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Blaming the Gluteus Medius, Overlooking the Deltoid
The gluteus medius (Gmed) is commonly written about, strengthened and blamed for many conditions, and rightfully so. After all, the Gmed plays a role in pelvic stability, hip motor control and lower-quarter dynamic movements.
The X Factor in Clinical Research: The Patient
It was the great baseball legend, former New York Yankees catcher Yogi Berra – he of countless aphorisms, each with a mind-bending twist – who once declared, "You can observe a lot by watching."
Calcium Helps Prevent Colorectal Cancer
Over the past 25 to 30 years, studies have suggested calcium may confer protection against colorectal cancer.
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."
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.
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.
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.
Transparency and Accountability: Q&A With the CCE
Every profession needs an organization dedicated to upholding the quality and integrity of its degree programs and educational institutions.
Talking to Patients About Healthy Aging
I've noticed that a particular category of patients seems to make up more and more of my practice – they work out, but still experience lots of degenerative joint disease (DJD) issues.
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.
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 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.
Understanding and Identifying Pediatric Growth-Plate Fractures
In general, fractures in children heal well with little intervention as long as the alignment is good. Fractures involving the growth plate, however, are a different issue. In fact, growth-plate injuries are the primary reason for the subspecialty of pediatric orthopedics.
Web Marketing: Content Is King
Google's sweeping updates to its search algorithms over the past few years have brought a paradigm shift in how you can optimize your chiropractic website to gain maximum marketing leverage.
5 Ways to Occupy Occupational Health
Despite the progress that has been made to better protect workers, occupational health and safety remains a priority area for many national governmental organizations due to the widespread problem of occupationally related morbidity and mortality.
Saying No to Medicine
An interesting article recently appeared in Men's Journal titled "When to Say No to Your Doctor." The article begins with the summary statement above and effectively arms readers with information that will help them "take more responsibility for your own health care, because you can't be sure anyone else is.
Help Patients Achieve Optimal Vitamin D Levels
Much research has been done on vitamin D levels and their impact on health; optimal levels have been correlated with a reduced risk of developing numerous conditions.
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?."
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.
Is It Time to Reconsider Cryotherapy?
Practitioners frequently get asked whether to use heat or cold for soft-tissue pain and injury problems. Of course, the correct answer is always that it depends on the nature of the client's condition. But, what are the key factors upon which heat or cold therapy depends? New research indicates the standard guidelines for hot/cold therapy may need to be reconsidered. Let's take an in-depth look at cryotherapy and some of the recent controversies around its use. In a later column we'll explore heat therapy.
Cold applications, most commonly known as cryotherapy, involve the application of cold directly to the body for therapeutic purposes. Most frequently, cryotherapy involves applying ice after an acute injury. Ice applications are used to manage and reduce inflammation and reduce pain. However, that long held belief has recently come under scrutiny as a number of authors are suggesting that icing an acute injury may not have the beneficial effects we once thought. Let's take a look at the key physiological effects of ice applications to better understand their use and if it's time to reconsider them.
In the case of decreased nerve conduction velocity and pain, cryotherapy slows the rate at which nerve impulses are propagated along a peripheral nerve. The slowing of this impulse affects both sensory and motor signals in the nerve. One of the most effective uses of cryotherapy, and the reason for its implementation, is the effect it has on reducing pain sensations through decreased nerve conduction velocity. Relieving pain is a good thing, but should be weighed against the other effects produced by the cryotherapy application.
One way that reduced nerve conduction velocity is used in a therapeutic setting is reducing the stretch reflex, also called the myotatic reflex. The stretch reflex is activated by the muscle spindles when they are stretched either too far or too fast (such as in an acute whiplash). Overstretching a hypertonic muscle can also activate the muscle spindles, causing increased muscle tension.
Cryotherapy can decrease the activation of the muscle spindles, which is a benefit for stretching. However, it also decreased the pliability of connective tissue, which is detrimental for stretching. There are times when the neuromuscular resistance to stretching is the key obstacle, such as in an acute muscle spasm. In this case, the neurological benefits of ice outweigh its detriments. One must weigh the benefits of decreased neurological activity verses decreased connective tissue pliability.
In the case of decreased cellular metabolism, cold applications slow down the cellular metabolic activity in the region where the cold is applied. This cellular metabolic reduction has long been hailed as a primary benefit of cold applications, especially in acute injuries. The theory was that it shortens the recovery period from the injury. However, this effect is the factor that clinicians and researchers suggest prolongs the healing process.
The argument goes something like this ... Humans have been evolving for millions of years. As part of that evolutionary survival process, our bodies have developed an injury response process that involves inflammation following an acute injury. However, in the last several decades, we have decided that we need to stop that process because it is detrimental to the healing response of tissues.
It is good to question this stance of whether or not it is beneficial in the healing process to impair the body's natural healing response. Like all good clinical questions, it should be followed up with research to test the hypothesis. Some initial studies have questioned the therapeutic benefit of reducing inflammation. In one study, treatment comparisons of patients who received ice applications immediately post injury in order to reduce inflammation were compared with those that did not receive ice applications. The ones that did not get ice applications actually fared better. We still need more well-designed studies to investigate this idea, but it does look like it may be time for a paradigm shift.
In the case of decreased circulation, in response to cold sensations, the smooth muscle cells in the walls of the superficial blood vessels contract and vasoconstrict. Vasoconstriction with cold applications is more pronounced in some regions of the body, such as the distal extremities. The effect of reducing circulation is a physiological effect of ice that may not be desirable.
In addition, tissue healing is enhanced by chemical mediators carried through the blood stream and reducing their movement may interfere with the tissue healing response. Again, this is a physiological response that has developed in the human and mammalian bodies over millions of years, so it seems likely that there would be physiological benefits to these chemical's circulation and detriments to their limitation.
Another argument against decreasing circulation is the effect ice has on lymphatic drainage. Edema occurs in the region of a soft-tissue injury after it has occurred. Current thought suggests that excess edema is not beneficial and should be reduced; hence, the use of ice.
However, edema also limits movement in the region and reduces the likelihood of further injury. Edema also increases our sensitivity to pain from pressure on the pain receptors. We generally consider this a bad thing because it hurts, but there is actually a benefit to the increased pain because it helps us limit further movement that could produce greater tissue damage.
Reducing circulation through cold applications also slows down lymphatic drainage and may actually have another detrimental effect on the tissue repair process as a result. Damaged tissue byproducts must be removed from the body and they are removed through the lymphatic system. It may be that cryotherapy for reducing edema could be detrimental in a number of ways.
Most therapeutic interventions have positive and negative effects. In each client case, we must weigh the potential positive effects against the potential negative effects to evaluate whether it makes physiological sense to pursue a particular approach. These studies may not be enough to alter the way we currently use ice in treatment. However, they should spur us on to pursue additional research in order to find if ice should continue being used like it has or if it is time for a paradigm shift.