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Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Exploring Charcot Marie Tooth Disease
The longer you stay in practice, the more likely it is that you will encounter a wide array of compromised health conditions that your clients present with. Sometimes a case that might look like a simple tendinosis or common carpal tunnel syndrome is exactly what it seems. But don't get caught in that trap! Often, what might look like a common or familiar problem on the surface may be something very different. For example, systemic nerve conditions are often mistaken for local nerve compression problems because the symptoms can be quite similar.
Charcot-Marie-Tooth (CMT) disease is a perfect example of a systemic disorder that can masquerade as one or several nerve compression pathologies. While this condition may sound like a dental issue, it is actually a hereditary neurological disease named after three physicians living in 1886 — Jean-Martin Charcot, Pierre Marie, and Howard Tooth. CMT is a genetically inherited disorder and does not result from overuse or mechanical nerve compression like many other common nerve problems. Although it is a genetically inherited disorder, generation skipping is not uncommon. It is a fairly common neurological disorder estimated to affect about 125,000 people in the U.S. alone. It is about as common as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). However, because CMT is not life-threatening, we don't hear about it as often.1
This pathology may sometimes go by other names as well. It is often called hereditary motor and sensory neuropathy. It is also referred to as peroneal muscle atrophy; however, this nomenclature can be a little misleading. Several of the sources that describe this condition as peroneal muscle atrophy cite a drop-foot gait as the most significant early indicator of the condition, and ascribe the drop-foot gait to peroneal muscle atrophy. However, a drop-foot gait occurs when there is inadequate nerve supply to the dorsiflexor muscles of the foot. Although the small and sometimes absent peroneus tertius muscle is a dorsiflexor, the primary peroneal muscles (peroneus longus and brevis) are plantar flexors, and therefore atrophy in these muscles does not produce the drop-foot gait.
CMT is usually divided into two predominant types, although recent clinicians have further divided these types into other subgroups. Type 1 is a neuropathy (pathological condition of the peripheral nerves) that occurs from demyelination of the nerve fiber. Nerve fibers in most of the peripheral nerves are covered by a myelin sheath, and it is the myelin sheath that is essential for proper transmission of the neurological signal (Figure 1). In type 1 CMT, there is a mutation in the myelin structure that causes it to become unstable and spontaneously break down. When the myelin breaks down, it is not able to transmit neurological signals properly.
Type 2 CMT is not a demyelinating disorder, but rather a neuropathy that occurs from what is called wallerian degeneration. The process of wallerian degeneration involves not only a breakdown in the myelin structure on the outer surface of the nerve fiber, but also destruction in the continuity of the axon. It is difficult to determine which type of CMT a client has without more specific laboratory evaluation procedures.
EVALUATION AND TREATMENT
One of the most problematic features for assessment of a condition such as CMT is the similarity of its symptoms to other peripheral nerve pathologies. For some reason, symptoms are usually perceived first in the distal lower extremities. It was mentioned earlier that the peroneal muscles are often affected. CMT appears to have the most significant effect on muscles innervated by the deep and superficial peroneal nerves. In this condition, the motor effects of nerve fiber disruption are much more significant than the sensory effects. Therefore, important symptoms to watch for include muscle weakness and lack of coordination rather than numbness or paresthesia. However, this may also be true for other compression neuropathies of the common peroneal nerve. Disruption of signals to the dorsiflexors of the foot is frequent, and that is the reason that foot drop is a common symptom.
Symptoms of CMT usually occur during the second decade of life and may initially present as a general awkwardness or clumsiness, especially in the lower extremities. This is commonly a period of awkwardness for many adolescents as they are growing, so detection is often not made early in development. Motor nerve damage resulting from CMT commonly progresses with age so the condition frequently gets worse as the person gets older.
It is common for clients to develop a pes cavus foot (excessively high arch, shown in Figure 2) as well as hammer toes. Observation of the leg will often indicate thin, "stork-like" legs due to visible muscle atrophy. The client is often able to walk on tip toes (primarily using the plantar flexor muscles), but will have great difficulty walking on his or her heels (primarily using the dorsiflexor muscles). The clinician should also take a detailed and thorough history because certain medications and even vitamins in high dosages may cause an aggravation of CMT symptoms.1
As mentioned earlier, most of these muscular symptoms appear in the lower extremity first, although some may appear in the upper extremity as well. When symptoms affect the upper extremity, the client primarily displays motor effects. S/he will usually report difficulty in operating zippers, buttons, or doing precise movements with the hand.
There is no current cure for CMT, although it is most commonly managed with conservative treatment that is aimed at stabilizing symptoms. Conservative treatments like physical therapy or orthotics are used to address the motor dysfunction in the lower extremities. In some cases, surgery is used to address more severe foot alignment problems like the severe pes cavus foot. However, because motor function may continually change with progressive degrees of nerve damage, surgical procedures may have limited effects. If the biomechanical alignment problem is changed with a surgical procedure and then motor function continues to alter with further nerve damage, the alignment in the foot may be changed rendering the surgical intervention less effective.
Due to the nature of this problem, it is not one that is likely to be corrected by massage therapy. Massage might be used to treat various distal extremity neuropathies and it may appear that there is some type of compression neuropathy occurring, when in fact the client has a hereditary neurological problem that cannot be corrected with physical intervention such as massage. There is no evidence that massage is harmful for CMT but, in the best interest of finding the true source of a client's complaint, it is valuable to know about this condition and consider it as a possible cause for the client's symptoms. If there is evidence that CMT may exist it is important to refer the client to a physician for evaluation.