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SOAP Notes: It's Time for a Cleaning
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
The Potter's Wheel: Reflections on Practicing in a Technology-Driven World
In my very early years of practice, an older patient named Cora would call me at home, usually late Sunday night after she had consumed an unknown quantity of beer.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
What the Science Says About Magnesium Stearate
It's often been said that scientific studies can be used to support just about anything. But discoveries are never made one study at a time.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Side Effects From Big Pharma: Wellbutrin – Dangerous for You and Your Baby
Are some of your pregnant patients taking Wellbutrin? If so, it could be a danger to them and their baby. This drug is extremely popular, but it has a serious history.
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Research Abstracts From the Journal of Manipulative & Physiological Therapeutics
Effect of Pain Relief on Lumbar Muscle Function and Activation; Effects of Thrust Amplitude and Duration of HVLA Spinal Manipulation; Immediate Effects of Upper Thoracic Manipulation on Cardiovascular Response.
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
A Building Block of Healthy Aging
Coenzyme Q10 has gained enormous attention in recent years, and with good reason —it's the Energizer Bunny of the cellular world.
Some Thoughts on the TMJ
The temporomandibular joint is an interesting and dynamic articulation that can cause a lot of problems.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
We Get Letters & E-Mail
Patient Perception and the Farce of "Fast Relief"; A Fly in the Ointment; Persecuted for Choosing to Practice Chiropractic.
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Are They Finally Fixing Medicare Reimbursement?
Even with federal sequestration cuts taking effect in March, including a 2 percent reduction in Medicare reimbursement to health care providers, hope may be on the horizon in the form of a much-anticipated, perpetually suggested overhaul of Medicare's Sustainable Growth Rate formula, which serves as the basis for determining physician reimbursement.
Have a Heart: Say No to Soda
It's not enough that soft drinks and other sugar-sweetened beverages have been linked to cavities and weight gain, among other negative health consequences.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
News in Brief
Controversial Florida PIP Law Under Review; D'Youville Chiro. Students Learning Art of Co-Managing; And the Award Goes To...; F4CP Recognizes Major Contribution by ChiroTouch.
Remembering Joe Weider (1920-2013)
With the death of Joe Weider, the world's most famous body-building visionary, crusader, fitness magazine publisher and icon, on March 23, 2013, chiropractic has lost one of its greatest friends and supporters.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
Why You Should Get to Know the National Vaccine Information Center
Barbara Loe Fisher has been a diligent advocate for providing parents with the information necessary to make informed decisions regarding the usage of vaccinations for their children.
Going Shoeless: The Pros & Cons of Barefoot Running
With the subculture of barefoot runners and the products catering to them growing daily, just about every chiropractor has been asked at one point or another about their opinion regarding barefoot running.
Medicine Presents: A Great Opportunity
The changing nature of health care presents both opportunities and challenges. While we tend to focus on our profession, we can sometimes forget the impact other health care professions can have on us.
What They Don't Say Could Hurt You
I have written previously regarding the difficulties of drawing information from patients who are poor historians, forgetful or just plain uncooperative. The thought to revisit the topic occurred recently during preparation for an upcoming seminar.
Correcting Kid Logic in Health Care and Research Design
A recent broadcast on public radio described a fascinating phenomenon known as kid logic.
April, 2011, Vol. 11, Issue 04
Putting Insomnia to Sleep: Using Cranial Techniques
By Sharon Desjarlais, CC
Have you ever been home alone late at night when a tiny creak in a floorboard suddenly becomes a gunman breaking in? That's your reticular activating system (RAS) triggering an adrenal response that's preparing you to fight or flee.
The RAS helps the body instinctively deal with issues of fear and survival. Unfortunately, it can't always distinguish between real and imagined threats. And according to Amy Lewis, LMT, an Upledger-trained CranioSacral Therapist, that dynamic is at the heart of much of the insomnia she's seeing now in her clients.
Insomnia, which means "no sleep" in Latin, is one of the most common sleep complaints among Americans. According to the National Center on Sleep Disorders Research at the National Institutes of Health, some 30 percent to 40 percent of adults report symptoms of insomnia within a given year, while about 10 percent to 15 percent report chronic insomnia lasting months or years.
"Insomnia comes in cycles that line up with our stress levels," Amy says. "I see it a lot in clients who present with complex pain patterns. But look at the stress that's happening worldwide. Then take that down to the level of the state, the county, the city, the neighborhood, the family and the individual. Add all that up and you've got recurring cycles of insomnia."
While individual cycles and sources of insomnia may vary, Amy believes it ultimately comes down to the RAS, which Dr. John Upledger referred to as the "reticular alarm system." Located in the ventricular area of the brain responsible for regulating arousal and sleep-wake transitions, the RAS is the filter for everything in our lives that's "coming at us," she says. That's why, with her insomnia clients, she focuses on cranial techniques that are known to affect the RAS.
Three Cranial Techniques That Relax the RAS
One of Amy's favorite techniques for relaxing the RAS is the "CV4." Named for its ability to compress the fourth ventricle, the CV4 is performed at the occiput to subtly stifle the expansion of the craniosacral system as it cycles through the phases of filling and emptying cerebrospinal fluid, which therapists can palpate as the cranial rhythm.
When you bring this rhythm to a "still point," fluid pressure builds in the membranes that surround the brain and spinal cord. By stretching these membranes ever so slightly, the fluid gently flushes the craniosacral system and moves the autonomic nervous system from a highly aroused sympathetic-dominant state to a relaxed parasympathetic-dominant state.
"What's different about using cranial work this way is its gentle, non-invasive nature," Amy says. "If I don't plow in there with my hands, I don't create a backlash or a rebound effect in the tissues, muscles or brain. I'm simply amplifying the parasympathetic nervous system. So we're moving from the adrenal fight-or-flight response to a parasympathetic response. We're just slightly moving that little diode on the scale."
Another technique Amy uses to address insomnia symptoms is called "cranial pumping." To perform this technique, you find a place on the client's body where you're comfortable feeling the cranial rhythm. The rhythm reflects the motion of flexion and extension, which signals the filling and emptying of cerebrospinal fluid as it cycles through the craniosacral system.
Amy likes to palpate at all the cranial listening stations, which are areas of the body that can quickly give you a general evaluation of the cranial motion: the heels, dorsa of the feet, anterior thighs, ASIS, ribs, shoulders and several holds at the cranium.
After feeling the rhythm for about three to five cycles, you begin to gently "nudge" the rhythm a bit further. "But you do it so subtly," Amy says. "There's not even any physical movement. You're really doing it with your thoughts and intention to create what feels like a ripple of Saran wrap over water."
By then tuning into changes in the symmetry, quality, amplitude and rate of the craniosacral rhythm, you can bring the body into greater balance. And that helps expand the internal stress threshold so the RAS is less likely to leap into hyper vigilance.
The Rock and Glide
The third cranial technique Amy recommends for insomnia is called the "Rock and Glide." With the client lying supine, place one hand under the sacrum and one under the occiput. Then tune into the rocking motion the dural tube makes to see how it feels. "I'll follow it for a few cycles and then give it a very gentle nudge, about 1 to 5 grams, with my intention again. This helps release the transverse fascial rings of the dural fascia."
For the "gliding" aspect, place your hands in the same position and focus on the longitudinal glide of the occiput and sacrum as it moves in flexion toward the feet and then back toward the head. "As I tune into the gliding motion and it reaches the sacrum, I begin to nudge with 1 to 5 grams of traction toward the feet while I hold the occiput in neutral. Then as the motion glides toward the occiput, I give another little nudge toward the occiput with slight traction while I hold the sacrum in neutral." You may do this for several cycles.
"The glide helps with nerve roots and lengthening of the dural tube, but I think of it as a relaxing cosmic cradle," Amy says. What a soothing way to help your clients get a good night's sleep!
Click here for more information about Sharon Desjarlais, CC.
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