resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Learning How to Treat PopeyeI want you to know as massage therapists, some things are just simple, very straight forward and can be helped within one to two visits. I sometimes see massage therapists looking for the more complicated reasons for pain. I have tried to convey in every article that you can save your hands and help more clients by understanding form and function along with simple assessment tools. Treating Popeye is no exception.
After two MRI's (one of the bicep and one of the shoulder), acupuncture, and a failed attempt of physical therapy, this young man found his way into my office to seek help for an unrelenting pain in the bicep. Lucky for me, his Orthopedist had ruled out that there was not a complete tear or a partial tear of the bicep tendon by doing the MRI's. But he wasn't so lucky in the fact he had been suffering with this pain and loss of function for more than six months and no one had any answers. His doctor said, "I don't know why you still have the pain, none of the lab work or the MRI's have a definitive answer. Let's try physical therapy."
I want to explore together controlled micro-tears of fascia, the difference of macro and micro-tears of fascia, how to assess bicep pain and the treatment options of micro-tears. A look into why physicians might miss this critical piece of the pie altogether. Plus, take a walk back in time with me to the beginning of the medical era of fascia reality. Try to guess the year!
I would like to clarify that a Popeye reference to a bicep usually means the client has suffered from a full bicipital tear and is left with a bulging in the center of the upper extremity showing a Popeye like effect from the tear. The look is actually the long head of the bicep hanging there not attached. You won't need many assessment tools for this one just your eyes to see that it is torn and your treatment options are relief of pain symptoms being caused from the tear. The long head of the biceps tendon is more likely to be injured because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears and because of the second attachment, many people can still function and only need simple treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical treatments, or if the client requires complete recovery of strength for a sport or work, surgery to repair the torn tendon might be required.
Can you think of anyone that would want to deliberately do controlled micro-tears to their fascia? The answer is actually everyone that works out. The most known sports would be bodybuilding for the big hypertrophy effect or a power lifter than is going to compete for lifting the most weight in his class. But it is what happens to all muscles that need to build stamina and endurance. Well, after all, Popeye didn't get that big bicep by not doing micro-tears to his fascia.
The effect of training causes micro-tears to the muscles being trained; this is generally known as a micro-trauma. These micro-tears in the muscle contribute to the soreness felt after exercise, called delayed onset muscle soreness. It is the repair to these small micro-traumas that result in muscle growth and development. Normally, this soreness becomes most apparent a day or two after a workout. However, as muscles become adapted to the exercises, soreness tends to decrease. A micro-trauma can be a cumulative effect from simple acts of daily living over a long period of time or playing a leisure sport such as golf that ultimately leads to pain and dysfunction. The extreme micro-tears are called a macro- trauma where the fascia has been injured by a traumatic event such as a car wreck, fall, or a sports injury.
My client worked out with weights and did bodyweight exercises almost every day. He stated he was just trying to maintain his physique and not trying to do anything over the top. Weight training aims to build muscle by prompting two different types of hypertrophy; sarcoplasmic hypertrophy and myofibrillar hypertrophy. Sarcoplasmic hypertrophy leads to larger muscles and so is favored by bodybuilders more than myofibrillar hypertrophy which builds athletic strength. Sarcoplasmic hypertrophy is triggered by increasing repetitions, whereas myofibrillar hypertrophy is triggered by lifting heavier weights. In either case, there is an increase in the size and strength of the muscles, tendons, bones, and ligaments through a process known as remodeling, the breakdown and growth of new tissue. But when tissue or fascia breaks down (catabolic) faster than it can rebuild (anabolic), injuries occur. Exercising or engaging in a physical activity too intensely, too long, and too often does not allow enough time for the remodeling process. This makes the client more susceptible to an injury.
Once fascia is injured either over stretched or torn the microscopic fibers are disrupted. Now, instead of fibers running parallel to each other in an organized fashion with their normal degree of elasticity and flexibility, the fibers now run every possible direction and have an extremely diminished amount of organization. Fascial injuries often heal in this tangle manner with those injured areas being referred to as microscopic scar tissues or microscopic adhesions. Finding and diagnosing these fascial tears with conventional, high-tech tests can be difficult, to the point of usually being virtually impossible. Advanced imaging techniques such as MRI will not show most fascial injuries because the fascia itself is so thin and microscopic. This is why numerous people that suffer with chronic pain syndromes will be run through test after test, with doctors telling them repeatedly, "We cannot find any reason for your pain." In some cases, they are told it is age related and you will just have to live with it.
Here is a fun quick history lesson. There are two people who have made the awareness of fascia prevalent and the first is Dr. Andrew Taylor Still in 1874, when he walked away from modern medicine to create Osteopathic Medicine. Dr. Andrew Taylor Sill saw that modern medicine at the time used harsh methods and harsh drugs that had more ill effects than good. He believed that problems with the fascia were the root of all sickness and disease. The second, Tom Myers, is quoted saying, "Fascia is the missing element in the movement/stability equation. While every anatomy lists around 600 separate muscles, it is more accurate to say that there is one muscle poured into six hundred pockets of the fascial webbing. The illusion of separate muscles is created by the anatomist's scalpel, dividing tissues along the planes of fascia." Medical professionals are still overlooking the importance of fascia to the detriment of their patients by relying on high tech tests for their diagnosis.
In its healthy state, fascia is smooth, supple and slides easily, allowing you to move and stretch to your full length in any direction, always returning back to its normal state. Unfortunately, it's very unlikely that your fascia maintains its optimal flexibility, shape or texture. Lack of activity or over activity will cement the once-supple fibers into place. Chronic stress causes the fibers to thicken and this is where the muscles start moving as a unit or recruiting muscles in a poor firing order. Fascia needs to be moved in all planes of motion in order for it not to form adhesions and become glued down to the muscle. These repetitive movements pull the fascia into ingrained patterns and once they've formed they are hard for the client to get rid of on their own. Foam roll, foam roll, foam roll is what they are told to do. There are two problems with this, one is that clients rarely use a foam roller properly and second, not all adhesions respond to this form of therapy. In addition, it is hard to form roll a bicep.
How do you help Popeye?
That's it; therapy can really be that simple. This client was better in the first visit during the session by 80%, presented on the return visit 90% improved, after the second and final session he was 100%. He thanked me for the education and was extremely grateful.