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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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...
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.
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.
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.
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.
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.
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.
The 4-Faced Troublemaker: Treating the Quadriceps Femoris
The famous quadriceps femoris group, which I refer to as the four-faced troublemaker, will be the topic of my next couple of articles—with step-by-step examples of my treatment protocols. Clients from my case studies encountered unique injuries with a different overload or deceleration, thus creating familiar trigger point (TrP) referral patterns.
For a deeper study of this quadriceps group, please see chapter 14 of “Myofascial Pain and Dysfunction: The Trigger Point Manual (Vol. 2)” by Janet G. Travell, M.D. and David G. Simons, M.D.
The Deceleration Injury
There are multiple reasons that have been given for forming trigger points—one explanation comes from understanding the mechanism of a deceleration injury. A deceleration injury is a result of momentum in which the body is forcibly stopped and the tissues are overstretched to help stop the body-part it is attached to. The onset or activation of a TrP is usually associated with some degree of mechanical abuse of the muscle in the form of muscle overload, which may be acute, sustained, and/or repetitive.1
In addition, leaving the muscle in shortened position can convert a latent TrP to an active TrP, and this process is greatly aggravated if the muscle is contracted while in the shortened position. In paraspinal muscles (and very likely others), a degree of nerve compression that causes identifiable neuropathic electromyographic changes are associated with an increase in the number of active TrPs. These TrPs may be activated by disturbed microtubule communication between the neuron and the endplate since the motor endplate is the peripheral core TrP pathophysiology.
An example of a deceleration injury that you may have already treated is the tissues of sternocleidomastoid (SCM). During a whiplash injury the cervical spine goes through a forced acceleration to a quick deceleration by the SCM and anterior cervical muscles. These tissues have sustained an overload injury, which when left shortened can convert a latent TrP to an active TrP along with the pain and stiffness.
Another example you may have encountered, common in baseball pitchers, is trigger points formed in the infraspinatus—due to the muscle performing as the “brakes.” The body goes through a quick acceleration and then a forceful deceleration by the rotator cuff to stop the momentum.
In personal training we have methods to help train the deceleration action of a muscle for the prevention of sports injuries. Deceleration training creates the ability to slow down and control force production. Too often people just jump right into exercise or run a 5K with very little preparation. In simple terms it is too much for the tissues to handle so quickly—there needs to be enough training time to allow for adaptation.
This is how the amateur athletes start the formation of the nodules—by micro-tearing of the tissues. Over time these micro-tears become knots in the tissue and cause either pain or dysfunction. Just a reminder of how our muscles work through three actions, concentrically to create acceleration and force production, isometrically to stabilize or balance and eccentrically to decelerate and decrease force production. Amateurs usually work on the first one, just get out there and run which is the concentric acceleration phase.
Case OF The Killer 5K
The first case I would like to share with you is a client who signed up for a 5k as a way to lose weight. Although she had not been doing any regular training she decided to just start running. Her knee became so problematic that she went to a rheumatologist thinking she must have a terrible case of arthritis.
After several tests the doctor didn’t discover anything that was obviously causing her pain. When she came to see me I asked how many miles she was running per week, when the pain started, and if she had changed shoes. She was only running a few miles per week, but was trying to increase each week. The pain came on gradually, and yes she had bought new running shoes for her training and event.
As a side bar to all of you, she wasn’t warming up; she hadn’t studied how to gradually increase her mileage; and she wasn’t stretching much after her runs because of time constraints. Along with that she didn’t follow the recommended - 10 percent use for new shoes for at least four weeks to gradually allow her feet, ankle, knees and hips adapt.
I had her point to the source of pain which was right over the knee cap. I performed a Thomas test looking at the quadriceps length and found that her right side (the area if pain) was much more restricted than her left. My goal was to increase the length in the quadriceps and decrease the knee pain.
This was the typical rectus femorisTrP which is found high on the thigh just below the anterior inferior iliac spine. Her posture also played a part due to her anterior pelvic tilt. The most important piece of treatment is to have a reference point or goal during the session to see if your treatment choice or modality is working. In this case my reference point came from the Thomas test and referred-knee pain.
The Rectus Femoris TrP Treatment Plan
I repeated this pattern for 45 minutes, re-testing my reference point after each round of the therapy. She was 90 percent better after first session and 100 percent after the second session. The muscle stabilization portion was her homework—this would help correct the things that got her there in the first place. Additionally, this would train the rectus femoris to handle the deceleration required for running.
The Case of Backswing & Follow Through
The second case was a client of mine who loved to play golf. He had complaints of sudden onset of medial knee pain, and a buckling knee. He was cleared by an orthopedic doctor with no real obvious cause for the pain. I tested the length of the quadriceps group using the Thomas test, along with looking at the adductor group’s length by using the FABER test. I also manually took the leg out into abduction with the leg medially rotated to isolate the adductor group. I found the side of the complaint (his left side) to be relatively shorter than his right in all three tests.
This prompted me to ask if he had recently changed golf shoes—which affect the way the ankle transfers energy from the right side (backswing) to the left side (follow through). If the shoe is too stiff it may not allow the ankle to go through ankle inversion and eversion appropriately, thus putting stress above the knee joint. This would have happened every time he performed his follow through. During palpation he was point tender at the proximal TrP of the vastus medialis, which refers over the anteromedial aspect of the knee and lower thigh.
The TrPs in this muscle are easily overlooked because the taut muscle fibers only minimally restrict the range of motion of the knee and because the TrP may not produce pain, but only dysfunction. The vastus medialis is often a “quitter.” After several weeks or months, the initial pain phase of its TrPs changes to an inhibition phase. The pain is then replaced by unexpected episodes of quadriceps weakness that produce buckling of the knee.1
Treatment of the Vastus Medialis TrP
Note—it’s important to use your reference points, point of pain, the Thomas test, FABER test and length of the adductors.
You may need to repeat each step until the length and pain are changed. I am happy to report this client was 100 percent better after one treatment.Editor's Note: Debbie’s next two articles will focus on the last two muscles of the quadriceps femoris group, vastus intermedius and vastus lateralis.