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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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...
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.
February, 2010, Vol. 10, Issue 02
Sources of Neck Pain
By Anita Boser, LMP, CHP
Clients usually think that pain is the "X" that marks the problem spot. As therapists, we know the source of pain is often somewhere else. In other words, "Where it is, is where it ain't," a colloquialism attributed to Ida P. Rolf. In the realm of a connective tissue matrix, internal pulls and compensations often create a symptom distant from the source of dysfunction.
As the pinnacle of the spinal cord, the neck has to accommodate for every weakness, imbalance and misalignment below, in addition to resolving direct trauma such as whiplash. There literally are thousands of sources of neck pain. In my practice, two are the most common: limited range of motion in the shoulder girdle and restrictions in the thorax.
Scapular Restrictions Limit Arm Flexion
When raising the arm overhead, the scapula must rotate 60 degrees to achieve full range (180 degrees of flexion). Not only does scapular rotation make full flexion possible, the glenoid cavity is then also in the proper position to provide support to the humerus. See Figure 1. The serratus anterior and upper and lower fibers of the trapezius contract to rotate the scapula. The costal fibers of the pectoralis major, the latissimus dorsi, and levator scapula also need to lengthen.
If the scapula can't fully rotate, the body will get the job done another way, usually by elevating the entire shoulder girdle. The levator then activates when it should release, and the scalene muscles often contract in an effort to assist. See Figure 2. The result is rigidity in the neck at the trapezius, levator and scalene cervical attachment sites, and often trigger points in the rotator cuff muscles which have to work through abnormal alignment.
Allow for Extension, Latissimus Dorsi
With your client on your table in a side-lying position, ask him to raise his upper arm in front of him and then up alongside his ear. Observe the rotation of the scapula. When the inferior angle stops moving anteriorly and superiorly assist the movement with a stroke to lengthen the latissimus and increase proper rotation of the scapula as you direct your client to rotate his elbow toward the ceiling. See Figure 3. (If the client's movement is very limited and/or his arm is weak, place a pillow under the upper arm to help support the weight.)
Scapula Coordination, Serratus Anterior
Turn your attention next to the serratus anterior. Have your client bend his elbow and place his hand on the table in front of his face or even under his head. With the back of your hand or soft fingertips, contact the fibers of the serratus on the lateral ribs. Ask your client to press into his entire hand so that the elbow moves slightly away from the shoulder joint. Feel for where the serratus is stuck or inhibited and use your touch to facilitate functional involvement. See Figure 4.
That's the Spot, Levator Scapula and Trapezius
Your client will certainly appreciate it if you address the adhesions that have most likely developed between the upper trapezius and the levator scapula. First release the superior edge of the trapezius from any underlying adhesions. Then, as your client extends his arm overhead again, release the levator, starting at its tendinous attachment to the scapular superior angle and directing it inferiorly. It also helps to work the length of the levator to its attachments on the transverse processes of the cervical spine, which are just posterior to the attachments of the scalene muscles, which will want some attention, too.
Thoracic Spine Immobility
While restrictions in the shoulder girdle place extra stress on the neck, lack of mobility in the thoracic spine often causes the cervical spine to exceed its range of motion. For example, if all of the motion to look over the shoulder, to side bend, or to look down comes from the neck, then the cervical spine muscles and ligaments get overworked and overstretched. The result is increasing stiffness as a means of protection.
Get in the Laminar Groove
The answer is to mobilize the thoracic spine and ribs, usually from T1 to T8. With your client in a sidelying position, you can use your knuckles to extricate the spinalis and paraspinal muscles at their attachments to the transverse and spinous processes. As you work, have your client make small unstructured movements under your hands. Use your pressure to stimulate the erectors and paraspinals and encourage more glide in the layers of tissue. Follow through to release restrictions in the myofascia between the ribs from their attachments to the transverse processes all the way to the sternum.
Shoulder restrictions and thoracic spine immobility are obviously not the only sources of neck pain, but adding these two assessments to your tool chest will expand your therapeutic potential and maybe even your reputation as a miracle worker.
Anita Boser graduated from the Institute of Structural Medicine and practices in Issaquah, Wash. She is the author of Relieve Stiffness and Feel Young Again With Undulation and Undulation Exercises. The exercises in this article are excerpted from her book. You can contact Anita at
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