Time-Saving Tips for Your Practice & Life
Of all the finite resources we possess, perhaps the most valuable one is time. There never seems to be enough time to accomplish everything that must be done, and all too often we sacrifice things in our personal life to meet the demands of our practice.
A Historic First for Chiropractic Assistants
The New Jersey State Board of Chiropractic Examiners will begin issuing licenses as early as Nov. 1, 2018 to chiropractic assistants who have undergone a 500-hour training course and passed a competency exam.
Multichannel Access: Software for a Better Customer Experience
It is no secret that today's consumer has high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular with acupuncture practitioners is they allows customers to book appointments and make payments online day or night.
The Benefits of Going Paperless
The benefits of going paperless in your practice are profound. If you haven't done it yet, here's why you should.
Support Patients With Multi-Channel Customer Service
It's no secret that today's consumers have high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular is that they allow patients to book appointments and make payments online day or night.
Bringing Acupuncture to Ohio
The jolt of seeing a woman conscious and talking during surgery left a lasting impression in 1971 when acupuncture was on the national news.
UHC Up to Its Old Tricks With Latest Headache Policy
A decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven and ineligible for reimbursement.
Neck Pain: Activation Exercises
In observing patients and studying rehab, I have learned that tight muscles are weak muscles and that stretching is sometimes less effective than muscular activation. There is a delicate balance between joints that move too little and joints that are hypermobile.
X-Ray: To Be or Not to Be - That Is the Question
For the past year, I have been asked by many practicing chiropractors, college presidents, faculty and others what my opinion is on the "Choosing Wisely" guidelines the American Chiropractic Association (ACA) recently adopted for its members.
The Science Behind the Efficacy of Cosmetic Acupuncture
The beauty industry continues to boom and grow constantly, from topical creams, lotions and potions all the way to cutting edge cosmetic surgeries.
Food for Thought: An Examination of Diet & Digestion
Even an acute poison can become an excellent drug if it is properly administered. On the other hand even a drug, if not properly administered, becomes an acute poison. — Charaka Samhita
Working for Someone Else: Know the Rules of the Game
Many of us decide to become acupuncturists because we are healers at heart and want to focus on treating patients, not because we want to own and operate a business. So we work for someone else, which can have great advantages, especially as a new graduate.
Travel-to-Treat Coverage Finally Becoming a Reality?
Long-awaited legislation poised to hit the president's desk extends liability insurance coverage from one state to another for DCs and other state-licensed health care professionals who care for athletes / athletic teams that cross state lines.
The Origin of Blood
The Roman doctor, Galen, (2nd century AD) did pivotal work to prove that blood, which he thought was produced by the liver, and the cardio vascular system existed. He conceived that the arteries and veins were two separate networks.
Depression & The Secondary Vessels
As an acupuncturist I see many people suffering from depression. I often think depression is the major imbalance of our culture. I have a patient I've been working with for several years. Her major challenge is chronic stubborn depression.
The Importance of the Scapulohumeral Rhythm
The shoulder has the greatest range of motion of any joint in the body. What is often overlooked in shoulder mechanics is that motion in the shoulder is not purely at the glenohumeral joint.
It's Time to Reward Yourself
An interesting study recently published in the Journal of the American Heart Association (JAHA) confirms what we all learned when we were children – and serves as food for thought as to how you can improve your practice and your personal life.
Lead Patients to the Fountain (and Foundation) of Youth
We're all seeking the fountain of youth and marketers are capitalizing on it. (Global demand for anti-aging products, treatments and services was valued at 140.3 billion in 2015, according to Zion Market Research.)
Your First Impression Always Deserves a Second Chance
Doctor, have you ever had a patient you just couldn't "warm up to"? You know, the kind of patient who "irks" you, who has a hidden agenda to get something you haven't anticipated, perhaps causing you to want to hide in a closet when they come in for treatment.
That's a Wrap: Compression Bands for Contemporary DCs
Over the past decade, compression bands have been increasingly utilized in trainer and manual therapy offices. I was first introduced to the compression band by Kelley Starrett, author of Becoming a Supple Leopard, and have since been using it as a teaching tool.
Chiropractic Management of Patellofemoral Arthralgia
Patient reports with pain in the front part of her right knee, especially during and after her weekly Zumba class. She states there has been no injury of which she is aware. No outward sign of injury is observed.
Vaccine Injury? The Autism Debate (Part 2)
As suggested in my first article on this topic [August 2018],1 my impression is that the vaccine authoritarians and radicals have not helped to mold a proper social / political environment for addressing the issue of vaccine injury.
Easy, Inexpensive Tools for a Successful Practice (I Promise)
Successful practitioners are the ones who know how to run a business, first and foremost. I became a licensed acupuncturist in 2006. After having worked in chiropractor's offices for nine years, I opened my own office in 2015: four treatment rooms, a back office and a waiting room.
The international standardization conference was held this year in Shanghai, China (June) - this was the ninth plenary session. Meetings for technical committees, or working groups also took place at the conference.
A New NCCIH Director ... One That Backs Acupuncture
The third time is a charm—the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), announced it's newest director, Dr. Helene Langevin.
An Update From the Acupuncture Now Foundation
Since launching the Acupuncture Now Foundation (ANF), our volunteer leadership has continued to work to achieve our vision of "Creating a World Where the Benefits of Acupuncture are Known and Available to All.
"Don't Crack My Neck": What Do You Do Next?
It's Monday morning and your first new patient of the day, a 35-year-old female, presents with chronic headaches and neck pain. The patient was referred by her primary care provider for evaluation and management without the use of cervical manipulation.
Possession: Blocks to Healing
Before we can approach treatment of a patient's primary elemental imbalance (AKA "Causative Factor" or "CF"), a number of specific energetic blocks must be considered and, if present, removed in order for treatment to be effective. I cannot emphasize this enough.
May, 2010, Vol. 10, Issue 05
Flexor Pulleys of the Fingers
By Whitney Lowe, LMT
The human hand is critical to our daily activities, especially as massage practitioners. Yet, rarely do we stop and consider what an engineering marvel the hand actually is. The human hand is capable of fine precision movements, as well as generating large forces during grasping activities.The skeletal structure of the hand and fingers is a set of rigid bones. Consequently, it takes great muscular control to perform the fine movements of the hand. Without this highly specialized level of control, we would have serious challenges performing all kinds of activities from simply grasping an object to the detailed motor control required to play a musical instrument or perform surgery.
A unique biomechanical pulley system provides the high level of control necessary to move the rigid finger bones with precision. The flexor tendons of the fingers run along the anterior surface of the fingers, and these tendons are tethered close to the bones by connective tissue "pulleys" at eight different locations from the metacarpophalangeal (MCP) joint to the distal phalanx. Because the tendons are closely tethered to the bones, their pulling force is more efficient. Let's take a look at these pulleys, how they work and what happens when they don't.
There are five pulleys in the fingers, called annular pulleys, and they are named A1 through A5 (Figure 1). The A1, A3, and A5 pulleys are smaller and considered minor pulleys (mostly due to size and lack of importance). The A2 and A4 pulleys are larger and are sometimes called the major pulleys.1 The A1, A3, and A5 pulleys are located at the MCP, PIP and DIP joints respectively. The A2 and A4 pulleys are located in the middle of the proximal and middle phalanx respectively (Figure 2).
A second set of connective-tissue pulleys, called cruciate pulleys, gives additional support and stability to the tendon sheaths. The term cruciate means cross, and you can see by their structure where they get their name (Figure 1). The cruciate pulleys are much smaller than the annular pulleys. There are three cruciate pulleys, designated as C1, C2, and C3. Their role for improving the flexor tendon's angle of pull is not as great, so if they are damaged, finger movement is not impaired as much as with the annular pulleys.
The annular pulleys may be damaged from an acute injury or from various degenerative conditions in the fingers. An example of the detrimental effect of rupture of the annular pulleys is shown in Figure 3. In this image, the A3 pulley has been completely ruptured and there is a partial rupture to the A2 pulley. As a result, the tendon is pulled away from the PIP joint, in what is referred to as a bowstringing effect. With the tendon pulled away from the PIP joint, its power is reduced and it is no longer able to produce normal range of motion. As a result, the hand is significantly weaker in gripping activities.
Stenosing tenosynovitis, also called trigger finger, is another disorder involving the flexor pulleys. In this condition, a fibrous nodule develops on the tendon near the edge of the tendon sheath. The nodule prevents the tendon from freely gliding in and out of the surrounding synovial sheath. Stenosing tenosynovitis is usually a problem with the tendon sheath, but in some cases, the nodule on the tendon catches on the edge of the flexor pulleys. If this is the case, the offending flexor pulley can be surgically cut to allow the tendon greater freedom of movement. However, if the pulley has been cut, that flexor tendon is less efficient, so the benefits of this procedure need to be weighed against the potential drawbacks.
While massage practitioners may not see a large number of clients with flexor pulley dysfunctions, there is still great value in understanding these details of hand mechanics. After all, the hand is our primary tool that we use in our work as soft-tissue therapists, and we need to keep it in good condition. Overuse problems may affect our ability to keep working, and physical injury is one of the primary reasons people leave this profession. Understanding more about proper mechanics helps keep you in better condition.
Click here for more information about Whitney Lowe, LMT.
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