A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
Multiarticulate Muscles & Injury: Understanding the Mechanical Load
Muscles have a primary role in creating and limiting movement in the body. They are also the major focus of our work in massage therapy, with many injuries caused by improper loads on the muscular system. There are key facets of analyzing a muscle's mechanical load that are essential in both assessment and treatment strategies.
One factor that is important for recognizing excess loads is how many joints the muscle crosses. The more joints a muscle crosses, the more complex its load management becomes. Many muscles, such as the supraspinatus, span a single joint and are only responsible for creating movement across that joint.
Other muscles - such as the hamstrings, biceps brachii, or finger flexors - cross more than one joint. A muscle that crosses more than one joint is called biarticulate or multiarticulate. A biarticulate muscle, like the semitendinosis, crosses two joints. A multiarticulate muscle, such as the flexor digitorum profundus in the hand, crosses two or more joints (Figure 1).
During a concentric contraction, a muscle shortens and its two ends move toward each other. However, movement is not that simple. We accomplish most movements because the limb, or body region that one end of a muscle attaches to is held stationary. The limb at the other end of the attachment moves toward the stationary limb as the muscle contracts.
Multiarticulate muscles' actions are even more complicated because these muscles' actions occur across two or more joints. Some multiarticulate muscles have similar actions across all the joints that they span. For example, the flexor digitorum profundus creates flexion at the wrist as well as flexion of each finger joint it crosses. The hamstrings, on the other hand, create extension at one joint (the hip) and flexion at another (the knee). Muscular problems involving multi-articulate muscles must take into consideration how these muscles are contracting or stretching over all involved joints.
Multiarticulate Muscle Capabilities
One of the unique capabilities of multiarticulate muscles is that they can generate force without changing their length while motion is occurring at a joint. Definitions of an isometric muscle contraction state that it is one in which the muscle generates force, but there is no change in the muscle's length and no motion occurring at the joint(s) the muscle crosses. Interestingly, multiarticulate muscles are capable of isometric contraction (no change in muscle length) while motion is occurring at the joints they cross. Let's look at how that could occur.
Consider the hamstrings, a multiarticulate muscle which both extend the hip and flex the knee. Suppose that during a squat the hamstrings are engaged to contract and the amount of hip flexion (which we would think of as lengthening the muscle) exactly matched the amount of knee flexion (which we would think of as shortening the muscle).
These two joint actions could cancel each other out in terms of how the movement affected the overall length of the muscle. Then there would be no change in muscle length even though there was a contraction engaged and motion occurring at the joint. That example is a bit of a thought puzzle, but it does help us understand how multiarticulate muscle function is clearly more complex than simple one-joint muscle actions.
A muscle's ability to generate force throughout its range of motion determines its relative strength. One disadvantage of multiarticulate muscles is that they can't generate maximum force over their entire range at the same time. This phenomenon is known as active insufficiency. Let's look at an example of how that works:
Begin with your wrist in full flexion. Then try to close your fingers and make a tight fist (Figure 2). The flexor muscles of the hand produce flexion of the wrist, hand and finger joints to help us grasp things. However, when fully flexing the wrist, grip strength is reduced because the flexors can't produce maximal flexion of the fingers when the wrist is already flexed. The limitation of simultaneous finger flexion with wrist flexion is because of active insufficiency. It happens because the muscle can't contract strongly over all these joints at the same time.
In clinical practice the problem of active insufficiency may lead to other problems. For example, suppose you were performing a resisted contraction of the hamstring muscles with the client prone, such as you would with a proprioceptive neuromuscular facilitation (PNF) stretching technique. It is common to produce a cramp in the hamstrings when contracting the muscle in this position. The cramp most likely occurs when the knee is close to fully flexed (past 120 degrees). With the hip extended (by lying prone) the knee does not have much range over which to contract (active insufficiency) and the contraction against resistance initiates a cramp.
Multiarticulate muscles also have another limitation called passive insufficiency. Passive insufficiency is simply the opposite of active insufficiency. It means that a multiarticulate muscle can't stretch to its fullest length across multiple joints at the same time. Most people experience this in a clinical setting when performing a straight leg raise movement to stretch the hamstring muscles. Notice that a greater degree of hip flexion is possible when bending the knee. If the knee remains extended, the hip can't be flexed as far because of the limitations of stretching the hamstrings over the hip and knee joints.
We often learn muscles and their actions as simple movements, and mainly for rote memorization of attachment sites and actions. However, movement analysis is much more complex and involved in real life. Incorporating key biomechanical concepts in your clinical decision-making process makes you a much more effective practitioner. Recognizing the roles and limitations of multiarticulate muscles helps inform assessment and treatment strategies for the most beneficial outcomes.