resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
January, 2014, Vol. 14, Issue 01
The "Sacs and Tubes Theory of Stress"
By Dale G. Alexander, LMT, MA, PhD
In 1996, while considering the treatment principles I had accumulated from many advanced trainings throughout my clinical career and the results they had produced for my clients, a deeply intuitive experience of anatomical understanding inspired me to conceive of the human body as composed of mostly sacs and tubes:
Integrating this personal epiphany with an understanding of Han Selye's General Adaptive Syndrome, my clinical thesis became clear: in response to "stress," the sacs around organs "cringe," while the tubes within them and between them "shorten and narrow and often twist." The intensity, duration and repetition of the stressor(s) are all relevant variables which may be reflected in the "degree" of these internal responses.1,2
As most body tubes are comprised of longitudinal and circular fibers, this notion of shortening and narrowing was not such a big theoretical leap.3 The notion of the "cringing of the sacs" was initially a "felt sense" of my own body's responses to positive as well as negative anticipation. Yet, supporting anecdotal evidence emerged recently when a client who had been a biology teacher for 35 years reminded me that during dissections of live frogs, the frog's heart would swell to twice its size when the pericardial sac was retracted.4
What are some of the possible effects of this proposed cringing, narrowing and shortening? To my perception, this clinical insight provides a credible explanation for the downward and forward pull of the head upon the neck, so often referred to in our profession's literature as forward head position. Let's take a look inside the body to appreciate just how many structures, especially viscera, are suspended from the anterior portion of the axial skeleton and have specific, palpable soft tissue linkages back to the cervical spine.
My understanding of the following anatomical references are based on seven years of study with Dr. Jean Pierre Barral DO, developer of the Visceral Manipulation approach to bodywork. I do wish to again gratefully acknowledge his dedication to articulating precise anatomical landmarks from his work with cadaver dissections and his ongoing exceptional teaching to the breadth of all professions that comprise the manual therapy field.5 His therapeutic ideas and anatomical assertions have been core to what has assisted me to help so many.
During embryological development, the heart and diaphragm muscle descend from C2 and remnant fibers to this origin remain throughout our lives. Less appreciated is that the heart and the diaphragm muscle are like siamese twins, conjoined at the inferior pericardium and central tendon of the diaphragm, meaning that one would have to cut them apart to separate them. The heart and lungs are suspended down and forward from the anterior surfaces of C4 - C6 by an overlapping system of suspensory visceral ligaments.
The liver is suspended down from the caudal surface of the diaphragm muscle via the coronary ligament which as noted above is related to C-2. In women, the uterus receives suspensory support from the contiguous relationship between the falciform ligament of the liver and the round ligament, which is composed of the obliterated umbilical arteries and veins.5 From C2 and from C4, 5 and 6 and all the way to the pelvic floor in women, any one of these relationships is symptomatically and therapeutically significant and when one considers that these viscera may become increasingly immobile and congested due to trauma or disease, they can become essentially "dead weight" pulling downward and forward on the cervical spine.
And, if this wasn't significant enough, my clinical work with clients suggested there was another anatomical linkage that can literally pull the "head down upon the neck" and that is the length and tension of the esophagus which is moored from the basilar portion of the occipital bone and then descends down and forward through the mediastinum and esophageal hiatus of the diaphragm becoming the stomach.6,7
The esophagus is a muscular tube composed of circular and longitudinal fibers. Imagine its fibers shortening and narrowing. Given its superior mooring from the cranium might esophageal tensions relate to clients presenting with recurrent headache patterns, neck pain and upper back symptoms?
Just stop for a moment and remember the last time you were highly nervous or anxious. For many of us, this provokes tension within our stomachs. What hasn't been considered is that a contracted esophagus may communicate this tension all the way up to the base of our craniums.
How might these combined vectors of compression affect the delicate nerve fibers exiting the brain, especially the vagus nerves and the superior origins of the sympathetic chain ganglia? How might the jaw respond to such a downward and forward pull? How might such compression rippling down the length of the human spine contribute to how easily our bodies congest fluids?
I perceive all of these anatomical actors flow from one to the other influencing our bodies' strain patterns that are reflected in our clients' presenting chronic symptomatic profiles. Now, also please consider that the right crus of the diaphragm literally wraps around the esophagus. Netter's anatomy plate #253 clearly shows this. What is not so commonly appreciated is that this aspect of the right sided diaphragmatic crus is contiguous with the ligament of Treitz which superiorly adds support to the 20 -25 feet of the small intestine by hooking around the douodenal-jejunal flexure.8,5
Might cringing of the peritoneal sac, the shortening and narrowing of the small intestine and the tension of the longitudinal fibers within the esophagus itself in combination be related to the incomplete closure of the cardiac sphincter more commonly known gastroesophageal reflux disease or GERD?7
Next, consider the mesenteric root of the small intestine which is moored down, forward and diagonally from the left anterior face of L2 all the way to the right sacroiliac joint.9 Given the diagonal element of this anatomical relationship, might the compressive force of chronic stress be a co-conspirator in chronic low back dysfunction and pain and be related to torsional elements so often found when one assesses the osseous landmarks of the pelvis?
The connections of the mesenteric root includes the same douodenal-jejunal flexure noted earlier so we actually have a proposed anatomical routing of manipulable soft tissue from the sacrum to the cranium in both genders. Little wonder the head is pulled down and forward for so many of us in response to how our "innards" react to stress.
We need to additionally appreciate the role of the flexor-extensor reflex systems in chronic somatic dysfunction. The downward and forward pull of the above described anatomical relationships will eventually and inevitably activate their respective reflex systems constantly. These reflex systems are governed by subcortical elements of our nervous system and, as such, we do not register their activation consciously or proprioceptively until something within the kinetic chain of the axial skeleton becomes dysfunctional. Once this occurs, whatever the reason, it is the job of the soft tissues to protect the joint or joints in distress usually by contracting along a continuum until they spasm, which really gets the person's attention.10
It is my assertion that the described anatomical relationships and the constantly activated flexor-extensor reflex system when viewed as a dynamic whole are prime contributors to the progression of osteoarthritis and joint degeneration in both the axial and appendicular skeleton.
These relationships allow us a novel view of our internal architecture. They also allow us in particular to re-consider the means by which progressions of dysfunction toward pathology may proceed. Principle among these stealth physiological progressions that underlie many chronic somatic problems are cardiovascular disease, cervical stenosis and gall bladder dysfunction/disease.
Compression, congestion and coordination or, more precisely, dis-coordination are a simple way to conceive of the downward spiral in the quality of our lives as we age and, how such progressions are related to "chronic stress."
Stress provokes cringing, shortening, narrowing and twisting functionally, "inside of our bodies." The soft tissues of the body support whatever comes to be the new normal. We can get used to damn near anything as human beings. That's the good news and is testimony to our species' adaptive capacities. The bad news is that once we do adapt, our bodies reflexively resist a return toward normal function.
As massage therapists who have a desire to assist clients to resolve their chronic somatic dysfunctions, it is our task to learn how to relieve these intrinsic forces of compression and to facilitate the movement of bodily fluids to redistribute areas of stagnant congestion. We can learn to assist the nervous system to re-coordinate its nerve and blood supply to include all the body tissues again and assist it to re-coordinate the movement of our body parts. When these skill sets expand, wondrous possibilities for healing emerge. I have seen this thousands of times. It is an amazingly satisfying experience.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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