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A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Prevention vs. Intervention
Why intervention can be the quality of life choice.
Pain is one way we learn. Most recently, the pain of my wife's fractured big toe led us to seek out a foot doctor. During conversation with him, I learned that the progression of immobility within the first MTP (metatarsophalangeal joint) can be a significant contributor leading toward an eventual knee replacement.1 This was a new awareness. As my newest course that I am now teaching is the Aspiration to Prevent Hip, Knee, and Shoulder Replacements, his clinical statement intrigued me. Also, one of the themes of this column continues to be: Our profession has the ability and skills to function as an early detection team for our clients; so I requested Dr. Bradley J. Makimaa DPM, FACFAS, to guide my understanding in preparing this article.2
Sadly, many of our clients live with chronic foot pain when an ounce of prevention could make a huge difference in their comfort level with skilled attention and care by a good foot and ankle specialist. And at other times, our clients present to us with problems that require a true pound of cure but don't know what their options are or from whom to seek qualified help. Clients do listen to our encouragements to seek proper medical care when we have an informed opinion. That's the purpose of this article, to contribute to you developing an informed opinion.
For many of our clients, stiffness and pain in their feet progressively emerges as they walk, dance, or run over the years. The foot joint being highlighted in this article is the condyloid synovial joint at the base of the big toe, the metatarsophalangeal joint. The early stages of this progressive degeneration is known as halux limitus. As the problem progresses toward joint immobility, it's latter stages are diagnosed as halux rigidus. This progression toward immobility is considered to be a form of degenerative arthritis.1 A history of having fractured or having severely "stubbed" the same big toe is a common human experience and is a question to ask of our clients.
As bodyworkers and massage therapists, we can easily feel the stiffness and the calcium deposits around this joint when it is progressing toward degeneration. A simple distraction and mobilization technique that I use is to traction the joint to the first barrier to motion, lifting the toe slightly, then request the client to push their big toe downward. Most often, the joint will slide and the active plantar flexion movement will reduce its compression. If, on the other hand, this produces quite a bit of discomfort or pain, and has a very limited range of motion, then the client is probably into the halux limitus territory and needs to be referred to a foot and ankle specialist. This is the ounce of prevention indicator.
In contrast, all of us have experienced clients presenting with a big toe that doesn't move at all. Sometimes it will be swollen and painful and sometimes it will be so stiff that palpation doesn't hurt in the least. Sadly, this means that the joint is frozen and that halux rigiditus is probably the more appropriate assessment. Occasionally, these symptoms will indicate a chronic gout condition. Again, an encouraging referral is in order. This is the pound of cure territory.
Let's now consider Dr. Makima's clinical experience on how this eventually contributes to knee deterioration, interventional surgeries, and possibly even knee replacement. "When patients have this ongoing limitation at the base of their big toe, their foot must invert to continue through the push-off phase of gait. It is the easiest compensation and closest in proximity to the motion. It really comes down to gait and having watched thousands of patients with this condition. They all invert their foot, i.e., tilt the sole of the foot toward the midline, to continue the push off phase of gait and continue the natural motion they used to have, only now all joint dorsiflexion and plantarflexion is done with the MTP's of the 2nd through 5th toes. This late phase inversion causes a closed chain external rotation of the leg and the knee and thus an exaggerated overloaded varus position of the knee at toe off."2
Varus, means bow-legged which adds compression and directs the force of each heel strike moving through primarily the medial compartment of the knee instead of being distributed between the medial, center, and lateral compartments of the knee.3 "Further, this results in a wiggle-waggle hip motion attempting to bring the foot back to a neutral position during the acceleration phase. Many of the patients I have seen with this gait have had one or several knee surgeries. Some led to knee replacements. I always ask if they have ever had the big toe addressed by the orthopedic surgeon or foot and ankle specialist (as they had an obvious giant bone spur formation and reported pain). The answer almost unanimously is "we will deal with the knee first" or, "no it has never been addressed."
I have had several patients cancel knee surgery after having a first MTP implant. I can't speak as to the long-term knee follow-up and previous damage but the correct gait with appropriate rehabilitation follow-up after surgery, definitely removed their knee pain."2
Having an implant done for the first MTP is the pound of cure approach that many of our clients may need, as it will allow them to continue a more active lifestyle and thus maintain their quality of life. Our collective desire as a profession to prevent physical deterioration can only assist those whose degradation hasn't spiraled downward to the point where medical intervention does need to be considered. Being alert to the conditions and symptoms which may indicate that such interventions are a possible necessity is a very significant service to our clients.
Dr. Makima states that overpronation, eversion during the push off phase, is the root of most foot pain and dysfunction and that orthotic support will always be helpful if that is part of the underlying cause. Taping procedures can be helpful to those whose big toe limitations and pain have not progressed beyond such conservative measures.
Additional red flags for when to refer clients to a foot and ankle specialist include:
The many additional foot and ankle problems that our clients may experience are beyond the scope of this article. However, the next time someone's big toe doesn't move with ease or is painful to palpation, do encourage them to see a foot and ankle specialist, their physician, or an orthopedist. Be a part of your clients' early detection team.