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Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Hooked on Shoulder Pain
We tend to look at anatomy and structure as something that is constant and unchanging, but the truth is there are a number of anatomical variations and many of the structures shown in anatomy books can be somewhat different among individuals. Adding to this complexity, a client's anatomical structure can significantly change with age, and those alterations can be the source for numerous soft-tissue pathologies. In this installment, we'll take a tour of subacromial architecture in the shoulder and explore how it differs between individuals and alters over time. These are critical factors to consider when determining the cause of shoulder pathologies.
The glenohumeral joint has the greatest range of motion of any joint in the body. The structure of the joint is such that there is very little stability provided by the bony architecture. As a result, the soft-tissues in this joint play a very important role in managing movement and providing stability.
One of the most common regions for soft-tissue injury in the shoulder is the subacromial space, so let's take a more detailed look at the structures in and around this region. The subacromial space, as the name suggests, is the region under the acromion process. Problems are most common directly under the acromion process, but may also occur in nearby areas that not directly under the acromion.
The coracoacromial arch (Figure 1) is a key area for soft-tissue injuries around the shoulder. The arch is created by the acromion process, the coracoid process, and the coracoacromial ligament which joins these two bony projections. The coracoacromial ligament is somewhat unique as ligament structures go, as most ligaments span from one bone to another in order to improve structural stability. The coracoacromial ligament spans between two projections of the same bone so it never moves or changes length as do most other ligaments.
A number of soft-tissue structures can become compressed under the coracoacromial arch, including the supraspinatus muscle and tendon, biceps brachii long head tendon, subacromial bursa, glenohumeral joint capsule, subscapularis tendon, and coracohumeral ligament. These structures can be compressed under different regions of the coracoacromial arch.
One key factor that plays an important role in the likelihood of subacromial impingement, is the shape of the acromion process. Anatomy books tend to show the acromion process as relatively flat, but other anatomic variations are common. The most common classification for differing shapes of the acromion is that originally described by Bigliani, shown in Figure 2.1
Bigliani classifies three different shapes of the acromion process. The most common is the Type 1 or flat acromion in which the underside of the acromion is relatively flat. The Type 2 or curved acromion has a curved shape which is concave on the inferior side of the acromion. It is the Type 3 or "hooked" acromion that warrants special attention in many subacromial impingement problems.
The structure and shape of the acromion can vary from person to person, but one of the more interesting factors of the acromion shape variations is that they can change. Most notably a Type 1 or 2 acromion can eventually become a Type 3, hooked acromion. So how does the shape of this bone change?
Various structures in the body change shape or form as we age. For example, the intervertebral discs lose height and the spine gradually compresses as we age, thus older people become shorter. The acromion's shape changes in reaction to mechanical and physiological forces acting on the structures that attach to it.
The coracoacromial ligament spans between the coracoid and acromion processes of the scapula. Tensile forces generated in the coracoacromial ligament cause it to pull on its attachment site at the acromion process. The body often develops calcification in regions where the bone is stressed as it perceives a bony injury. Calcification occurs at this attachment site in reaction to the constant pulling of the ligament as its fibers blend through the periosteum and into the bone. Over time the buildup of calcification causes the hook to develop on the end of the acromion.
Bone spurs can also develop on the underside of the acromion process, usually from the humeral head repeatedly impacting the underside of the acromion process. In either case, the hooked acromion results from forces impacting the acromion process over time. These calcifications don't happen quickly and that is why it is not common to see the hooked acromion in young people.
The hooked acromion is a frequent contributor to soft-tissue disorders such as subacromial bursitis, shoulder impingement and rotator cuff dysfunction. The hook on the end of the acromion takes up crucial subacromial space and causes increased friction on a number of soft-tissues that lie under the acromion. The size of the hook may or may not be relevant to the level of damage, or the client's individual experience of the pain. Even a relatively "small" hook can sometimes be enough to create dysfunction and pain for the client.
Why Massage Matters
Now that you have a clearer picture of structural variations in the acromion process you may wonder why it matters and how it affects your massage practice. Shoulder pain is a very common reason for people to seek help from a massage therapist. Massage is often advocated for shoulder pain because there are so many soft-tissues in this region. When soft-tissue injury or dysfunction results from a hooked acromion, the root of the problem and the condition will recur until that dysfunctional structure is addressed. Massage can, however, be helpful in addressing some of the shoulder pain that occurs.
In a case where it is possible that a hooked acromion is aggravating the client's condition, it is advisable that the client be referred to an orthopedist (who specializes in shoulder injuries) to determine if surgery is warranted. The arthroscopic shoulder procedures for addressing subacromial morphology have advanced greatly and are generally minimally invasive, with recovery times much shorter than they were previously. The client should be aware that the continued impairment of soft-tissues under a hooked acromium can lead to longer and more involved damage and disability.
So, if you have a client that is experiencing shoulder pain, pay close attention to the location of pain and what motions or activities aggravate that pain. If the pain is felt in the anterior or lateral shoulder region and aggravated with forward flexion or abduction, there is a good chance that subacromial pathology of some kind exists. If the client is over 30 there is an increasing chance that a hooked acromion could be involved. The older they are, the greater is the chance of this shape variation. You may not be able to accurately palpate the hooked acromion so it is best to refer them to another health professional for a comprehensive evaluation.