Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
An Inside Look at Labral Tears
There are many instances in the clinic in which a common clinical situation requires practitioners understand an orthopedic pathology in order to determine if massage would be an appropriate treatment. Justin's labral tear is a perfect example of why knowing about orthopedic conditions is highly beneficial in your practice.
Justin is an active, athletic 35-year-old veterinarian. One of his favorite summer sports is water skiing. Three weeks ago he had a good fall while out jumping wakes. His ski caught the ridge of the wake as he crossed over it. He maintained his balance, but his right arm was jerked pretty hard to the right. At the time, he felt a sharp pain in his shoulder, and it has continued to bother him since.
In our interview, Justin mentioned that he had seen a physician and was told he had a labral tear. He was still a little unclear about what this was, but wondered if massage would be helpful. So what is a labral tear?
The shoulder has the greatest range of motion of any joint in the human body. However, in order to allow for such great range of motion, there is a trade-off of stability. In fact, the human shoulder joint is one of the most unstable joints in the animal kingdom.1
The glenohumeral joint is categorized as a ball and socket joint. The humeral head is a well-rounded ball, but the glenoid fossa is not much of a socket because it is so shallow. The labrum helps make the depression deeper and aids in stability. The fossa is surrounded by a rim of cartilage called the glenoid labrum. The fibrocartilage that makes up the glenoid labrum is similar to that of the meniscus in the knee. It can be torn, chipped, or cracked, and blood supply is generally poor so it often takes a long time to heal when injured.
The glenoid labrum is fibrously connected to the glenoid fossa, but is also attached to other structures in the shoulder region and these other connections play an important role in many labral injuries. Along the superior margin of the shoulder joint, the tendon from the long head of the biceps brachii attaches to the supraglenoid tubercle. Prior to inserting into the bone, the biceps brachii blends fibrously into the superior portion of the labrum (Figure 1). This connection plays a very important role in labral injuries like the one Justin experienced.
In addition to the biceps tendon, a number of ligaments that comprise the glenohumeral joint capsule also attach around the rim of the glenoid labrum. Of particular interest is the inferior glenohumeral ligament as it is commonly involved in labral injuries (Figure 2).
Mechanism of Labral Injury
There are two common types of injuries that occur to the glenoid labrum. The first involves the biceps tendon attachment along the upper margin of the labrum. We'll take a look at that one first. Then we'll take a look at the other region of labral injury which is the anterior and inferior portion of the labrum.
The biceps tendon attaches directly to the labrum before it inserts into the bone. As a result, very high tensile loads generated by the biceps brachii muscle are transmitted to the upper margin of the labrum. The mechanics of Justin's injury, as he explained it in his history, was that he was skiing behind a boat, and moving across the wake, trying to jump it. He was jerked very hard as he hit the boat's wake. This sudden tensile load is likely what caused the labral injury he experienced.
When the biceps tendon experiences an immediate, strong pull, it lifts the outer rim of the labrum and can tear it away from the more central portion. These forces will cause a tear in the superior portion of the labrum that runs from anterior to posterior (Figure 3). This particular injury is frequently referred to as a SLAP lesion. SLAP stands for Superior Labrum Anterior Posterior (meaning the tear is in the superior portion of the labrum and running from anterior to posterior).
Sudden high force contractions of the biceps brachii muscle are a common cause of SLAP lesions. This injury often occurs with a sudden eccentric load on the biceps, such as catching something heavy that is falling or sudden deceleration of the throwing arm. When the muscles have to suddenly contract (to stop motion) it puts a high force load on them. This is often what causes rotator cuff injury. Because the biceps brachii also has to decelerate the forceful elbow extension when you throw, it must contract suddenly to stop that motion. The sudden pulling on the biceps is transmitted to the superior margin of the labrum. This injury is common in athletes like baseball players, whose sports require a lot of throwing.
The SLAP lesion is very difficult to identify with physical examination and is even challenging with certain high-tech diagnostic studies because of the soft tissue involvement. However, there are certain indications that one can look for that are likely indicators of a labral injury. There are certain clinical signs such as popping or clicking of the shoulder during motion that is accompanied by pain deep in the shoulder. In the history, there would be trauma that involved sudden forces to the shoulder.
If you are suspicious of a labral injury, the best protocol is to refer the client to an orthopedic physician, one specializing in shoulder injuries, so that the injury may be diagnosed and possible treatment initiated (this condition can require surgery).
The second common type of labral injury is called a Bankart lesion or Bankart tear. It is a tear to the anterior and inferior portion of the labrum near where it blends in with inferior glenohumeral ligament (Figure 4). This portion of the joint capsule and labral complex can also be stressed in repetitive overhead motions, such as throwing or serving a tennis ball. The Bankart lesion is also relatively common when the shoulder is dislocated as the humeral head pulls on the anterior inferior portion of the capsule as it moves out of the joint.
Sudden forceful trauma to the joint, such as falling on an outstretched arm, is another cause of labral tears. The labral tear may occur from excessive tensile loads from the joint capsule or from the humeral head being thrust against the back side of the labrum. In some more traumatic cases of the Bankart tear, a chunk of bone gets pulled away when the inferior glenohumeral ligament and labrum pull away from the glenoid fossa. This is called a Bankart fracture and requires an arthroscopic surgical procedure to repair.
There are a number of complications that may develop as a result of a labral tear. First, because of the poor innervation and circulation to this tissue, the tear may often be significantly advanced before it causes enough pain to be recognized by the client. Because the labrum is designed to hold the humeral head in position, a tear or disruption in the labral complex can lead to shoulder instability. Increased instability in the shoulder may then predispose the person to dislocations, or other shoulder pathologies such as impingement or rotator cuff pathology.
Another complication that may develop are paralabral cysts. As a result of the labral tear, there is increased fluid in the area that leaks out of the capsule. Once that fluid escapes the capsule, it is still contained within a small cyst. These paralabral cysts usually occur from SLAP lesions and are often found around the suprascapular notch. They have been known to cause entrapment of the suprascapular nerve.2 Because the suprascapular nerve innervates the supraspinatus and infraspinatus, this cyst could cause rotator cuff dysfunction due to impaired muscular innervation.
To Massage or Not?
The first question to answer when determining if massage is appropriate is whether or not it is likely to cause an adverse or detrimental effect. There is no indication that massage or any gentle range-of-motion activities performed within normal limits would likely cause any adverse effect on a labral injury.
Once it is determined that massage is not likely to cause any adverse event, the next question is could it be beneficial in treating the injury. In this case, a labral tear is too deep in the shoulder joint and the labrum is a non-contractile tissue that won't be accessible to or benefitted by palpation. Therefore massage will not have any direct effect on resolving the labral tear. However, as in many situations that does not mean that massage is not of any benefit.
Injuries such as Justin's labral tear are frequently accompanied by resulting dysfunctional mechanics at the joint. Myofascial trigger points may develop around this region, or other biomechanical imbalances may occur as the shoulder attempts to compensate for pain, instability, or loss of function associated with the injury. Massage can certainly be used to help restore biomechanical balance in the shoulder in these situations.
The key take away lesson here is that details from the client history are very important along with the physical examination. In Justin's case, information provided in the history along with symptoms of deep pain and clicking sounds with movement of the shoulder were strong indications of labral injury. Massage treatment can easily be employed in a situation like this concurrent with other treatments to address the labral tear.
We are sometimes faced with conditions that need to be treated first by another healthcare professional. It is very important and helpful for the massage therapist to have an understanding of these pathologies and be able to ascertain when they might be occurring, and make an appropriate referral.
It is also imperative for us to understand the limitations of what we do so we don't give a client false hopes about what massage can accomplish. Once a condition like this is diagnosed, massage is an excellent adjunct treatment that can prevent further issues.