Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
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.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
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.
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.
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!
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
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.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
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.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
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.
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.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
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.
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.
Exploring Elusive Compartment Syndrome
Many of our clients come in with chronic, aching muscular pain. The natural reaction is to attempt to relieve their pain, often through deep pressure massage applications. However, there are certain conditions in which performing deeper levels of treatment is contraindicated and can actually make the condition worse.
Compartment syndromes fall into this category and understanding this orthopedic disorder is very important for the massage therapist because in certain cases, it can be an extremely serious injury. A review of some core anatomy principles helps illustrate what a compartment syndrome is and how it develops.
What is a Compartment Syndrome?
Muscles are gathered together in groups and surrounded by fascial walls, bones, or tough interosseous membranes. The space within these anatomical boundaries is called a compartment. Figure 1 shows a cross-section of the lower leg and the compartments are easy to identify in the images with their different colors. There are four separate compartments in the lower leg. The compartments contain not only muscles, but also arteries, veins, nerves, and lymphatic vessels.
A compartment syndrome occurs when the contents of the compartment expands, thereby increasing pressure on all of the structures within the compartment. Chronic overuse or acute trauma can cause inflammation and swelling of the muscles within the compartment and is usually responsible for the increase in compartmental pressure.
As the muscles swell, pressure increases within the compartment and can cut off blood supply or cause permanent nerve damage. Compartment syndromes occur most often in the lower leg, but can also occur in the thigh, hands, forearm, feet, and buttocks, among other regions.1 To better understand how they occur, let's take a look at the two different types of compartment syndromes: acute and chronic.
Acute or Chronic
Acute compartment syndromes are less common than chronic, but are far more dangerous. The reason they are more dangerous is they usually involve greater degrees of swelling and consequently greater pressure levels develop within the compartment. Acute syndromes are caused by direct trauma to the compartment, vigorous exercise, blood clots, tight bandaging, or long periods of unusual compression. In cases of direct trauma to the compartment, symptoms may not appear immediately, which can confuse identification of the condition.
An example clinical case report describes a man who passed out on a staircase for 8 to 10 hours as a result of a drug overdose. The prolonged pressure on his thigh and gluteal region from the staircase caused irreversible neurological damage to his sciatic nerve, as well as other systemic effects including kidney injury.3 Acute compartment syndromes can also result from long surgeries where a body part is immobile for long periods on the operating table, so medical staff must be careful to prevent constant pressure in one location.
Chronic compartment syndrome, also called exertional compartment syndrome (ECS) is far more common than the acute injury. The most common location to develop ECS is the anterior compartment of the lower leg. ECS occurs when muscles swell as a result of repetitive activity. Symptoms abate when the individual stops the activity.
While the lower leg is certainly the most common location for ECS, it may occur in other regions of the body as well. ECS of the forearm may occur after prolonged activities requiring significant grip strength. The condition is commonly reported in competitive motorcycling where it is known as "arm pump," but is also reported in gymnastics, hockey, wheelchair athletics, climbing, waterskiing, and kayaking.4
A recent study reported on a thigh compartment syndrome that occurred eight days after a soccer trauma. The man affected was hit on the thigh during a soccer game, causing severe edema of the vastus intermedius. This swelling eventually led to a thigh hematoma 8 days later, that developed secondary to the rupture of the profunda femoris vein. The tissue damage was deep enough not to be immediately apparent after the incident.2
It can be difficult to accurately identify a compartment syndrome just by physical examination alone. However, there are some key characteristics. Other than a rapid vs. slow onset, symptoms of acute and chronic compartment syndromes are pretty similar. In some acute compartment syndromes, the symptoms are more pronounced because the compartment pressures are greater.
Pressure on vascular structures can cause discoloration of the limb or coldness in the extremity. Lack of venous return can also cause sensations of tightness or fullness of the extremity that are different from those of chronic muscular overuse. Neurological sensations, such as paresthesia, numbness, or weakness are likely to result from compression of motor and sensory nerves. These neurological sensations are generally not present with chronic muscular overuse conditions like shin splints so this is a helpful way to distinguish the compartment syndrome from shin splints in the lower leg.
Complaints of aching or cramping in the affected muscles is common. In chronic cases these symptoms occur within about a half an hour after starting exercise. Symptoms often persist throughout the exercise, and then gradually subside once the activity is stopped. In the lower leg, it is common for compartment syndrome to occur after a history of other lower extremity dysfunction such as shin splints.
The most accurate way to determine the presence of compartment syndrome is through the use of an intra-compartmental pressure reading. This procedure is performed by a physician who inserts a special needle into the compartment that can read the intra-compartmental pressure. Once it is determined that a compartment syndrome exists, there are different strategies for treatment depending on the severity of the compartmental swelling. Keep in mind that it will be difficult to identify a non-aggravated compartment syndrome with a compartmental pressure reading if the needle pressure reading is performed well after the exercise induced trauma has subsided.
Treating acute compartment syndrome involves an emergency procedure to decrease compartmental pressure; delaying this procedure can cause irreversible tissue damage. This is one instance in which RICE (Rest, Ice, Compression, & Elevation), the common method for treating an acute injury, is actually a bad idea. Rest is certainly beneficial, but ice can cause decreased tissue fluid movement and that is not helpful for reducing compartmental pressure. It should be pretty obvious that additional compression is also a bad idea for a condition where excess compression is causing tissue damage. Elevation could also impair return of needed circulation.
In the case of an acute compartment syndrome an emergency surgery called a fasciotomy may be performed. In this procedure, the surgeon cuts a slit in the fascial wall, and lets the contents of the compartment bulge through until they can subside in size back to their normal state. If the intracompartmental pressure is not relieved in an acute condition, permanent tissue damage can result.
Chronic compartment syndromes are often treated with various activities that help reduce the cumulative overload on the muscle. Stretching and various exercises are commonly used in physical therapy to address the ECS.
One of the key questions that emerges for the soft-tissue therapist is what role massage might play in addressing this condition. Massage generally increases pressure on the tissues being treated so this is an important consideration with compartment syndrome.
The key to using massage as a treatment for ECS is that it can be very effective in helping to reduce the chronic muscular tension that led to the condition. However, treatment should not be applied while symptoms are aggravated. For example, if a person has just gotten through running and is complaining of aching pain in her lower legs, this is not the time to do the treatment. On the other hand, if she is consulting you three days after her last run and the pain has subsided, at this point massage would be appropriate.
Massage for a compartment syndrome should always be applied within the client's pain tolerance and it is important to make sure that it does not aggravate any of the existing vascular or neurological symptoms that would indicate increasing pressure in the compartment. Of course, an obvious and most important factor in the treatment of any compartment syndrome is finding a way to reduce the offending activities that have led to the chronic overuse to begin with.