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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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...
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
July, 2011, Vol. 11, Issue 07
Human Silly Putty
By Erik Dalton, PhD
Although "creep" is an engineering term, it also applies to human tissue...the lumbopelvis in particular. Spinal and sacroiliac ligaments, joint capsules, facet cartilages and especially intervertebral discs are viscoelastic and are somewhat similar to silly putty.Leave a ball of putty on a table overnight and by the next morning it's deformed into a flattened pancake. So be it with humans. We're taller in the morning than at bedtime, primarily due to disc and fascio-ligamentous deformation that occurs throughout the day. Of course, silly putty is much creepier than discs, fascia or ligaments but, in time, gravity will deform and sometimes strain all these materials.
As ligamentous creep turns to strain, soft tissues are no longer able to prevent separation of bone and that's when our problems begin. Contrary to what many docs tell their patients, most low back and pelvic pain does not result from a single traumatic lifting, bending or sports injury, but rather from cumulative viscoelastic creep due to lack of rest between loading cycles. According to Bogduk and Twomey, "After prolonged strain, spinal ligaments, joint capsules, and IV discs of the lumbar spine may creep, and may be liable to injury if sudden forces are unexpectedly applied during the vulnerable recovery phase."1 Bottom Line: Once viscoelastic tissues are strained, they're less likely to return to their original length and, therefore, are more prone to future injury.
I often scratch my head in wonder when reading research that dismisses the effects of gravitational exposure on human viscoelastic tissues. It's even more frustrating when scientists and clinicians discount the role distorted postural faults such as pronated feet, crooked SI joints, and forward heads play in commonly seen pain syndromes.2 Each-and-every day, the weight of gravity (14.7 pounds per square inch) pushes straight down on our bodies. These compressive forces should be equally distributed throughout the neuro-myo-skeletal system...but are they? Prolonged one legged standing (excessive weight bearing on one limb, i.e., performing bodywork) is an oft-overlooked culprit creating ligamentous creep that might be a precursor to more serious conditions like joint laxity, lumbopelvic instability, sprains and osteoarthritis. To demonstrate the phenomena of creep, let's look at the myo-mechanics of a fairly common pain-generating disorder called iliosacral upslip or "shear."
What Is An Upslip?
In those presenting with true iliosacral upslips, joint apposition between the ilium and sacrum is altered, i.e., "the sacroiliac grooves ain't grooving". Since these superior shears are more affected by gravity than other iliosacral dysfunctions, they have almost a zero chance of self correction. During history in-takes, clients often report the symptoms to be much more painful than expected from the injury they describe. In fact, many can't recall any precipitating event.
Typically, when we see this upward shearing force of ilium on sacrum, the person's SI joints are lacking either form or force closure. In form closure, SI joint stability is dictated by a series of ridges and complimentary depressions that produce friction and help interlock the two bones. But synovial joints like a little movement (joint play), not only to provide spinal shock absorption, but also to enhance lower extremity torque conversions and transverse rotations that travel up the kinetic chain and propel the body through space.3 Fortunately, Mother Nature has accommodated this functional demand by installing a back-up system researchers call force closure. Force closure stability is generated by contractive action of core musculo-fascial tissues such as the pelvic diaphragm, transverse abdominis, multifidus and thoracolumbar fascia. Together, they provide a sophisticated neurologic feedback mechanism that reflexively interacts with the brain to provide joint stability and coordinated movement...or lack of it as is the case in chronic upslips.
In the presence of chronic upslips, prolonged cyclical loading can deform SI joint ligaments to a point where an act as innocent as slamming on the brake, tumbling on one hip, or clumsily stepping off a curb, can jostle the joint enough to cause the ilium to "jump-a-notch" on sacrum. Here's a good "upslip" case study of a client named Marion who called complaining of stabbing buttock and low back pain.
Marion The Hairdresser
I'd treated Marion off-and-on for several years for neck, jaw and rib pain resulting from a severe whiplash injury, but today was different...her low back and hip were in a world of hurt. This was her first visit since becoming a momma a year earlier and her history in-take revealed two related factors contributing to her injury: 1) Cumulative viscoelastic creep (hypermobility) left over from the relaxin birth hormone, and 2) Prolonged one-legged cyclical loading at her hairdressing job.
A classic upslip case, Marion presented with acute right-sided lumbopelvic pain, funky gait and anatomical landmarks showing a 1 1/2" short right leg, lax sacrotuberous ligament right, OL and psoas spasm right, and superior/posterior right ilium. Spring testing of the right ilium (supine and prone) revealed no inferior glide. Marion's right QL fired before gluteus medius on the hip abduction test and she lifted the swing leg with the spasmed QL as she tried to walk. Although all her anatomical landmark and gait evaluations pointed to an iliosacral upslip, why do you think she could not identify a traumatic perpetrating event?
The books tell us iliosacral upslips are traumatically-induced injuries, but Marion first felt the excruciating pain when she got out of bed. Turns out, the incident that most likely pushed Marion over the edge occurred the night before as she stepped off a foot stool. That slight jar caused the hypermobile pelvic ligaments and restraining muscles to collapse and explode into a full-blown crippling hip spasm. Over the years, I've seen many cases like Marion's and I've noticed that in the early stages of ligamentous creep, the brain down-regulates nociceptive pain signals. But when the joint finally jams, the brain lights-up the central nervous system with pain and protective guarding to prevent further insult to the damaged area.
Fixing The Fixation
Here are a couple of techniques that helped fix Marion's upslipped hip. In Figure 4A, she's pulling the knee to her chest to inferiorly drag the ilium while I slowly elbow my way through the lumbodorsal fascia, QL, and iliocostalis myospasm. Once these hypertrophied (hip-hiking) soft tissues regain flexibility and mobility, a maneuver is used to get the sacroiliac "grooves-a-groovin." But before proceeding to the upslip correction, Marion is asked to do a couple minutes of deep abdominal breathing to help neurologically reset and relax the deep spasmed core muscles.
In Figure 4B, Marion lies supine and I apply an inferior tractioning force to drag the ilium to the first restrictive barrier feeling for neutral leg and hip alignment. By taking the limb into a bit of internal rotation, I'm able to bony-lock the hip allowing the tractioning force to travel through the SI joint. Using my body weight with her thigh securely arm-locked, a distraction force is applied as Marion forcefully contracts the QL and hip-hikes against my resistance. After a few seconds, she is asked to cough vigorously to help jostle the joint and reposition the soft tissues. Traction combined with the forced exhalation allows Marion's ilium to drop down into the groove "from whence it came." Note: The pain should immediately ease except in those with hypermobility issues or core stability problems in which case a referral to a good functional movement therapist is recommended.
Lastly, here's an effective home-retraining exercise I gave Marion. Lying supine, with her heels circling an exercise ball, she lifts her buttock and slowly rolls the ball side to side. I've found this simple routine helpful in normalizing neuromuscular firing patterns while evenly tonifying damaged ligaments. Rest, ergonomic retraining and regular follow-ups are mandatory until pelvic stability is established. Remember, the first couple weeks are critical; even the slightest jar can turn the ligaments back into silly putty.
Click here for previous articles by Erik Dalton, PhD.
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