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The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
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.