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National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
The Importance of Dosage in Manual Therapy
Research is slowly beginning to reveal the importance of optimal dosage in manual and movement therapies and it may surprise you (as it did me) to learn that very small variations in applied load (compression, stretch, etc.) can make the difference between a positive and a negative therapeutic outcome.
Recent studies have shown that variations in the:
This list should include other variables, such as whether a particular method is used alone, or in combination with others (say, stretching as well as effleurage) – and when employed with other methods - and in what sequence. In other words - how much is too much, and how much is too little?
Evidence is also emerging that the unique characteristics of the client/patient who is receiving treatment - the gender, age, past and present medical conditions, degree of physical fitness etc - are all factors capable of modifying the responses to manual treatment. (Dennenmoser, et al, 2016)
The following examples, taken from recent research studies by hand surgeons, offers us glimpses of the emerging evidence. Wang & Guo (2012) showed that quite different effects emerge when damaged tendons are mechanically loaded, for example, involving stretching. When 4% of tendon stretch was used, there was a reduction of collagen production and tensile strength of the tendon but an increase in catabolic (break-down) of tissues, slowing healing after trauma or surgery. However, 8% of tendon stretch increased collagen production (essential in the repair process) and the tendon's tensile strength, plus differentiation into tenocytes (needed for creation of new tendon tissue), while reducing formation of adhesions and inflammation. This encouraged more rapid healing after trauma or surgery. In contrast, a 12% stretch reduced collagen production and organization, while increasing inflammation, edema and tenocyte differentiation, slowing down healing after trauma or surgery.
That's the basic science, but it leaves a major (as yet unanswered) question: How are you to know the difference between loading tendons to match the ideal (8%), while avoiding the less effective degrees of load (4%, 12%) in practice, in a clinical setting?
Other examples of the clinical challenge of achieving an ideal degree of load during treatment emerge from another basic science study by Zein-Hamoud & Standley(2015). They report that, "The key components of the response to mechanical forces are fibroblasts, which [tend to] respond to different types of strain by secreting anti-inflammatory chemicals and growth factors, thus improving wound healing and muscle repair processes." They also note that, "Heterobiaxial, but not equibiaxial, strain affects fibroblast morphology - [likely due to]- actin, which mediates strain-induced cellular Ca++ release."
In their study involving fibroblast behavior during the repair of a damaged bioengineered tendon, these innovative scientists identified that:
The question arises again: How is a practitioner/therapist to know the difference between loading soft-tissues with the beneficial degree of force, approximately 6% compared with the less helpful 3% or 12% , in order to match these findings? Clearly many therapists get this right, and my personal experience and opinion is that methods that meet tissue resistance and engage restriction barriers heterobiaxially and non-forcefully (as for example in Myofascial Release, or gentle Muscle Energy Technique application), are closer to achieving the ideal, than those that employ more aggressive forms of load.
Of course, the examples described above only highlight the treatment part of the equation. There is of course another element; the nature of who and what is being treated. Dennenmoser et al, (2016), explain the results of research involving applied mechanical friction: "Electrical impedance...can be used to determine the amount of water within human tissue and to differentiate between intracellular and extracellular water. Ultrasound elasticity imaging directly reveals the physical property of fascial tissues and makes it possible to quantify changes in tissue thickness as well as stiffness before and after [treatment]." Their results revealed that the tissue (muscle and fascia) responses will be quite different depending on numerous features that are only partially related to the way treatment is applied. "Besides the expected softening-effects on the lumbar region, both kinds of tissue, musculature and fascia, react differently depending on the sex, age, pain-history and activity-level of the person"
Dosage in manual therapy is an area that is both under-researched and "under-translated" into practice, and all manual professions need to focus on ways of teaching and training that encourage optimal delivery of therapeutic load. Additionally, attention the nature of the individual and the tissues being treated presents a further educational challenge that requires our attention.