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Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Suffering Makes Us Human
It is possible that suffering, instead of being something negative, can be one of the greatest gifts to bring out one's humanity — if we allow it to be.
When I started to think about what I wanted to do, I toured different schools to choose where to pursue my original chiropractic education.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Are You a Stakeholder?
In today's world many new things are occurring, especially in the world of information technology. With these changes, comes an entire new set of vocabulary words and definitions.
How to Market to the Medical Profession
The world of health care is changing dramatically. When situations occur that cause expenses to increase, it is time for you to develop strategies that maintain and grow revenue.
Yo San University Receives $1 Million Gift
Long-time Yo San University supporter Thomas S. Blount recently gave a $1 million dollar gift to the University, it's largest charitable gift to date. Mr. Blount was a retired naval officer, aerospace consultant and philanthropist.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Cold and Flu Season: Expanding the Repertoire
As we move into the winter months, it is important for clinicians to have a solid working knowledge of effective herbal protocols for treating and managing clinical cold and flu presentations.
Building Community: A New Way to Socialize Your Practice
Social Media can seem like a slippery slope when, in fact, it is fairly easy to understand. With social media platforms, you can connect with current and potential new clients, build strong customer loyalty and increase brand awareness.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Breech Baby: A Scientific Approach
You learned a classic cookbook style treatment strategy in college for treating breech baby presentation. I'm sure you've used it. The main ingredient: moxa at Urinary Bladder 67.
Detoxification Demystified and the Crucifers that Help
"Let food be your medicine and medicine be your food," is a quote often attributed to Hippocrates, a philosopher of the 5th century BC.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
The 2015 Nobel Prize Shines a Spotlight on TCM Research
Traditional Chinese Medicine continues to make it's presence felt on the world stage as the 2015 Nobel Prize in Physiology or Medicine was jointly awarded to William C. Campbell and Satoshi Omura for their work on combating parasites and YouYou Tu for her discoveries in combating Malaria.
Challenging the Traditional Diagnosis of Carpal Tunnel Syndrome
In the light of clinical studies, and research available today, this article will take a close look at common forearm, wrist and hand problems that often seem to be diagnosed and treated incorrectly. This article is based on a true case study of a client from one of my seminars in Boston. This particular client had recently undergone surgery at both his wrist and elbow. Both surgical procedures were attempts to release the pressure on his median nerve, to treat carpal tunnel syndrome. Unfortunately, the actual nerve compression problem was actually in his neck and shoulder before the nerves ever branched off to become the median nerve at the elbow and wrist. Once we treated the tight muscle groups such as his SCMs, anterior and posterior scalenes, and his pectoralis minor, the numbness, tingling and parasthesia that surgery did not correct in his arm and hand went away.
The term multiple crush phenomenon refers to a condition when there is more than one compression on a nerve trunk. Sections of the nerve distal to the first site of compression become nutritionally deficient because of axoplasmic flow blockage. Consequently, these distal areas are more susceptible to irritation from even a minor degree of compression (i.e. becoming the second or third site of the crush).
If you look at a classic postural distortion pattern of someone talking on the phone, it is clear to see that poor work ergonomics can shorten muscle groups in the neck, shoulder, elbow, forearm, wrist and hand. (Figure 1 ) When muscles like the SCMs, anterior and posterior scalenes, and pectoralis minor shorten, the brachial plexus of nerves get compressed under the clavicle. (Figure 2)
This is often compounded with cervical nerve compression problems. So the nerves are compressed twice already. Then at the elbow, the median nerve runs through the bicipital apeneurosis, and again through the pronator teres. (Figure 3) If there is tension or damage to the bicipital apeneurosis or teres minor, the nerves are now compressed four times before they ever reach the carpal tunnel.
Therefore, when a client complains of clinical symptoms such as parasthesia, numbness, and pins and needle sensations in their hands, the manual therapist should look at all areas of nerve compression between the brain and the fingertips. In my opinion, the assessment should start in neck and shoulder, progress to the elbow, and then end at the wrist. This approach to treatment would address what Dr. Erik Dalton refers to as descending syndromes.
Based on the photo of the woman on the telephone, let's look at a simple road map. This assumes that posturology has addressed a true leg length discrepancy, and myoskeletal alignment techniques have facilitated alignment of the bones in the cervical spine.
Step 1. Release the tight SCMs, and anterior and posterior scalenes.
This should start with myofascial release, followed by treating active and latent muscle belly myofascial trigger points, and stretching those muscles that often pull the first rib up onto the clavicle to compress the brachial plexus of nerves. (Figure 4)
Step 2. Release the pectorals major and minor muscles.
After doing myofascial release to the pectorals major (Figure 5), treat trigger points in the pectorals minor (Figure 6), and stretch the pectoralis major and minor muscles. Make sure to treat a muscle strain in the pectorals minor, if found, and address capsular adhesions of the shoulder if there is a bone on bone like end feel when stretching the pecs.
Step 3. Release the biceps (taking tension of bicipital apeneurosis). (Figure 7) If there is a strain in the bicipital apeneurosis treat that after releasing the biceps muscle belly. The median nerve will be scarred down by scar tissue in the bicipital apeneurosis if that is strained.
Step 4. Release the pronator teres. (Figure 8)
Keep in mind the median nerve passes through this muscle. In people that work on the computer, this is a posturally short muscle that often gets neglected in clients diagnosed with carpal tunnel problems.
Step 5. Release the wrist and hand flexors. (Figure 9) There are nine tendons that pass from these muscles under the flexor retinacculum. Tension in the wrist flexors cause overdevelopment of their tendons, and can compress the median nerve under the tight flexor retinaculum leading to "true" carpal tunnel syndrome.
Step 6. Free up the flexor retinaculum, and release individual tendon adhesions in the carpal tunnel. Active myofascial release is done by having the client spread and extend the fingers to help release the flexor retinaculum and flexor tendons in the tunnel. (Figure 10)
This should be followed with the client stretching those same muscles as part of client self care. Ergonomics of the work station would also be addressed. This article will flow into a series of articles, starting with complicated forearm, wrist and hand conditions, to take a more detailed clinical look at conditions like "true carpal tunnel syndrome" and the significant difference between tendinitis, tendinosis and tenosynovitis conditions. The treatment by the manual therapist cannot get optimal results if we do not understand the different pathologies of these very different basic clinical conditions of the forearm, wrist and hand. Manual therapists will get their best results with complicated clinical conditions when they learn to match the appropriate modality or manual therapy discipline to each specific underlying pathology. Our industry also needs to also take a closer look at things like multiple crush phenomenon to eliminate multiple causes of conditions such as carpal tunnel syndrome.
Editor's Note: Art images and case study information were taken from James Waslaski's new book with Pearson Publishing, Clinical Massage Therapy: A Structural Approach to Pain Management.