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.
A Postoperative Story: The Surgery Explained & Secrets to My Recovery
I'm back for another year! Hope yours is off to a good start. In my previous column (A Postoperative Story: Part 2 of the Hip Replacement) I described the incision made for my posterior approach hip replacement surgery.
If working with a joint replacement patient, be sure you know the rehabilitation protocols of the particular appliance. If you don't, with permission, consult with the surgeon to learn them. Otherwise, stay away. Most have range of motion (ROM) and direction of pressure limitations. Remember, do no harm.
Once the incision is made, the hip joint is then dislocated and positioned to remove a portion of the femur. A hole is then drilled down the center of that bone, and the appliance is inserted. The lateral aspect of the greater trochanter is undisturbed, and the rest of the deep six external rotators (medius and minimus) are not cut.
Then the acetabulum is routed out and the new socket is installed. Now the femur is repositioned, forced into the new socket and moved around to check appliance tightness and overall fit. Mine was too tight, so it was again dislocated and a different sized appliance was installed. The surgeon was then satisfied with the fit and function and "sewed me up." Just think about the stretch and strain that puts on the muscles and fascia of the hip and thigh. Yikes!
Sadly, medical establishments don't see any need for soft-tissue therapy after these manipulations. All they give, unless one knows enough to ask for more, is ROM exercises and recommend walking. These are very necessary, but in my opinion inadequate for optimal results.
After the Surgery
They had me walking two hours post -op. At about six hours post-op they gave me my initial exercises. These consisted of bent-knee hip flexion, straight leg hip abduction, and bent knee hip extension.
I suggested straight leg hip extension and flexion, and was told I could do them as long as there was no pain. Ha, every-thing was painful initially, but those movements did not cause additional pain.
The physical therapist (PT) was concerned that straight leg extensions could cause back pain, and suggested not to do them if they caused any pain in my back. No problem for me. These exercises need to be done religiously multiple times a day. They recommended three times a day, but instead I did three sets of twelve reps three times a day, plus three reps of each every time I got up.
As soon as I awoke from the anesthesia, I started tensing and relaxing my hip extensors, as well as my internal and external rotators. I just tensed and relaxed the muscles slightly to get them firing and to cause micro movement around the new joint and incision. I continued with this as healing progressed until I was actually contracting against the resistance of the bed and a pillow between my knees with full strength. Now there was some movement allowed but only about 5 degrees. However, working up to three sets of twelve reps was building strength without getting out of bed.
I love exercises I can do in bed.
Once I could stand on my new hip relatively comfortably, using a counter top for balance, I started doing the ROM exercises with the non-surgical hip first, three sets of six reps each, then exercising the surgical side, working up to three sets of twelve reps. Again, these were bent knee hip flexion and extension; straight leg hip flexion and extension; and straight leg abduction. After three weeks I added reaching back and grabbing my ankle during the bent knee hip extension and pulling the ankle towards the hip (knee flexion) to stretch the quadriceps during the third set.
Walking – this may be the most important thing one can do. Every time I got up, even in the middle of the night, I did three laps around the kitchen and three reps each of the ROM movements. Keep those tissues moving as much as possible. Also, walk as much as you reasonably can post-op.
We typically adapt our gait to avoid pain when joint degeneration occurs. These incorrect patterns need to be replaced with proper, functional patterns. As this is a dysfunction unique to each individual, I recommend consulting with a PT or a provider good with gait re-patterning skills at about six-weeks post-op. Precise strengthening exercises will be a part of this. My PT recommended TheraBand resistance bands and ankle weights. From my estimation, hip abductors and extensors need the most work as they take the biggest trauma from the surgery. My surgeon did not offer this aspect of rehab, but when I asked for it he gladly wrote the PT referral.
Massage for Recovery
Remember, there is no longer any pain in the joint as it is not innervated, but the surrounding soft tissue and fascia are. Properly trained massage therapists are the ideal providers to address these traumatized tissues. As I wrote last month, Neural Reset Therapy (NRT) and manual lymph drainage (MLD) rapidly normalized the soft tissues and eliminated the pain. The scar tissue and traumatized muscle was easily treated early on, and therefore I do not have any pain or movement restrictions post–op.
That's my story and I'm sticking to it. I hope you have found it interesting and useful. I'll be back in the March issue—see you then for therapy tips that are painless for both the patient and provider, along with updates and opinions on the politics of the profession.