Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
We Have Much to Learn from Current Fascia Research
Fascia is fashionable. Over the past few years, you may have noticed the increase in conferences, congresses, symposia, workshops, online courses, books and articles that contain the word fascia in their title. Fascia was, for many years, seen as a sort of second-class tissue, a form of supportive wrapping, a nuisance during dissection, where it obscured the views of pretty muscles and joints. Fascia's increased visibility, due largely to the series of International Fascia Research Congresses, has attracted publication of a huge number of serious basic science research papers, as well as an avalanche of clinically related, fascia-related articles. These articles range from a focus on the fascial influences of foam-rolling, kinesiotaping, connective tissue massage, muscle-energy and other stretching techniques, myofascial release, a variety of exercise models (with plyometrics taking the lead), as well as a range of new trademarked approaches, led by the Italian export Fascial Manipulation.
One of the surprising features resulting from current fascia research (and there is an awful lot of it) is how little our increased understanding of fascia's functions has changed what manual therapists actually do – or need to do.
Rather, I believe, greater fascial awareness and understanding helps most therapists to do what they already do, more effectively, rather than having to relearn their skills. I have outlined a few examples of this here.
Before looking at examples of how emerging fascial knowledge refines, but doesn't necessarily change, what we do – it's important to establish a basic fact: It is impossible to treat fascia directly (short of actual surgery). In fact, all treatment approaches that target the soft tissues of the body, the muscles, ligaments, tendons and of course the joint-related tissues must involve fascial structures. The key message here is that it is not possible to "treat," - for example, a muscle (in any way whatever), without fascia being a feature of the process.
This elegantly phrased quote, from a research article by Weppler & Magnusson (2010), summarizes this point: "Skeletal muscles comprise contractile tissue intricately woven together by fibrous connective tissue that gradually blends into tendons...made of fibrous connective tissue [that] attach the muscle to bone. Although contractile tissue and tendons are sometimes evaluated separately for research purposes, they cannot be separated during routine clinical testing and stretching procedures, nor during functional activity," nor, of course, during manual treatment.
Five Clinically Relevant Examples
Note: This is not a definitive list. I have selected some key examples, there are many others!
Load transfer via fascia. Load-transfer research demonstrates how force is transmitted from one part of the body to another via fascial connections (described by some as "chains" and others or "trains"). For example, Carvalhais and colleagues (2013) demonstrated how contraction of latissimus dorsi – during adduction of the shoulder - produces external rotation of the contralateral hip via the superficial layer of the thoracolumbar fascia; while Stecco et al., (2013) showed how gluteus maximus contractions directly influence the knee via the iliotibial band. Potentially, therefore left-knee dysfunction could involve right latissimus dorsi behavior. Awareness of such links would not necessarily alter your treatment methods, but might well cause you to look at a wider set of possibilities when seeking causes of knee pain.
Fascia's sliding and gliding fascial functions. The different layers of the body - for example, between muscles or separating dense fascial structures from muscle or from other fascial layers – contain viscous loose connective tissues that allow a gliding, sliding function, protecting sensitive neural structures, as well as facilitating pain-free, efficient movement and force transmission, as described above. Gliding function may be lost because of trauma, inflammation or aging, resulting in fibrosis, thickening, densification. (Pavan et al 2014). Knowledge of the sliding functions of fascial tissues might not change what you do at all, but may help to explain why attention, lightly applied, as in myofascial release, can offer such dramatic benefits.
Mechanotransduction or changing cell behavior: for example, reducing inflammation and speeding healing of damaged tissues. Mechanotransduction describes the many ways in which cells respond to different degrees of load, such as pressure, tension, stretch, friction, etc. Research using important fascial cells (fibroblasts) that are largely responsible for the early stages of healing traumatized tissues, has shown that when these cells have been distressed by many hours of rapid movement, so that they start producing inflammatory chemicals, a brief period (a minute to 90 seconds) during which the cells are "treated" with the equivalent of myofascial release (MFR) or positional release (strain/counterstrain or SCS) – normalizes them. (Standley & Meltzer 2008.)
When MFR methods are applied to fibroblast cells in damaged tissues, a speeding up of the repair process is observed. (Hicks et al 2012). More recently, Cao et al (2015) conducted research on bioengineered tendons that had been artificially injured, to see how different degrees of light load (as in MFR) would effect the healing process. They tested a variety of degrees and durations of light stretching and identified that particular variations. For example, three minutes of stretch using around 6% of stretch, was effective in speeding up repair, while 12% for five minutes slowed it down. These percentages represent the degree of increased length of the tendon induced by stretching.
This remarkable research does not change the way gentle MFR or SCS are applied in manual therapy treatments of injured, painful, irritated, inflamed tissues – but helps explain why stronger degrees of stretch may not be as effective as light load.
Fluid dynamics and pain reduction. Manual methods that use isometric contraction – such as Muscle Energy Techniques (MET) – have the effect of improving fluid movement, particularly involving fascial fibroblast cells. Changes in the hydrostatic pressure in fascial tissues leads to improved drainage, reducing inflammatory chemicals (Langevin et al 2005, Fryer & Fossum 2009).
This is another example of fascial research indicating why (and how) mild stretching methods, particularly those involving isometric contractions, are effective in pain management. The information doesn't change the treatment methods, but it does clarify our understanding of what's happening.
Eccentric MET stretch and fibrosis, post-surgery. Remarkable clinical work in India, by orthopedic surgeons working in rehabilitation of individuals who have had recent hip or knee replacement surgery, or surgical repair of fractures, has demonstrated the value of slowly applied isotonic-eccentric stretching in such cases, thus reducing fibrosis and speeding recovery compared with traditional passive stretching methods. These MET variations have been successfully used for many years, by osteopaths and manual therapists in treatment of musculoskeletal dysfunction and have now been scientifically validated. Although this clinical research adds a wider range of application for MET, it does not change the way many of us already use this valuable method (Parmar, et al 2011).
The Bottom Line
Current fascia research is informing us, refining rather than revolutionizing what we do. Understanding the mechanisms of what we do in practice can help in the choice of what methods are best for particular clinical settings - how to best apply the multiple tools that manual therapists have for the optimal benefit of patients.
You may have noticed that the examples I have given in this article largely focused on biomechanical (and fluid related) effects of manual treatment. Apart from these there are, of course, important neurophysiological effects but that's a whole other story for another time.