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News in Brief
Life to Open Branch Campus in Italy; Northwestern Research Arm Benefits From Big Donation.
Introduce Your Patients to Collagen Induction Therapy
Cutaneous (skin) aging generally occurs from either intrinsic or extrinsic processes. Intrinsic aging results from natural skin tissue damage and degeneration.
DC App – The Next Generation
According to a survey by technology firm CDW, health care professionals gain approximately 1.2 hours per day in productivity simply by using a tablet computer in practice.
Avoiding "Just a Pop Doc" Syndrome
Yes, it's harsh. Patients don't like to admit it. They have an unspoken plan when they first visit you: to come one time, get rid of their pain and then get rid of you. They know it's unrealistic, but they'd like to pay nothing for this service.
Chronic heightened emotional states create a perfect breeding ground for illness. Through my practice I noted the increasingly obvious relationship between one's mental focus on negative thinking, emotions, resistance to experiencing feelings and disease.
Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo.
Acupuncture Detox as Part of Drug Rehabilitation
In the U.S., more than 2,000 alcohol and drug rehabilitation programs have added ear acupuncture to their practice. The development of the protocol was determined by Lincoln Hospital as it delivered 100 acupuncture treatments daily.
Are You Ready for the 2016 Patient?
In October, Apple released its iOS 8 operating system for the iPhone and iPad. The new system includes Health, a new app that will interface with an ever-growing number of other apps.
Implications of Section 2706: The Non-Discrimination Provision Survey
In late April 2014, NCCAOM diplomates received an email survey with the subject line: "End discrimination against acupuncturists" polling CAM practitioners for a Request for Information from the Department of Health and Human Services, released in mid-March.
Inspire Your Patients to Make Healthy Choices
Have you tried to get your patients to change their eating habits or their diet and couldn't get them to succeed? Were they confused and unsure of what the right thing was to eat? You are not alone!
The Acupuncture Now Foundation: What Our Profession Needs
Although acupuncture is growing in popularity it continues to be underutilized due to misunderstandings about its true potential. Only a fraction of those who could be helped by acupuncture know enough to seek it out.
Treating Chronic Depression with Acupressure
In Traditional Chinese Medicine there already exists a comprehensive theory linking the body and mind.
Home Safety: Help Families Avoid Common Injury Hazards at Home
These days, many parents childproof their homes before a baby is even mobile. You will see an array of electrical outlet covers, bumpers on the corners of the coffee table and safety latches on the cupboards.
The Death of the Travel Card
As long as I have been in practice, the travel card has stood as the primary style of documentation for chiropractic. It is quick, simple and direct. Unfortunately, the rules have changed.
Peer Points: Promoting TCM Knowledge
When Elaine Wolf Komarow, LAc, received her first acupuncture treatment in 1989, she said it changed her life. "I felt more aware, calmer, and happier. I was so fascinated by the changes that I began to learn everything I could about the underlying philosophy of Chinese medicine," said Komarow.
Chinese Medicine: The Natural Way to Children's Wellness
As a child, I did not like going to the doctor. For the most part, when I had to go I wasn't feeling good to begin with, and I was heading into a sterile environment to be awkwardly probed by a man in a white coat for a very short, impersonal period of time.
Foundation for Chiropractic Progress Announces First Group Member
The Michigan Association of Chiropractors has joined the Foundation for Chiropractic Progress as its first group member.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
Step by Step: Long-Term Treatment of Soft-Tissue Injuries Combines Skill and Care
Treating soft-tissue injuries with long-lasting results starts the moment an individual enters the office. When it comes to pain, the only thing that matters to the patient is relief.
It Pays to be a Foodie
If there is an inner foodie in you, just waiting to burst out—this article is for you! Do you want to know how I know? I'm that girl. My middle name might as well be "Foodie." I love food! And if my patients are any indication, many of them do as well.
Solving the Pain Puzzle
Legendary former New York Yankees baseball player Yogi Berra once said, "You can observe a lot just by watching." He would have been a great chiropractor. We are trained to become experts with our hands: palpation, adjusting, soft-tissue release, etc.
Five Element Acupuncture Can Enhance Your Practice
For eight years I have been teaching and supervising TCM students at an acupuncture college in Colorado, in Five Element acupuncture.
Micro-Needle Dermal Roller Use in the Treatment Room
Recently micro-needle dermal rollers have been getting a lot of media attention. As a practitioner who specializes in acupuncture facial rejuvenation, I know that skin needling with a dermal roller (also known as collagen induction therapy), promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter.
Treating Acute and Chronic Neck Pain With Ischemic Compression and Exercise
There are many reasons not to manipulate the neck with cavitation: the patient is too old, their neck is too tight, etc. But the most common reason is that plenty of patients are afraid of "the crack," mostly because of the bad publicity about that procedure.
Capturing the Essence of Tai Chi
Over the last 12 years, I have been working on one of the few documentaries about Tai Chi. It's called The Professor: Tai Chi's Journey West and it's about Cheng Man-Ching who moved to New York in the 1960s.
Make Low-Level Laser Therapy Part of Your Evidence-Based Practice
Low-level laser therapy (LLLT), also referred to as photobiomodulation, has been increasingly utilized in the clinical setting over the past decade.
Following the Thinking of the Classics
I have heard about the "best time of day" to carry out certain examinations or therapies. For example, I remember making a note years ago that early morning is the best time to take someone's pulses.
Why Drugs and Supplements Can't Cure Disease
Chronic diseases are the outcome of disease-promoting, goal-oriented behaviors. So, the notion that diseases can be cured with drugs or supplements should be abandoned. Hypertension is the best example of this.
Are You Ignoring the 10,000-Hour Rule?
Having trained interns and mentored new practitioners, it has been my observation that their No. 1 clinical concern is adjusting skills. Their second clinical concern is their ability to read X-rays. Physical diagnostic skills are a distant third.
The Power of Mu Xiang to Treat Irritable Bowel Disease
Bloating and gas pain is something that everyone has had to deal with at one point or another; however, that's usually reserved for holiday dinners and other large gatherings.
March, 2012, Vol. 12, Issue 03
Kinesiology: May the Force Be With You
By Whitney Lowe, LMT
There is no question about it - kinesiology is cool! That's what I think anyway, and it boggles my mind when others are not as intrigued. But, I think it is just that some simply do not realize the benefit of this fascinating field of study.In many cases, knowing kinesiological principles is not just useful, but absolutely essential. Anyone working with pain and injury complaints should have a solid working knowledge of the primary clinical sciences.
Using kinesiology to its full extent is one of the things that will set you apart from other massage therapists and other health care professionals. Surprisingly, kinesiology is one of the clinical sciences least understood by soft-tissue practitioners. Many confuse the science of kinesiology with what is called, “applied kinesiology,” which is completely unrelated. More challenging for others is not knowing how to effectively apply these principles in a clinical setting. Yet, kinesiology's real value is revealed when it fully informs your clinical work.
Sadly, for many, this captivating subject got boiled down to mind-numbing memorization of muscle attachment sites and actions in massage school. Notably, it is the passive learning style that predominates in kinesiology education in both basic and continuing education. Read - memorize - take a test. However, if you take a moment to explore the key elements of kinesiology, you might just discover a host of valuable ways to incorporate this science in your own clinical work.
What is Kinesiology?
Kinesiology is the exploration of human movement and integrates three disciplines: musculoskeletal anatomy (form), neuromuscular physiology (function) and biomechanics. Kinesiology is that area in which these three disciplines intersect (Figure 1). Having a good foundation in these clinical sciences as they relate to soft-tissue treatment is a great starting point. By default, understanding kinesiological principles returns a better understanding of human structure and function.
Your basic education started you out with a solid foundation in muscular anatomy. Soft-tissue therapists should know what the structures are under the skin to which they will be applying soft-tissue treatment. Those working with any level of pain or injuries must know these tissues to have an idea what might be playing a role in their client's dysfunction.
The clinical knowledge necessary for therapeutic treatment does not stop with muscle names or with muscle attachment sites. In fact, it should not stop with muscles at all, but should progress to ligaments, tendons, nerve and fascia - the other soft-tissues often needing to be addressed in various conditions. While muscle tissue is the most common structure soft-tissue therapists work with, it is by no means the only cause of soft-issue pain. If you are not aware of other soft-tissues that may produce pain, you will miss important characteristics of the client's condition.
While anatomy is the study of structure, physiology is the study of function. The second key element of kinesiology is the function of the locomotor tissues, specifically the neuromuscular connection. Movement occurs because of neurological impulses delivered to muscles causing them to contract. When there is a disruption or irregularity in neuromuscular activity or control, movement disorders and pain can result.
Massage treatments frequently incorporate this fundamental understanding of neuromuscular physiology even though you might not be aware of it. Consider the way in which PNF stretching takes advantage of neuromuscular control principles such as post-isometric relaxation. Other methods such as active isolated stretching rely upon specific positions so as not to initiate the neuromuscular stretch reflex. The client who has postural dysfunction and painful trigger points is treated with methods based on physiological principles of how to best deactivate and neutralize these dysfunctional trigger points.
Biomechanics is the third intersecting clinical science of kinesiology. It is the study of structure and function of biological systems through mechanical physics, basically the study of physical forces. It is sometimes confused with body mechanics, which one learns in applying massage strokes. Performing biomechanical analysis requires an understanding of both anatomy and physiology.
To determine how a structure might respond to various mechanical forces, you must be familiar with its physiological characteristics in response to mechanical stress. Evaluating a soft-tissue injury requires exploring the forces applied to the body during injury or activity: their direction, velocity and intensity. Through this mechanical analysis, the practitioner evaluates whether those forces were sufficient to cause specific tissue injuries and consequently how those tissues should be treated.
There are five types of force that can be applied to soft tissues of the body, but only two play a dominant role in most soft-tissue injuries. The five types of force are compression, tension, torsion, bending and shear. Most soft-tissue injuries result from an excess of either compression or tension forces or a combination. The ability to identify type and magnitude of different forces acting on the body is a key aspect of biomechanics that is essential for rehabilitation science.
Putting it Into Practice
As you can see not only is kinesiology a much broader science than you may have realized, but it is an integral part of becoming a highly skilled soft-tissue therapist if you are working with pain and injury complaints. An arsenal of techniques is essentially your bag of tools. However, even with a great bag of tools, if you don't understand when to use a wrench and when to use a screwdriver and how much force to use when you apply it, your work will be so much less effective. Let's take a look at a few examples to see how quality evaluation and treatment rely heavily on kinesiology.
Case 1: Phillip
Philip works in a machine shop that builds frames for construction projects. A good deal of his day is spent using various power tools. When using these tools, he is subjected to repetitive motions along with vibrations from the tools which you can observe in this video clip.
Recently he has been complaining of neurological pain in his forearm and hand. Initially, it is tempting to suspect that he has carpal tunnel syndrome because that is a nerve compression problem that many people are familiar with. However, in applying anatomical concepts, we are reminded that there are numerous potential sites of nerve compression throughout the upper extremity and not all of them affect the median nerve. The untrained therapist may simply jump in and attempt to treat the nerve pain directly in his hand and wrist. Yet, that may not be the primary site of dysfunction.
After performing the relevant palpation, range-of-motion and manual resistive test procedures, there is a suspicion that Philip's primary complaint involves the median nerve. Performance of the upper limb neurodynamic test #1 indicates a reproduction of symptoms in his median nerve. This video clip shows how to perform the upper limb neurodynamic test #1.
Philip describes to us some of the physical activities that he engages in during work including the various motions that he performs with his wrist and arm on a repetitive basis. When performing the upper limb neurodynamic test, we notice that symptoms are more easily reproduced in his forearm with movements of his elbow that stretch the median nerve compared to movements of the wrist that also stretch the nerve.
By applying our knowledge of anatomy and mechanics to how the median nerve is stretched in these different positions, you conclude that his primary nerve pathology is likely to be near the pronator teres muscle in the forearm as opposed to a compression pathology at the carpal tunnel in the wrist. This is because stretching the nerve around the elbow causes more symptoms than stretching it near the wrist or any other part of the upper extremity. Consequently, our treatment approaches focus increased attention on the forearm and are much more successful than if we had incorrectly focused on the wrist.
In this case, we used kinesiological analysis to identify the type of soft tissue dysfunction Philip was experiencing and also more accurately pinpoint where the pain was originating from. This information will also play a crucial role in constructing the most effective treatment. We identified the pronator teres muscle to be a key culprit in the nerve compression. Our analysis of movement noted that this muscle is exceedingly overused in the power tool work activities he is performing.
The pronator teres muscle is not easily treated and requires specific identification to address it properly. Key treatment methods are selected for Phillip using our detailed knowledge of the muscle's location, attachment sites and motions of the forearm and wrist that shorten or lengthen it. The pin and stretch technique in this video clip is highly effective for Philip's pathology and is a great way to address nerve compression by the pronator teres muscle. Using our kinesiological skills in assessment and treatment allowed us to get Phillip back to full activity much sooner and with great results.
Case 2: Robbie
Robbie is an avid snowboarder and outdoor enthusiast. Recently, he suffered an injury to his quadriceps when landing improperly from a jump. He describes what happened to him which you can see in this video clip. Because this was an acute injury, accurately analyzing the forces his knee experienced during the injury is of crucial importance to identify which tissues received the greatest degree of stress.
As he describes his injury, it's evident that his knees took a heavy compressive load from landing on the hard packed snow, especially because he landed in a slightly awkward position. However, his primary complaint centers around pain that appears to be in his distal quadriceps muscle group and not with the internal knee structures themselves. In this instance, we must use our biomechanical analysis and knowledge of form and function to understand what happened with the quadriceps muscles as he landed from this jump. In school you learned that the primary action of the quadriceps is knee extension. However, this is the action of the quadriceps when they are in concentric contraction and the muscles are shortening.
It is imperative to remember that muscles are also engaged as they are increasing in length, which occurs during an eccentric muscle contraction. This distinction is very important because most serious muscle injuries occur from eccentric overload. Unfortunately, the emphasis in school on memorizing muscle actions and only focusing on their concentric contractions has led people to miss the other functional activities of a muscle which are crucial to understanding soft-tissue injuries.
Now, consider how the quadriceps are engaged as Robbie lands from the jump, especially since he said he was in a slightly awkward position making them suddenly take on a greater than normal load. It is likely that his injury was from an excessive eccentric load of the quadriceps as they resist the body's attempt to crash to the ground. The biomechanical action of decelerating motion when landing from a jump is a frequent cause of quadriceps injury.
Exploring Robbie's case further through various assessment procedures, we identify his primary location of pain and most likely site of injury to be in the quadriceps retinaculum, the connective tissue where the quadriceps muscle fibers blend into the connective tissue that eventually joins with the patellar tendon (Figure 2). Having identified the problem to involve some degree of tissue tearing and resultant muscle tightness, the focus of our treatment is on encouraging tissue elongation and reduction of muscular hypertonicity.
There are many good massage techniques that could be used to address the fiber tearing and resultant adhesions that may develop in the quadriceps retinaculum. Deep friction massage, longitudinal stripping and compressive effleurage are all highly valuable. Yet, because Robbie is such an active individual and wants to get back to his activity as soon as possible, a more aggressive treatment approach may be called for with him. Active engagement techniques for his knee extensor group are an excellent treatment choice.
Accurately performing active engagement techniques requires knowledge of kinesiology because you must understand when the muscle is engaged in concentric contraction, eccentric contraction or passively lengthening or shortening. In this instance, the goal is increasing tissue elasticity along with reducing adhesions and encouraging the most effective muscle relaxation. Active engagement techniques that encourage tissue lengthening are the ideal choice for this goal. The active engagement technique for the knee extensors demonstrated here is an exceptional way to address his primary complaint and get him back to activity as soon as possible. Without a solid grounding in kinesiology, we would not be able to identify his knee complaint nor choose the type of active engagement technique that would be most effective in addressing his injury.
How to Learn More
Understanding kinesiology is exceptionally important when you treat clients having pain and injury complaints. Yet, it isn't easy to find formal coursework in kinesiology that is directly applicable to your massage practice. Most university courses in kinesiology are aimed at physical education professionals and not at manual therapists or health care professionals. A continuing education course specifically on kinesiology would not integrate the other sciences and clinical reasoning required for application. There are some excellent books available on kinesiology, but many people find kinesiology textbooks overwhelming and are not sure how to use the books.
The most effective way to learn kinesiology is through activities that put the information directly into practice and require creative thinking and clinical reasoning by the individual. Choosing CE courses that emphasize kinesiology in conjunction with other clinical sciences as they are applied to various situations is an efficient way to learn these principles. Courses that include problem-based learning, case study evaluations or scenarios include deeper levels of analysis and allow the individual to immediately apply kinesiology to their coursework.
You can also improve your application of kinesiology by just watching simple movements you see someone performing and analyzing them. Watch someone walking, raking the yard or working at a checkout stand and analyze what type of forces are being applied to the tissues involved in the activity. When you can apply these principles in the context of your day-to-day work activities, they are much more likely to stick and become meaningful for you.
Massage therapists are ideally positioned to use kinesiology as a valuable and indispensable tool for both assessment and treatment. Putting greater emphasis on applying kinesiology in your practice will pay off with significant rewards of increased treatment success and satisfied clients.
Click here for more information about Whitney Lowe, LMT.
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