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News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
July, 2014, Vol. 14, Issue 07
Following the Body's Clues
How 29 minutes of massage therapy changed a life.
By Debbie Roberts, LMT
There was a higher power at work when I helped Marianne. You know as a therapist when you jump right in and try to help someone and all your efforts work, but you are not entirely sure why.Then your mind is reeling in the possibilities of what just happened, followed by you can't wait to get your nose into a text book to further investigate how exactly you made those dramatic changes. A twenty-nine minute demonstration at a massage therapy conference using a gross cervical movement screen, a piece of equipment that allows firm pressure and my hands led the way to an incredible, life changing event for my volunteer, Marianne.
On January 5, 2012, Marianne and five of her children were in their minivan stopped about 10 cars away from a red light. She was one and a half car lengths away from the car in front of her. Her two-year-old had just woken up and they all had turned around to give the child attention, when they were hit from behind and then shoved forward to hit the car in front of them. The driver was texting while driving and the approximate speed was 55 miles per hour on impact. She was knocked unconscious from the whiplash as her head did not hit anything during the accident. She became conscious as they were prying her foot from underneath the gas pedal. She was taken to the emergency room and a CT scan of the neck was performed. She was told nothing was broken, given a muscle relaxer, pain medication and then sent home. The total ER visit was only about four hours. She woke up the next morning with varied symptoms. When she followed up the next day with the doctor, he referred her to a neurologist because he felt she had a severe concussion and a possible stroke because she had lost function in the right side of her face and neck.
In the two and half years of seeing the neurologist, he had prescribed every kind of medicine for migraines which never worked. She felt she wasn't being heard, that the headaches were not vascular headaches. He prescribed narcotics, muscle relaxers, ultra sound, tens machine and physical therapy. He also prescribed Botox for the migraines.
She started seeing a chiropractor who performed adjustments, Dural unwinding, myofascial release and cranio-sacral therapy. The treatments never seemed to last. "I got more relief in the 30 minute demonstration than in the 29 months of medical care, physical therapy, chiropractic care and not to mention the $100,000 I have spent elsewhere," said Marianne.
By now I am sure you are wondering what on earth did I do so different than the other well intentioned skilled therapist and doctors? How did I know I had helped her? As a group, we looked at her range of motion of flexion, extension, side bending and rotation. Well, she had none. Yep, you heard me none. In order to drive, she turned her whole body. After two years, she literally had no motion to her cervical spine to look in any direction and she was forced to move through her thoracic spine. I was very nervous to work on her after she revealed her history and by observation her neck appeared to have permanent damage. The other thing that was odd, nothing showed up on the MRI to indicate such severe damage that would be contributing to this kind of loss of motion.
Addressing the group, I talked about changing muscle inhibition left over from an accident and how to approach the injury using isometrics for neuromuscular re-education of the mechano-receptors. The importance and value of taking the movement screen, also that I didn't have any preconceived notion that in 30 minutes what changes I could make. In other words, I was willing to fail.
I began doing the demonstration placing the cranial device under her T-spine, doing soft tissue work to the scalene muscles and trapezius. I then tried some very light isometrics with no post-isometric stretch to see if I could help re-set the mechano-receptors and encourage length to the scalene, SCM and trapezius muscle. I didn't stretch the neck because she grimaced every time I moved her neck in the slightest. The direction of lateral flexion with the isometric set off her pain pattern over the right eye. Since this elicited the pain pattern of the stroke, I didn't do any further cervical isometrics.
I continued the demonstration and used the cranial device to support the neck and let her doing some gentle rocking to her tolerance. The place I always go looking when someone has severe headaches is the first rib. Hers was very prominent and had no motion on springing. Leaving the cranial device at approximately T2-3, I explained that first rib dysfunction can give a lot of headaches and hers felt really elevated and fixed. I used the technique of positional release which uses the elbow and forearm to guide the humerus lateral to medial towards the spine to influence the first rib, asking the typical question of any pain or discomfort, and there was none. I then asked her to put her head in a slight rotation to the side of dysfunction and placed my left thumb over the rib head and asked her to make an isometric contraction of the forearm adducting to her side. I pulled the scapula out further with her head in the same position and asked her to contract again. I repeated the above about four to five times. I also rolled her onto her side just far enough to place the cranial device at the level of T3-4 along the rhomboids and middle trapezius using my fingers began a posterior to anterior push. I repeated the lateral to medial positional release into the spine and finished again with her on her back the cradle resting under her neck this time and repeated the downward adduction of the humerus into her side.
By now, they were flashing the lights at us to end the demonstration. She sat up carefully and I stopped the crowd that was trying to leave and said, wait we need to see what it is we accomplished. You assess in the beginning and at the end of every session don't you? I don't know who you could have picked up off the floor first, her or me. She flung her head back into extension; easily tossed her chin to chest into flexion without difficulty looked over her shoulder, and with some reservation accomplished about 20 degrees of side bending. She continued to take her head from flexion to extension because it was so exciting. It happened so fast, I grabbed her and said don't do that. I was so taken back by the amount of motion I was afraid she would hurt herself somehow or undo what I had done.
What had I done? I went to one of my resource reference books, An Osteopathic Approach to Diagnosis and Treatment, third edition. There, in chapter 78 Practical Applications and Case Histories of the Thoracic Cage, I found just what I was looking for. An explanation and a case history of something very similar to what I had experienced. I also called one of the author's to get her input into the somatic dysfunction of the first rib.
She explained that the first rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress and posture, as well as by the dysfunction of the C7-T1 complex. The patient may complain of "shoulder" pain, stiff neck, upper back or neck pain, and here it is an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. Since the anterior and middle scalene muscles assist in raising the first rib, they can also compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms.
What I had accomplished was helping a first rib dysfunction that was hung up on the C7-T1 vertebra. The whiplash injury with the head turned to look in the back seat created an eccentric load to the scalene and trapezius. The force was so great that it displaced the first rib. I used the cranial tool at approximately the C7-T1 vertebra in a posterior to anterior position and I was able to use isometrics and positional release lateral to medial resulting in a release of the first rib.
I encouraged Marianne to continue to get body work done to the scalene's, trapezius, rhomboids and SCM to decrease the hyper tonicity. This will help to encourage the first rib to have better motion. Massage therapy is not an exact science that is why we have so many modalities to choose from. I wasn't sure I would be able to help, but I was willing to be vulnerable and fail. Marianne is eternally grateful I tried.
Click here for more information about Debbie Roberts, LMT.
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