resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Understand Shoulder Separation
There are numerous orthopedic disorders that develop a common name by which they are more frequently known. Examples include runner's knee or tennis elbow. A shoulder separation is another condition that has come to be known by its common name, although sometimes that is misleading.
The term shoulder separation is often misconstrued as a dislocation of the humeral head from the glenoid fossa, but that is inaccurate. The glenohumeral joint is the primary joint of the shoulder, but there are three other significant articulations — the scapulo-thoracic articulation, the sternoclavicular joint and the acromioclavicular joint. A shoulder separation is a sprain to the ligaments of the acromioclavicular complex.
The acromioclavicular (AC) joint is the junction between the distal end of the clavicle and the acromion process of the scapula (Figure 1). The AC joint is a standard diarthrodial joint (one with a cavity), but it may sometimes contain a fibrocartilaginous disc. At this joint, the clavicle joins the acromion and acts as a strut to improve stability in the shoulder complex. Therefore, there is very little motion at the AC joint.
Stability in the AC joint is maintained through several important ligament structures. The primary stabilizing support at this joint is the acromioclavicular ligament (Figure 2). The acromioclavicular ligament provides stability against horizontal shear forces at the AC joint and consequently, provides the primary horizontal stability.
Additional stability at the joint is created by two other ligament structures that together are referred to as the coracoclavicular ligaments. They span between the coracoid process and the clavicle. Both of these ligaments, the trapezoid and the conoid, are named for their shape (Figure 3). The primary function of the coracoclavicular ligaments is to produce vertical stability.
Description of Pathology
A shoulder separation is defined as a sprain to the ligaments supporting the AC joint. Most injuries occur from falling directly on the shoulder or being hit with something heavy. If the injury occurs from falling and hitting the ground, the sprain may be more likely if the glenohumeral joint is in an adducted position (arm at the side). When the arm is adducted, the lateral shoulder region is the first contact point when the shoulder hits the ground. This mechanism of injury happens often in collision sports, and because more men than women are involved in these types of activities, shoulder separations are much more likely to occur in men than women.
A sprain to the AC joint complex may occur in a number of different ways. A classification proposed in 1984 by Rockwood for AC sprains has since been adopted and widely used to describe the severity of the problem.1
Type I: Local tenderness is present, but there is no anatomical deformity, and no complete tear of either ligament.
Type II: Local tenderness, and there is some recognizable anatomical deformity (often the "raised" clavicle). There is a tear of AC ligament, but the coracoclavicular ligaments are intact. There is no marked elevation of lateral end of clavicle.
Type III: There is a great deal of tenderness and significant anatomical deformity associated with damage to the AC ligament. There is damage to the coracoclavicular ligaments as well. In some instances, there may be clavicular fracture associated with Type III – VI. There is usually between 25% to 100% superior translation of distal clavicle.
Types IV – VI involve complete rupture of the associated ligaments of the AC joint.
Type IV: Complete rupture of ligaments that are supporting the AC joint. The distal clavicle is impaled posteriorly into trapezial fascia. Usually a posteriorly directed force to the distal end of the clavicle will be responsible for an injury of this type.
Type VI: Ligament rupture with inferior translation of distal clavicle below the coracoid or acromion processes.
Type I and II are the most common and will occur much more often than the more severe dislocations described in Types III – VI.
How to Identify the Separation
Most often, there is a history of traumatic force to the anterior/lateral shoulder region. Sometimes, the condition may result from chronic overuse. Yet, repetitive overhead motions like throwing activities may cause progressive weakness in the joints and make them susceptible to sprain.
Because the AC joint is so superficial, it is easy to palpate the region for tenderness, which is a likely factor in all six types of shoulder separation. In a more severe sprain, a visible anatomical deformity, such as the distal clavicle protruding from the edge of the acromion, may be visible.
The individual is also likely to have pain with a variety of motions of the shoulder that stress the damaged ligaments of the AC complex. In particular, movements involving horizontal adduction of the arm, both active and passive, are likely to reproduce the client's complaint.
Fractures may accompany severe shoulder separations, so the client should seek proper evaluation from a physician if there are indications of severe acromioclavicular injury that may indicate fracture possibilities (characteristics of Type III – VI sprains).
Treatment methods for shoulder separations will depend on the severity of the injury. Type I sprains are usually treated with ice applications to reduce initial swelling, and rest from any offending activities. Type II conditions will be treated in the same manner as type I, with the addition of a sling or harness to give the region a period of immobilization to promote proper ligament healing. Type III injuries may be treated with surgery, but they are increasingly treated in the same manner as above, except for a longer period for usage of the sling (usually about 2 to 4 weeks). Gentle mobilization and strengthening will follow removal of the sling. Shoulder separations that fall into type IV – VI usually require surgical intervention.
The onset of muscle spasm and guarding following immobilization is a prominent indication for the use of massage in the rehabilitation process. Few methods are as effective as massage in reducing the overall hypertonicity in surrounding shoulder girdle muscles. Deep longitudinal stripping techniques and static compression methods are used to treat myofascial trigger points and muscle tightness associated with the sprain.
Deep friction massage applied directly to the acromioclavicular ligament is beneficial for stimulating collagen production in the damaged tissue and reducing excess fibrosis during the healing process. The practitioner should wait until after the initial inflammatory stage (usually the first 72 hours) before administering friction treatment directly to the damaged ligaments. Injuries that are type III and higher require a longer period prior to applying friction treatments to make sure that further ligament damage doesn't result. It is very helpful to consult with the client's other health care professionals about when massage would be appropriate depending on the severity of the injury
While shoulder separations are not necessarily frequent, they are not uncommon either. Massage should not be the sole treatment for a shoulder separation, but it can play a very important role in addressing the recovery from this injury. Even in the more severe sprains, massage can be an important part of the rehabilitation process in order to regain proper function in the shoulder girdle.