Trending: CBD / Hemp Oil
A recent survey of DCs regarding cannabidiol (CBD) / hemp oil provides food for thought as to the viability of CBD-based products as a component of chiropractic patient care. Here are some observations from the executive summary of the survey:
Confessions of a Former Drug Rep: Statins Are Endangering Your Overweight Patients
As I sit at my desk on the sixth anniversary of my successful liver transplant, I can't help but reflect on what caused that life-threatening ordeal. Looking back on my personal situation, I want to offer my insight into what is happening routinely to many patients.
NCCAOM: A Route to National Certification
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is offering a route to achieve national certification—without having to take any of the NCCAOM exams. This is specifically for California licensed acupuncturists that meet the eligibility requirements.
A Resting of the Soul
In my pursuit of being a skilled health care provider, I focus on reading journals, attending classes, staying current on medicinal research, and choosing the correct billing codes. However, most of us would never have started down this career path if there wasn't something more.
Autoimmunity, Gut Health and Diet: Connect the Dots
According to the National Institute of Health (NIH), autoimmune disease is recognized in approximately 24 million individuals in the U.S., consisting of more than 80 various disorders that contribute to the top 10 causes of death in female children and women of all age groups.
Facebook Marketing 101
Many of the health care practitioners we work with have smaller practices. The provider tends to wear many hats – office manager, salesperson and healer.
The Secondary Insurance Plan
I have a patient that has Medicare, but also has a secondary insurance plan that does cover acupuncture. How do I bill Medicare to get a denial so that I may bill this secondary payer?
News in Brief
WFC Among Founding Members of Global Rehab Alliance; HealthSource Selects GoChiroTV as Exclusive Digital Signage Partner; Western States' Online Degree Programs Among Best in the Nation; Logan University, University of Missouri-St. Louis Forge Partnership.
Vaccines & Autism (Part 1)
It turns out chronic inflammation is the driver of autism expression. Unfortunately, those who emotionally embrace the vaccine issue rarely, if ever, consider this relationship, which hinders a rational view of the vaccine issue.
Art of the Associateship: It's OK to Trust, But Verify
Trust is a valuable part of any business relationship. It serves as the foundation for all business operations and ultimately long-term success for owners, employees and customers. This is especially true in the world of health care.
#TechPain: Causes, Solutions
For the past several decades, the science of ergonomics has blossomed. The workplace is much safer and life is generally more pleasant thanks to the application of ergonomic principles.
The Certified Practitioner
Certified Chinese herb practitioners often identify themselves with the credentials "LAc" (Licensed acupuncturist).
Why the Automatic Denials for Modifiers 25 and 59?
Your experience is one shared by many chiropractic providers who bill through those plans. It appears to be the national trend, but by far is more prominent in Texas and Illinois.
A Bold Strategy to Take Chiropractic to New Heights
Building public awareness of an entire profession requires strategic planning – especially when it pertains to the exploration of ground-breaking marketing tactics that target new audiences with key messaging about the value of chiropractic care.
Reducing Hip, Knee & Shoulder Replacements (Part 2)
In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation.
UnitedHealthcare Can't Seem to Keep Chiropractic Down
AA decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven.
The Classical Texts & Integrative Medicine
The acupuncture profession has been undergoing many changes in the past years. There has been a shift towards a more integrative approach to medicine as more hospitals include integrative departments.
The Hidden Hip in LBP: Critical Screening Tests
In 1998, Harvey used this test on 117 elite athletes and found excellent interrater reliability to differentially assess iliopsoas, quadriceps or TFL/ITB tightness.
Blockchain Health Records?
Keeping data secure has become a nightmare for the average consumer. Just consider general user account hacks on Yahoo (3 billion records compromised), eBay (145 million records compromised) and Facebook (87 million records compromised), to health record breaches involving Anthem Blue Cross (78 million records compromised) and TRICARE (almost 5 million records compromised).
It's All About That Ki
As an industry are we shifting too much toward a Western mind set? We strive to understand how acupuncture works using imaging and extensive studies. We spend numerous hours of our training learning Western medicine and learning to speak their language. What happened to our core though?
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
Treating Pain With Nutrition
Back in 1910, when D.D. Palmer published The Chiropractor's Adjuster and introduced the world to what he called the "triad of health" – thoughts, trauma and toxins – he explained that the body can only be made optimally healthy if all three aspects of health are addressed.
Why Take X-Rays When You Already Have an MRI?
Let's clear up the issue regarding the efficacy of plain-film studies when an MRI study has already been performed. I review imaging studies primarily for chiropractors, and often their patients have been to other health care providers before finding their way to a DC.
Help Shape the New Neck Pain Best Practices Guideline
The Clinical Compass (originally the Council on Guidelines and Practice Parameters – CCGPP) has issued a call for interested chiropractic clinicians to help shape a new best practices guideline for chiropractic care of neck pain.
Doc, Are You a Social Media Holdout? Your Future Is Now
Whether you like it or not, to compete in any business, even chiropractic, you really should know and consider using social media. It is no longer a small, sleepy, local world we live in; it has become a far-reaching community.
Valuable Adjunctive Therapies
Based on the latest CDC statistics, more than 795,000 Americans have strokes per year, 140,000 of which are lethal. Approximately 87 percent of all strokes are ischemic with an estimated health care and missed work cost of $34 billion annually.1
CBD for Athletes: The Advantages of Cannibidiol
For athletes, pain is often part of their sport or activity. And to a certain extent, it is to be expected. However, after pushing themselves to the limit, soreness and fatigue set in, hampering their ability to perform and recover.
End of Life Treatment
TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
The Three Types of Ankle Sprains
The majority of ankle injuries involve sprains to the supporting ligaments of the ankle. Most occur to the ligaments on the lateral side of the ankle and are generally referred to as inversion ankle sprains because it is excessive inversion that causes the sprain. There are two other ankle regions that are also susceptible to ligamentous sprain: the deltoid ligament complex on the medial side of the ankle and the distal tibiofibular syndesmosis above the ankle joint. Let's examine some key factors associated with each of these injuries.
Spain #1: Lateral Ankle
Inversion ankle sprains affecting the lateral ligaments are often considered the most common lower extremity soft-tissue injury. The architecture of the leg and foot bones as well as the smaller size of these ligaments make them more vulnerable to injury. The primary function of the lateral ankle ligaments is to resist excessive inversion of the ankle. Yet for this important role, these ligaments aren't as strong and resilient as those on the opposite side of the ankle. That is one of the reasons that inversion sprains are much more frequent than eversion sprains.
There are three primary ligaments that make up the lateral ankle ligament complex. Their attachment points are easy to identify, as the ligament names designate the two bones they connect. These three key ligaments are the anterior talofibular (connecting the talus and fibula), posterior talofibular (also connecting talus and fibula), and the calcaneal fibular (connecting the calacaneus and fibula). Of these, the anterior talofibular and calcaneofibular are the most commonly injured with the inversion ankle sprain (Figure 1).
Excessive inversion is the most likely foot movement that sprains these ligaments. However extreme plantar flexion, especially if combined with inversion, is also a likely contributor to inversion ankle sprain. A common example of lateral ankle sprain is stepping off an elevated surface like a curb, or stepping down into a hole where the foot is both plantar flexed and inverted.
Alignment of the foot and ankle complex is essential to transmit body weight and ground reaction force through the foot and ankle region. Once the foot turns inward, it is no longer a stable base of support and the entire body weight magnifies the force these ligaments have to resist.
When a person has sustained an inversion ankle sprain, the primary goal is to prevent any excessive movement during the ligament's healing so scar tissue can knit the torn fibers back together and maintain as much stability as possible. Deep friction techniques are often advocated to treat an ankle sprain, with the theory being that it can help reduce fibrous scar tissue that might adhere the healing ligament to adjacent soft-tissue. There has also been some speculation that friction massage may aid in fibroblast proliferation to help repair damaged tissue.
Sprain #2: Medial Ankle (Deltoid Complex)
On the opposite side of the ankle is the deltoid ligament complex. It is sometimes just call the deltoid ligament, but it is actually a group of four separate ligaments. The name deltoid refers to the fact that as a group these ligaments make up a triangular shape, which is the Greek letter Delta.
The four separate ligaments that make up the deltoid group are the anterior tibiotalar, tibiocalcaneal, posterior tibiotalar, and tibionavicular (Figure 2). Similar to the lateral ankle ligaments, the names of these ligaments indicate which two bones they connect.
A sprain to the deltoid ligament complex is also referred to as an eversion ankle sprain because it is excessive eversion that causes the injury. There are two main reasons why eversion ankle sprains are less common than inversion sprains. First, the deltoid ligament group is much stronger than the lateral ankle ligaments. Second, the fibula extends farther distally on the lateral side of the ankle than the tibia does on the medial side. Because of this further extension, the fibula blocks the foot from moving to that side during eversion movements and consequently generates greater ankle stability against excessive eversion.
If the deltoid group has been stressed to the point of ligament injury, there were most likely excessive forces to the ankle to produce that injury. As a result, there are frequently other structural injuries that occur along with deltoid ligament sprains, such as fracture or dislocation. If your client sustained an injury sufficient to damage the deltoid ligament group, it is a good idea to have them evaluated by another health professional to make sure there aren't other serious injuries along with the ligament damage.
Sprain #3: Syndesmosis
A third group of ligaments are sometimes injured in what is called a high ankle sprain and involve connective tissues that are superior to the ankle. These injuries involve the syndesmotic ligaments that bind the distal tibia and fibula together. The webbing of connective tissue that binds the distal connection of the two leg bones includes the anterior inferior tibiofibular ligament, the distal posterior tibiofibular ligament, interosseous ligament, and the interosseous membrane (Figure 3).
It is not that important to memorize these individual ligament names. The most important characteristic to remember is there's just a tight webbing of ligamentous tissue binding the ends of the tibia and fibula. In addition, the joint is also bound by the interosseous membrane which spans between the tibia and fibula throughout the lower leg.
Injuries to the ankle syndesmosis are most likely to result from excessive rotation of the ankle (adduction or abduction of the foot), extremes of dorsiflexion, or combinations of dorsiflexion with adduction or abduction. In some cases the shearing and twisting forces applied to the ankle not only damage the distal syndesmosis ligaments, but can transfer through the interosseous membrane of the leg and cause damage much higher up than the ankle.
The type of injury that produces syndesmosis sprain commonly occurs in sports played on turf with cleated shoes. For example, suppose an athlete has a cleated shoe that digs into the turf and keeps the ankle relatively immobile. If that person falls forward (causing dorsiflexion of the foot) at the same time that s/he is attempting to turn to the side (causing rotational stress in the ankle), injury to the syndesmosis is likely.
The common lateral ankle ligament injuries are usually not difficult to identify because the injured ligaments are superficial, making their palpation much easier. However, in the syndesmosis joint, palpation of the injured ligaments is not easy because other soft tissues obscure the ligaments.
Unlike the medial and lateral ankle ligaments, the syndesmosis ligaments are not as easily palpated, and are also not as easily treated with soft-tissue therapy. The toe extensor and foot dorsiflexor tendons lie superficial to the distal syndesmosis, so any pressure in this area has to work through those tissues first.
It is valuable to have a good understanding of ankle mechanics and location for these different ligament structures. Recognizing the forces required to cause certain types of injury can help pinpoint the type of tissue involved and allow us to direct our treatments most appropriately.