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.
Head and Shoulder Pain from the Splenius Cervicis
When clients report symptoms of pain in the head or eye, it is always of serious concern and they should seek medical care to determine the cause(s) and treatment options. Physicians and other healthcare providers are excellent referral sources to your practice, since a percentage of their patients are suffering with many issues that may include myofascial pain. Let's examine the splenius cervicis muscle, its anatomy, the location of myofascial trigger Points (TrPs), the associated pain referral patterns of each TrP, some treatment and self-care tips.
The splenius cervicis along with the splenius capitis muscle are the most superficial of all the extensors in the cervical region. The deepest of the extensor muscles are very short in length and attach to the next vertebra. In contrast, the splenius cervicis is long and crosses many vertebrae. Below the splenius cervicis attaches to the spinous process of the third through sixth thoracic vertebrae and the fascia over them. Above it attaches to the posterior tubercle of the transverse process of the upper two to four vertebrae. (See photo 1A)
Unilateral contraction of the splenius cervicis muscle produces extension, lateral flexion and rotation of the neck, turning the face toward the same side. Bilateral contraction produces extension of the neck.
Clients typically report a "stiff neck," limited cervical range of motion and/or pain in the shoulder, neck, head and or eye. Drs. Simons and Travell et, al, identified two (upper and lower) myofascial trigger points in the splenius cervicis muscle. In photo 1, "X" indicates the common location of trigger points. Solid red areas identify essential pain zones, the regions of referred pain that is present in nearly every person with active trigger points. The dotted red regions indicate spillover pain zones or the regions of referred pain on some, but not all, patients with active trigger points.
The splenius cervicis Upper TrP is located, as the name implies, in the superior portion of the muscle in the musculotendinous junctions. It can "refer a diffuse pain through the inside of the head that focuses strongly behind the eye on the same side, and sometimes refers into the ipsilateral occiput."1 (See photo 1A, B) The splenius cervicis Lower TrP is classified as a central TrP and located in middle of the muscle belly. It "refers pain upward and to the base of the neck."1 (See photo 1A, C)
During this technique, many posterior neck muscles are treated. Palpation of boney landmarks will help you determine your location. A combination of subjective complaints, objective findings, precise palpation and knowledge of TrP pain patterns will help you determine if the splenius cervicis muscle is involved. A few other muscles in the region that should also be assessed include: trapezius, levator scapulae, sub occipitals and scalenes.
The client is supine on a table. The therapist is seated at the end of table with the shoulder of the treating hand aligned with client's head, neck and body. The thumb of the treating hand is positioned at the base of the occiput, with the pad of the thumb palpating the posterior aspect of the transverse process. Avoid intruding on the nerve root by never treating the lateral aspect of the transverse processes. The therapist's non-treating hand will support the client's head while creating extension of the cervical spine. (See photo 2A)
While lowering the head toward the table, glide the thumb inferiorly, applying pressure anteromedially, to treat the posterior aspect of the transverse process, repeat three or four times. Turn the head 45 degrees away from the treating side and repeat the above step three or four times. Examine the same region using cross fiber movement will help to thoroughly check for TrPs. (See photo 2B)
In photo 3, the non-treating hand continues to support and control movement of the head and neck. The fingers of the treating hand cup the cervical spine as the thumb is positioned anterior to the upper trapezius. The thumb is pointing toward the client's feet with the pad of the thumb facing medially. It is important for the thumb to always remain posterior to the transverse processes to avoid pressing on the brachial nerves. Rotate the client's head toward the treating side with the side of the patient's head now resting on the therapist's forearm. Apply pressure with pad of thumb pointing 45-degrees anteromedially.
When you palpate an active TrP in a client, they recognize the referred phenomena. If the referred pain does not release after applying sustained pressure for a maximum of eight seconds, then release and check the spot later with less pressure.
Keep in mind that trigger points can form for a number of reasons. Examples include direct trauma during a motor vehicle accident, to sustained stress from poor posture, to improper biomechanics, to poor ergonomics at work and throughout the day. Discuss their activities of daily living. Do they drive for hours everyday? If so, the seat, stirring wheel and mirrors likely need to be properly positioned. Do they work on computer all day? If so, does the monitor, keyboard or chair need adjustments? At home, do they rest on the couch with their neck in extreme flexion?
Empower your clients with self-care tips they can utilize between treatments. Show them how to stretch. Give them the locations, times and tips to perform simple stretches throughout their day in the kitchen, bathroom, while walking the dog, at the beginning and end of everyday. They will feel better and appreciate your efforts.
Pain in the head or neck can create a great deal of anxiety for anyone. Sometimes a little therapy and a few lifestyle changes can make all the difference. Clients want to know what caused the pain and if there is anything they can do to prevent it in the future. If you provide effective solutions, people will refer their family, friends and co-workers. While many muscles could be involved, remember the splenius cervicis can cause pain from head to shoulder.