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Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
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.