic system that surrounds the brain and spinal cord. To understand how it is semi-closed, we must first understand how CSF enters and leaves the system. Within the ventricles of the brain, you'll find a capillary network - the choroid plexus - that produces CSF. In essence, blood circulating through the choroid plexus is "turned into" CSF, which then enters the craniosacral system.
The choroid plexus has stretch- and compression-sensing receptors within the saggital suture of the cranium. As CSF is added to the craniosacral system and its volume increases, the dural container expands, spreading the bones of the head. The parietal bones then move apart and spread the saggital suture. When this happens, the whole neuromechanism signals the choroid plexus to stop or greatly reduce the production of CSF. As the fluid drains from the system, the dura and cranium shrink and the parietals come together, compressing the saggital suture. The pressure-sensing nerve endings connected to the choroid plexus then send a signal to resume CSF production and the cycle repeats.
Normally, the system seems to operate on a cycle of about six seconds; CSF is produced for about three seconds and then production ceases for about three seconds. This creates the rhythmical rise and fall of fluid pressure within the system.
From the lateral ventricles, CSF enters the third ventricle via the foramina of Monro, then the fourth ventricle via the cerebral aqueduct. The CSF then enters the subarachnoid space and the central canal of the spinal cord via the foramina of Luschka and of Magendie, where it joins the CSF that is already bathing the brain and spinal cord, and all neural tissue enclosed by the dura mater. The fluid then circulates down and around the spinal cord and up and around the brain.
Cerebrospinal fluid passes out of the semi-closed hydraulic system via folds - called arachnoid granulation bodies or arachnoid villae - of the arachnoid layer of the cranial meninges that project through the inner layer of dura mater into the venous sinuses of the brain.3 CSF is reabsorbed into the venous blood through these arachnoid villae, which are primarily in the saggital venous sinous.
Although the rate of reabsorption is fairly constant, it seems to be regulated (think of a car idling) by a cluster of arachnoid granulation bodies found at the anterior end of the straight sinus. From its position at the "crossroads" of the intracranial membranes, this cluster can become aware of any tension within the membrane system and may regulate the outflow of CSF accordingly.
To summarize in a different way, the craniosacral system is like a leaking toilet with the tank cracked into pieces and lined with a giant exam glove (which is the dural membrane). The float-switch in the toilet tank is the saggital suture, which causes an inflow whenever enough water/CSF leaks away down the drain (sinuses).
Generating Whole-Body Effects
The craniosacral system is intimately related to the nervous, musculoskeletal, vascular, lymphatic, endocrine and respiratory systems. Just as abnormalities in the structure or function of any of these systems can influence the craniosacral system, abnormalities in or injuries to the structure or function of the craniosacral system can have profound and deleterious effects on the development or function of the nervous system, especially the brain.4
There are also ways in which the craniosacral system directly influences important, ongoing physiological processes. For instance, the continuing rhythmical movement of the system may serve to "milk" the pituitary gland and affect the neuroendocrine system. The rhythmic motion may also be an important stimulus for the development of the brain. Similarly, the motion around the skull sutures may pump the newly formed red blood cells out of the flat bones of the skull and into the general circulation.5
Of course, any abnormality of the craniosacral system could impact the body or any of its parts through the central nervous system. Any deficiency in circulation of CSF could affect brain and nerve functioning. Any restriction of nerves passing out of the craniosacral system due to restrictions in the cranial sutures or membranes may affect their end organs. Thanks to the Pressurestat Model, we can see why.
Click here for previous articles by John Upledger, DO, OMM.
John Rollinson practices full-time in Northampton, Mass., and at several school clinics in the area. You can contact him at www.rosetrust.org.
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