tag:blogger.com,1999:blog-91615400713408351272024-03-12T20:08:50.835-04:00Ideal Balance AcupunctureMedical insights for patients at Ideal Balance: Center for Sports Medicine Acupuncture. Discussing the anatomy behind common types of pain and acupuncture treatments.Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-9161540071340835127.post-85816299612049608522022-11-20T19:15:00.012-05:002023-10-10T09:01:34.452-04:00Abdominal Muscles and Back Pain<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Abdominal trigger points can refer to the low back</span></h1>
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Many people are aware that the abdominal muscles have something to do with back pain and this awareness is centered around 'core' support and the role of these abdominal muscles in back support. While this is certainly the case, my patients are less aware that the abdominal muscles can be directly tied to the back pain they experience. The rectus abdominis specifically can harbor trigger points, or sensitive contractile knots, that can cause pain not necessarily in the abdomen, but can instead refer pain to the back.
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4t4XzPFk5Nn8Mk0rcc6WAZcOQuuWwbPeVUX_932gOLvXI1WyfMkaBIbvhqu6Js0RI4EsC-tOkI0kKDOGuhpjFuZ7VRrrF3IeZX9jxLrzCvP_lIVekpleFwVSEoE5FG9jwp4RuksT60QDc1DSceGEvyUcx9iQnjJYWak9-4UXHdHnWFevbg5i-Yibepw/s999/Rectus%20abdominis%20anatomy%20blog.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;">
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Regardless if you have a developed rectus abdominis or not, this is the muscle that people refer to when the discuss a 'six pack' ab. Technically, there are four grouping of muscles on either side, and each of these compartment are bordered by a tendinous intersection. The upper compartment is lies over the lower ribcage and this compartment is less visible when people do have 'six pack abs', so you are really seeing the lower three compartments on either side.
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The rectus abdominis attaches from the pubic bone to the lower ribcage and sternum. The muscle is involved with flexion of the trunk, forced exhale and compression of the abdominal organs.
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While it is actively involved in forced expiration or exhale, when the muscle becomes rigid and restricted, it can reduce the ability to take a good, deep inhale and this is most frequently the case when this muscle becomes a component of low back pain.
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4Yld7au-uaAesi2r45g_3U_J7tYCUBZuCJTQjTCqjuWwN5HpP6SchZozJhd7uNNfmom1gRL3ZI2N6aQZRGu0ilIl7SjmzCobGCACFuF1gmbG47DMnVY0svobMadB35E5_I3bSidPMTtN0KV4AzgXhxxVa5Mj3UGDmzbRRwL--V1c0wrWcQN3C7QFzpw/s450/rectus%20abdominus%20posterior%20referral.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;">
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There is a characteristic referral pattern when this muscle is contributing to back pain which can be seen on the image to the right. The low back portion of the refer specifically usually is associated with trigger points in the umbilical region, in my opinion, and they can frequently even occur in the tendinous intersection in this region. This image to the right shows and X at the pubic bone attachment which can also occur, but I still find this occurs more frequently at the umbilical region. The mid back pain referral is more often at the region just below the lower ribcage and close to the xiphoid process which is the lowest part of the sternum or breastbone.
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Many people with low back pain will look at the referral that travels across the low back/upper pelvic region and say, 'That describes my back pain!" It could be the case, then that the rectus abdominis is a contributor. It is the case, thought, that there are other frequently causes of this horizontal distribution of low back pain. Specifically, the joints of the lower spine, referred to as facet joints, can become irritated and cause a similar pain distribution. Below is and image that illustrates this referral pattern and you can see that there is some overlap.
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It can be a combination of causes, all contributing to the pain that brings people in to see me. Palpation can be used to see if this muscle is referring pain, but there are also other clues. Urinary problems, digestive disturbances, and dysmenorrhea (painful periods) can all be associated with trigger points in the rectus abdominis. Clinically, it is worth investigating if this important muscle is contributing to the back pain and other problems, and then adding protocols to treat it into the mix. Acupuncture, dry needling, manual therapy and specific corrective exercises are all helpful and tools I use for this trigger points in this muscle and for back pain in general.
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-1.8736567183276982 -117.57607039999999 58.013156718327693 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-91286776592265296502022-11-03T14:26:00.014-04:002023-10-10T09:02:12.149-04:00Upper Trapezius Pain and Dysfunction<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Upper trapezius trigger point pain pattern</span></h1>
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Restriction and pain associated with the upper trapezius muscle is a common finding in my clinical practice and something I address often with patients. Stress, excessive sitting at a computer, and poor core support are but a few of the things that can lead to this muscle forming painful trigger points (hypersensitive nodules that refer pain). The image on the left from Travell and Simon's excellent book, Myofascial Pain and Dysfunction: A Trigger Point Manual, illustrates the common pain referral from this muscle. Many people suffering from chronic neck pain and stiffness and/or muscle tension headaches will likely find this a familiar pain pattern.
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Trigger point based acupuncture (trigger point dry needling), trigger point injection, and deep tissue myofascial release techniques are all excellent resources I use to treat this common complain. However, self stretching can be an excellent resource as well and here is a video showing a self stretch I frequently give my patients.
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<h1 itemprop="name" style="text-align: left;"><span style="font-weight: normal;">Upper Trapezius Stretch</span></h1>
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<div itemprop="description" content="A self-stretch for the upper trapezius is demonstrated step-by-step and with demonstration to help ensure the best benefit for those performing this stretch.
The upper trapezius frequently develops painful trigger points which can refer along the posterior neck and deep into the temple region. Trigger points causing taut bands in this muscle are common with patients complaining of a stiff neck and muscle-tension headaches. With neck stiffness, the neck frequently feels tight when turning to the opposite side and there is a tight sensation towards the end of the range of motion which presents with limited range of motion. This muscle is frequently dysfunctional along with the SCM muscle."></div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-1.8736567183276982 -117.57607039999999 58.013156718327693 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-47446786164642461602022-11-02T23:15:00.015-04:002023-10-10T09:02:39.597-04:00Mobility of the Lower Ribcage<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Lower ribcage mobility has relationships to the diaphragm, spine and internal organs.</span></h1>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJFjAcEWalXSwKNboOikYL457in_S0xDRIkgOg9mqN3fQghwVdNFu248t25x5S7A6VyZPpoWg_fnSI-i_Ag3nzjVSXiQG-Kltt4PJ-YxInJHOomtkhgeg3C7VWBl51JChuUW-wsxAykRVN1IzYON921uCtckYA1x6S4ugbxZZdGQqh1cOvYsBelMCtxw/s1404/ribcage%20diagram.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;">
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The lower ribcage has a lot of movement potential, especially when compared to the rest of the ribcage. Part of the movement potential of this region is determined by the anatomy. The lowest two ribs, called the floating ribs, articulate with the lowest two thoracic vertebrae. This is the only place they articulate with bone. Ribs 8-10, called false ribs, articulate with the thoracic vertebrae and then indirectly connect to the sternum through a large bit of cartilage. The remaining ribs, referred to as true ribs, attach directly to the thoracic spine and the sternum. The direct connection to the sternum limits the movement of these ribs (1-7), but since ribs 8-12 do not have this direct attachment, they allow more rotation, compression, and expansion.
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There are attachments of the respiratory diaphragm and the internal organs to the lower ribcage. Specifically, the liver, intestines, spleen, and stomach have strong attachments to the lower ribcage. Good movement in this region helps massage the internal organs and take the diaphragm through a good range of motion. This keeps these structures healthy and supple.
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Much of the movement of this region is driven by the Liver and Gallbladder sinew channels, especially the rotational movements of the ribcage in relationship to the pelvis. The obliques are the driving force of this rotation. The internal obliques are most associated with the Gallbladder sinew channel. The Liver sinew channel involves the medial line of the body, but includes the external oblique which fascially connects with the contralateral adductor longus. Trunk and pelvic rotations are very tied to these channel sinews and imbalances are treated through these channel sinews.
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Another movement of this region involves the ability of the left and right sides to flare (move away from each other) and to hold stability preventing excessive rib flare. This is largely controlled by the transverse abdominis and has more to do with the Kidney sinew channel. When the Kidney sinew channel does not properly support this region, the ribs excessively flare and the ribcage tilts posterior.
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<h1 style="text-align: left;"><span style="font-weight: normal;">Ribcage mobilization exercise</span></h1>
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Check out the following videos for a simple qigong exercise to improve the mobility of this region, while massage the internal organs, mobilizing the diaphragm, and strengthening the core. This qigong pattern is derived from an internal martial art called liuhebafa and the movement is called 'Stop Cart and Ask Directions'. It is the first movement of this series.
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<div itemprop="description" content="Stop Cart and Ask Directions is the first move of the liuhebafa (lok hup ba fa) form; one of the primary Chinese internal martial arts. In this movement, the core activation and lower ribcage mobilization is established which is a foundation of the entire form and a major focus that I highlight in my own practice and teaching. This first movement can be isolated and repeated as a qigong pattern to emphasize these principles.
If done correctly, this movement engages the ‘core’, primarily the obliques and the transverse abdominis. This core engagement moves the lower ribcage and mobilizes the diaphragm and internal organs, specifically the organs which attach directly to the diaphragm. These would be the liver, spleen, stomach and intestines. The organs attach to each other via ligamentous structures and have their own range of motion. Movements as demonstrated in this video take these organs through a full range of motion, giving them a sort of internal massage to optimize their health. Practicing this movement is an excellent way to improve digestion and breathing, all while increasing flexibility of the spine and ribcage."></div>
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<div itemprop="description" content="This is a step by step demonstration of a qigong pattern from Liuhebafa, an internal martial art similar to taiji. The focus is mobilizing the lower ribcage and activating the abdominals, especially the obliques and the transverse abdominis. See the link above for discussion of this exercise."></div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-71821365617001062652021-05-05T12:19:00.011-04:002023-10-10T09:02:54.140-04:00Pelvic Rotation in Taiji and Qigong<p> This month we will be focusing on rotation, specifically how this movement involves the innominate bones and the sacrum. I frequently find that, when demonstrating rotation, students often think of the pelvic structure as a block that rotates as a unit. However, the pelvis is quite dynamic and there can be much movement between the two innominate bones which allows sacral rotation to occur. This is seen also with walking or running. The back leg in gait pulls the innominate bone on that side into an anterior tilt, while the forward leg pulls the other innominate bone into a posterior tilt. The entire pelvis is 'twisted' or moves into torsion. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjmHMTkmIKk6TaWxlSjkCYmuHXHRD2gjcuK5fW28MLTCsmU6U0yUglVkZAD1f0aL7PbtiSgXMAxQR_Ce_HRx_FOl-TBsOlzKnsNlNyADgoivCgWzUGr_v6rhzjCQV44XpLa0XmQ9p8dlX8/s938/walking+posterior+view+blog.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="938" data-original-width="600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjmHMTkmIKk6TaWxlSjkCYmuHXHRD2gjcuK5fW28MLTCsmU6U0yUglVkZAD1f0aL7PbtiSgXMAxQR_Ce_HRx_FOl-TBsOlzKnsNlNyADgoivCgWzUGr_v6rhzjCQV44XpLa0XmQ9p8dlX8/s320/walking+posterior+view+blog.png" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">When the practitioner is in a horse stance or in a neutral stance hip width apart and performs pelvic rotation, this same dynamic occurs, or at least the potential is there for it to occur. This movement will create a rotation all of the way from the feet and potentially upward throughout the body to the head, a movement that takes the joints through their full range of motion in the transverse plane.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">We will be exploring this rotation in the Eight Pieces of Brocade, Taiji, Taiji Ball, and even the Core classes this month. Check out the schedule below.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 16pt;">May 2021 Taiji
and Qigong Schedule<o:p></o:p></span></b></p><div class="separator" style="clear: both;">
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="background: white; border-collapse: collapse; mso-padding-alt: 0in 0in 0in 0in; mso-yfti-tbllook: 1184; width: 701px;">
<tbody><tr>
<td style="background: rgb(217, 226, 243); border: 1pt solid windowtext; padding: 0in 5.4pt; width: 104.15pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Monday</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="background: rgb(217, 226, 243); border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Tue</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="background: rgb(217, 226, 243); border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 104.05pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Wednesday</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="background: rgb(217, 226, 243); border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 36.55pt;" valign="top" width="49">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Thur</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="background: rgb(217, 226, 243); border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Friday</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="background: rgb(217, 226, 243); border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Saturday</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="background: rgb(217, 226, 243); border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Sun</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 104.15pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Eight
Pieces of Brocade</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">9:30-10:15am
est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49"></td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104.05pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Eight
Pieces of Brocade</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">9:30-10:15am
est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.55pt;" valign="top" width="49"></td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Core
(No Floor)<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Strengthening
for<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Qigong</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><br />
</span><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">9:00-9:30am est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Taiji
Ball</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">10:00-10:30
am est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49"></td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 104.15pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Core (Floor)
Strengthening for Qigong</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">10:30-11:15
am est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49"></td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104.05pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Five
Animal Sports </span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">10:30-11:15am
est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.55pt;" valign="top" width="49"></td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Eight
Pieces of Brocade</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">9:30-10:15am
est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Five
Animal Sports Practice</span><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">10:30-11:30
am est</span></b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49"></td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0in 5.4pt; width: 104.15pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Taiji
(Tai Chi)<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">6:00-6:45pm
est</span></b><b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></b></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"> </span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104.05pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">Taiji
(Tai Chi)<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><span face=""Trebuchet MS", sans-serif" style="font-size: 11.5pt;">6:00-6:45pm
est</span></b><b><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"><o:p></o:p></span></b></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.55pt;" valign="top" width="49">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"> </span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"> </span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 104pt;" valign="top" width="139">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"> </span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0in 5.4pt; width: 36.5pt;" valign="top" width="49">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: "Open Sans", serif; font-size: 11.5pt;"> </span></p>
</td>
</tr>
</tbody></table>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-84702602860036861362020-03-20T08:02:00.007-04:002023-10-10T09:03:07.781-04:00Taiji (Tai Chi) and Qigong for Health<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Taiji (Tai Chi) and Qigong for Health and Wellness During Social Distancing</span></h1>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><br /></span>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129;">Below is the schedule for online video conferencing based (Zoom) Taiji (tai chi) and qigong classes to assist with health and wellness for my patients, colleagues, and friends during these times when we are isolated at home. My goal is to threefold: 1) to increase circulation and support optimal health; 2) to decrease stress; and 3) give something fun to learn or deepen your understanding if you are already doing some form of Taiji or qigong. It’s also a nice way for us to enjoy a social activity together while taking care of ourselves.</span><br />
<span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span face=""trebuchet ms" , sans-serif"><iframe allowfullscreen="" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/lOQD6mujHpM/0.jpg" frameborder="0" height="266" src="https://www.youtube.com/embed/lOQD6mujHpM?feature=player_embedded" width="320"></iframe></span></div>
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;">Classes will currently be free, though if you'd like to support this effort, you can find a donate button at the bottom of this page. These classes will be 'follow along,' so I will not be able to give much in the way of advice regarding personal health issues. Consult with your doctor if you have any concerns about starting a new exercise routine. If you have a particular health need that requires more individual attention, I can set a private consult and lesson tailored to your specific needs. This will be for a fee, but I am open to a sliding fee based on need as I am well aware of the financial difficulty facing most people. Also, insurance might cover this as there are changes underway for Telemedicine.</span><br />
<span face=""trebuchet ms" , sans-serif"><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline;"><br /></span>
<span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline;">Send your name and email (indicate if you want to be contacted for future classes and you can opt out at any time), and I will send the code and password so that you can join the classes. I look forward to seeing you soon.</span></span><br />
<span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><br /></span>
<br />
<h2 style="text-align: center;">
<span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline; font-size: large;"><b>Schedule for the Week of March 15 - March 22</b></span></h2>
<h2 style="text-align: left;">
<b style="background-color: white; color: #1d2129;"><span face=""trebuchet ms" , sans-serif" style="font-size: large;">Saturday March 21</span></b></h2>
<div>
<ul>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><span style="background-color: white;"><b>Seated Work 1:00 -1:45pm est</b></span></span></li>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><span style="background-color: white;"><b>Eight Pieces of Brocade 2:00 - 2:45pm est</b></span></span></li>
</ul>
<div>
<span face=""trebuchet ms" , sans-serif"><br /></span></div>
</div>
<div>
<div>
<h2 style="text-align: center;">
<span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline; font-size: large;"><b>Schedule for the Week of March 23 - March 29</b></span></h2>
</div>
</div>
<div>
<span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline; font-size: large;"><b>Monday March 23</b></span></div>
<div>
<ul>
<li><span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><b>Eight Pieces of Brocade 9:30 - 10:15am est</b></span></li>
<li><span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><b>Opening the Breathing 10:30 - 11:15 am est</b></span></li>
<li><span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><b>Five Animal Sports 3:00 - 3:45pm est</b></span></li>
</ul>
<div>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129; font-size: large;"><b>Wednesday March 25</b></span></div>
</div>
<div>
<ul>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>Eight Pieces of Brocade 9:30 - 10:15am est</b></span></li>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>Seated Work 2:00 - 2:45pm est</b></span></li>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>Five Animal Sports 3:00-3:45pm est</b></span></li>
</ul>
<div>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129; font-size: large;"><b>Friday March 27</b></span></div>
</div>
<div>
<ul>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>Eight Pieces of Brocade 10:30-11:15am est</b></span></li>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>Five Animal Sports 3:00-3:45pm est</b></span></li>
</ul>
<div>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129; font-size: large;"><b>Saturday March 28</b></span></div>
<div>
<ul>
<li><span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>Five Animal Sports 10:30 - 11:15am est</b></span></li>
</ul>
<div>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129; font-size: large;"><b>Monday March 30</b></span></div>
</div>
<div>
<ul>
<li><span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><b>Eight Pieces of Brocade 9:30 - 10:15am est</b></span></li>
<li><span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><b>Opening the Breathing 10:30 - 11:15 am est</b></span></li>
<li><span class="text_exposed_show" face=""trebuchet ms" , sans-serif" style="background-color: white; color: #1d2129; display: inline;"><b>Five Animal Sports 5:00 - 6:00pm est</b></span></li>
</ul>
</div>
<div>
<span face=""trebuchet ms" , sans-serif" style="color: #1d2129;"><b>More classes in April will be added so keep an eye on the schedule. See below for class descriptions:</b></span></div>
</div>
<div>
<b><span face=""trebuchet ms" , sans-serif"><br /></span></b></div>
<div>
<span face=""trebuchet ms" , sans-serif"><span style="background-color: white; color: #1d2129;"><b>Eight Pieces of Brocade</b>. This sequence includes 8 moves, each working on a specific organ system. This form is easy to do (but there can be a lot of nuance), does not require difficult stepping or shifting of weight and can even be done seated. This form is very accessible but has much to offer for all. It can be very meditative and calming, as there is some repetition and less difficulty in terms of learning the moves.</span><br style="background-color: white; color: #1d2129;" /><span style="background-color: white; color: #1d2129;"><br /></span></span></div>
<div>
<span style="background-color: white; color: #1d2129;"><span face=""trebuchet ms" , sans-serif"><b>Five Animal Sports.</b> This sequence includes 5 moves that are part of each "Animal" (25 moves total). Chinese physiology has many correspondences, and each Animal represents and organ that is being worked on. This form is a bit more difficult but can still be modified for individual health challenges. It does involve stepping and shifting, but it can be modified to be seated if necessary. This form is very dynamic and a lot of fun!</span></span></div>
<div>
<span face=""trebuchet ms" , sans-serif"><br /></span></div>
<div>
<span face=""trebuchet ms" , sans-serif"><b>Seated Work. </b>In seated work, we do either of the forms above in a seated position, with emphasis on expansion of the spine and movement of the chest and shoulder girdle. If these areas are moved in an expansive way, then the organs will be mobilized and there will be better circulation in the thoracic (chest) and abdominal cavities. This class will obviously be indicated for those who need to modify the forms in a seated position but can add extra insight for anyone at any level.</span></div>
<div>
<span face=""trebuchet ms" , sans-serif"><br /></span></div>
<div>
<span face=""trebuchet ms" , sans-serif"><b>Opening the Breathing.</b> This class supports the other classes by focusing on proper use of the chest and shoulder girdle muscles, so that the chest can remain open during practice and breathing can be regulated.</span></div>
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-64460891583912379412017-12-13T16:17:00.008-05:002023-10-10T09:03:31.358-04:00Iliac Crest Syndrome<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Iliac Crest Syndrome - A Common Cause of Low Back Pain</span></h1>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuK_R0ESNo5ZCrltOqnEX6t0jdfc4eqE8UNAeuCXd7hQ-b3uzb1Ohn2XUf4oRKA4FSs8xbq_iN-7GNZSuSa6HkjP5KAUy5ZNHh_uYrgWL0lf4UAzHJjVk0jM1xUmV35HVp6LvO0Vi7ot4o/s1600/iliac+crest+pain+websize.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="250" data-original-width="414" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuK_R0ESNo5ZCrltOqnEX6t0jdfc4eqE8UNAeuCXd7hQ-b3uzb1Ohn2XUf4oRKA4FSs8xbq_iN-7GNZSuSa6HkjP5KAUy5ZNHh_uYrgWL0lf4UAzHJjVk0jM1xUmV35HVp6LvO0Vi7ot4o/s400/iliac+crest+pain+websize.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 1: Pain site at the posterior iliac crest region</td></tr>
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
Pain
experienced at the iliac crest is a frequent low back condition
affecting patients seeking help from Sports Medicine Acupuncturists<span style="font-family: "Liberation Serif", serif;">®</span>.
The iliac crest is the top (or ‘crest’) of the ilium, which is
the most superior or upper portion of the pelvic structure. If you
were to place your hands on your hips, they would be resting on the
iliac crest. Pain at the iliac crest, referred to as ‘iliac crest
syndrome,’ is experienced at the posterior (back) portion of the
iliac crest and can be persistent (Fig. 1).</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyGM9scHmYWZCdl14of1gDfOGrzAYDhHD1lyZz0Ui3xa_GWQmdkgyJRHujKo4Z5okEsore0KnAM3RFnRkRLFQorpRRr5qY8ROAKkyB7tUAw653tlKod-vc1cx7802bjdE09S9z-b0NpuEp/s1600/yaoyan+superficial+and+deep+websize.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="300" data-original-width="174" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyGM9scHmYWZCdl14of1gDfOGrzAYDhHD1lyZz0Ui3xa_GWQmdkgyJRHujKo4Z5okEsore0KnAM3RFnRkRLFQorpRRr5qY8ROAKkyB7tUAw653tlKod-vc1cx7802bjdE09S9z-b0NpuEp/s320/yaoyan+superficial+and+deep+websize.png" width="185" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 2: Palpation of <i style="font-size: 12.8px;">yaoyan </i><span style="font-size: 12.8px;">at </span><br />
<span style="font-size: 12.8px;">the superficial and deep vectors</span></td></tr>
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
This
pain is at an acupuncture point called <i>yaoyan</i> which is a
commonly used 'extra point'. Extra points are points which are not on
main acupuncture channels, but have been found to be clinically
important nonetheless. This particular extra point is found at the
attachment site of two important back muscles. Depending on the
depth, these muscles are either the iliocostalis lumborum or the
quadratus lumborum (Fig. 2).</div>
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
The
iliocostalis lumborum is the more superficial of the two of these
muscles. It is one of three muscles which are part of a group called
the erector spinae (Fig 3 left image). This is the group of muscles that span the back
from the hip through the neck and run parallel to the spine. The
iliocostalis lumborum is the ‘lumbar’ or low back portion of this
group; it runs from the top of the iliac crest (the ‘ilio’ part
of the name) to the ribs (the ‘costo’ part of the name). This
muscle then continues upward (but it is then called the iliocostalis
thoracic and iliocostalis cervicis) and is the most lateral of the
three muscles of the erector spinae. The iliocostalis functions with
the other muscles of this group to perform extension of the torso,
which is the motion involved in bending backward. However, since this
muscle is a bit more lateral than the others in the group, it is also
involved in side bending motion. In this case, only one side is
primarily involved<span style="font-family: "times new roman" , serif;">–</span>the
right muscle in right side bending and the left in left side bending.</div>
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
The
quadratus lumborum is a deeper muscle underneath the iliocostalis (Fig. 3 right image). It
runs from the iliac crest and has attachments on the lumbar (low
back) vertebrae, and ends at the 12<sup>th</sup> (lowest) rib in the
back. This muscle laterally flexes the trunk. It does this by
shortening the space between the top of the hip and the 12<sup>th</sup>
rib. This would either pull the rib towards the hip (sidebending on
that side) or pull the hip towards the rib (elevating or hiking the
hip up on that side).</div>
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
Both
of these muscles have attachments on the iliac crest and both can
become pain-producing sites. In both cases, these muscles would be in
a shortened position when the hip is hiked on the side of pain. This
is frequently what is seen with iliac crest pain.
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivl5WwP29Ac-3hAAELWSIXLYNqZdxa41ofRn1vP-wZdOimjerHmdYAadA018Rtjz3bZy5t_fwuo-HlIHxwpSkC8FNXpp7IOxgwTFWSTbWN7Kw2pF7jDCX2i5bWWuQYpwYZWFAohYEqQGip/s1600/Yaoyan+superficial+and+deep.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="299" data-original-width="356" height="335" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivl5WwP29Ac-3hAAELWSIXLYNqZdxa41ofRn1vP-wZdOimjerHmdYAadA018Rtjz3bZy5t_fwuo-HlIHxwpSkC8FNXpp7IOxgwTFWSTbWN7Kw2pF7jDCX2i5bWWuQYpwYZWFAohYEqQGip/s400/Yaoyan+superficial+and+deep.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 3: Image on the left shows the iliocostalis which is the lateral muscles of the erector spinae group. The image on the right has this group removed to highlight the deeper quadratus lumborum muscle. Both are common sites of pain at the iliac crest. Both images are from Netter's <i>Atlas of Human Anatomy</i>.</td></tr>
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<div class="western" style="line-height: 100%; margin-bottom: 0in;">
When
the hip is elevated on one side, as is often the case with iliac
crest syndrome, it is not simply the muscles discussed which are
involved. Other muscles whose job it is to stabilize the hip and
prevent it from elevating are also part of the overall picture. The
gluteus medius and minimus are the primary muscles which do this, and
these muscles have a propensity to become inhibited and fail in their
stabilization roll.</div>
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<a href="https://www.blogger.com/null" name="_GoBack"></a>
When treating iliac crest syndrome, it is important to address all of
the muscles involved in the imbalance. This includes both the
shortened and overactive muscles such as the iliocostalis and
quadratus lumborum, along with the inhibited and overlengthened
muscles such as the gluteals. Acupuncture and manual therapy are
powerful treatment options to correct these imbalances, and
corrective exercises performed by the patient can solidify treatment
at continue to return function.</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-60045367228359515522017-03-02T16:05:00.007-05:002023-10-10T09:03:44.010-04:00Injures Caused by Foot Overpronation<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Foot Overpronation Can Cause Many Different Injures.</span></h1>
Pronation of the foot involves dorsiflexion of the ankle, abduction of the foot, and eversion of the foot. In layman's terms this is described below, but the important aspect is that these movements drop the medial arch of the foot.<br />
<ul>
<li>Dorsiflexion involves a bend of the ankle in the direction of the dorsum or top of the foot. It brings the top of the foot towards the knee.</li>
<li>Abduction is a turning out of the foot away from the midline.</li>
<li>Eversion is a turning out of the foot which brings the medial arch down.</li>
</ul>
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<tr><td class="tr-caption" style="text-align: center;">Fig. 1: Comparing a neutral foot (middle) to foot overpronation (left) and supination (right). Notice how the pronated foot turns away from the midline (this is abduction) and the medial arch falls towards the floor (this is eversion). Image Ducky2315 (Own work) [CC BY-SA 3.0 9http://creativecommons.org/licenses/by-sa/3.0)]</td></tr>
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<div>
A certain amount of pronation is normal in weight bearing as this acts as a shock absorption. Connective tissue structures in the foot elongate and produce a certain amount of tension which, upon recoil, helps propel the movement, thus acting as an energy saving mechanism during walking and running. However, overpronation is a frequent occurrence which is an excessive pronation. This can lead to a range of injuries of the foot, ankle and lower leg, but also can cause or contribute to injuries of the knee, hip and really anywhere in the body.</div>
<div>
<br /></div>
<div>
Frequent injuries are listed below with a brief description of how overpronation contributes.</div>
<div>
<br /></div>
<div>
<ul>
<li><a href="https://blog.ideal-balance.net/2016/01/foot-pain-and-plantar-fasciitis.html">Plantar fasciitis/fasciosis</a>: As the foot goes excessively into pronation, the plantar fascia is overstretched. The reoccurring motion eventually irritates the plantar fascia and can lead to chronic pain in the bottom of the foot, usually where this tissue attaches to the calcaneus.</li>
</ul>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVdyt-WcbNFODrBXSHvYCW6Mf6sTabJD8qesFJJ7LaTAscdBF5Bw1-A9wOremSAFq8gUqviPaxfAqgKUepqJXfpepmcNrRfRugPR045tkAPC26_vEwRBeAux6u4qohxwui7naJcWZzBese/s1600/tib+anterior+and+posterior+blog+size.png" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVdyt-WcbNFODrBXSHvYCW6Mf6sTabJD8qesFJJ7LaTAscdBF5Bw1-A9wOremSAFq8gUqviPaxfAqgKUepqJXfpepmcNrRfRugPR045tkAPC26_vEwRBeAux6u4qohxwui7naJcWZzBese/s400/tib+anterior+and+posterior+blog+size.png" width="341" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="font-size: 12.8px;">
Fig. 2: Both tibialis anterior and tibialis posterior attach to </div>
<div style="font-size: 12.8px;">
<span style="font-size: 12.8px;">the </span><span style="font-size: 12.8px;">medial arch. </span><span style="font-size: 12.8px;">In foot overpronation, the arch drops and these </span></div>
<div style="font-size: 12.8px;">
<span style="font-size: 12.8px;">muscles are</span><span style="font-size: 12.8px;"> pulled long. </span><span style="font-size: 12.8px;">This can irritate the tendons of these </span></div>
<div style="font-size: 12.8px;">
<span style="font-size: 12.8px;">muscles</span><span style="font-size: 12.8px;"> and can also </span><span style="font-size: 12.8px;">contribute to shin splints.</span></div>
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<div style="text-align: left;">
</div>
<ul>
<li>Tibialis posterior tendinopathy: This condition can be misdiagnosed as plantar fasciitis, but pain is usually more at the medial ankle. The tibialis posterior supports the medial arch and can become irritated with excessive pronation as it too is repetitively overlengthened when walking or running.</li>
<li>Shin splints: Shin splints can be classified as anterior or medial shin splints. The involve either the tibialis anterior or the tibialis posterior, respectively. Both of these muscles support the medial arch and can have a shearing effect where they attach to the tibia with overpronation.<div class="separator" style="clear: both; text-align: center;">
</div>
</li>
</ul>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6pv1-thaGN3zce1QgukV0ZgtvHyUkgWiCg5tdkazqd1L1NivsEy2vCZ9HF7qeScgByAJXSL4lchA432vUH5QLzsRlHevLPoNAWeKVwcaaRFCJSzr4h0dZqRXyo1hZ2Y3jdnRqqVfWsaaQ/s1600/overpronation.jpg" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6pv1-thaGN3zce1QgukV0ZgtvHyUkgWiCg5tdkazqd1L1NivsEy2vCZ9HF7qeScgByAJXSL4lchA432vUH5QLzsRlHevLPoNAWeKVwcaaRFCJSzr4h0dZqRXyo1hZ2Y3jdnRqqVfWsaaQ/s1600/overpronation.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 3: Note the effects on the knee and hip.</td></tr>
</tbody></table>
<ul>
<li>Knee pain: There are many knee conditions that can become aggravated with overpronation. As the foot pronates, the lower leg turns inward. This becomes excessive with overpronation, and the knee tends to collapse in. This can contribute to medial knee pain from conditions such as pes anserine tendinopathy or lateral knee pain from conditions such as <a href="https://blog.ideal-balance.net/2015/12/iliotibial-band-friction-syndrome.html">iliotibial band friction syndrome.</a></li>
<li>Hip pain: Like knee pain, there are many hip conditions that can be aggravated from foot overpronation. One example is greater trochanteric bursitis which is often caused by an excessive raising of the hip during weight bearing. This frequently occurs with foot overpronation and with the knee moving in.</li>
<li>Back pain, shoulder pain, neck pain: Foot overpronation can be involved with many other muscle imbalances as described above with knee pain and hip pain. These imbalances can affect regions as far away as the neck.</li>
</ul>
<div>
Sports Medicine Acupuncture<span style="font-family: "liberation serif" , serif; vertical-align: super;">® </span>is a great system for treating both the injury and the underlying causes of the injury such as foot overpronation. It employs acupuncture, manual therapy, and corrective exercises in addition to other possible treatment options. Both local acupuncture and manual therapy techniques can be used to reduce pain and improve the health of the injured soft tissue. And acupuncture to specific points within the muscles can correct the underlying muscle imbalances that occur with foot overpronation which lead to the injury and, if uncorrected, will cause a recurrence. Corrective exercises help the treatment hold and further corrects the underlying muscle imbalance.</div>
</div>
<br />
<div>
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGQu7eyHxNtYw0s25w0fxxtePX46E94xg-1zVtbu_Hz5QB4q2p3-7ocPvpIEHZSgcMCvWJq6uHN26VDLyvMtUVuBas0fBGJ6VSENAhTPU4zFxzv6NYfOzwWmECciaRo71PlJNwYB9kxznV/s1600/adductor+hallucis+blog+size.png" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="177" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGQu7eyHxNtYw0s25w0fxxtePX46E94xg-1zVtbu_Hz5QB4q2p3-7ocPvpIEHZSgcMCvWJq6uHN26VDLyvMtUVuBas0fBGJ6VSENAhTPU4zFxzv6NYfOzwWmECciaRo71PlJNwYB9kxznV/s400/adductor+hallucis+blog+size.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 4</td></tr>
</tbody></table>
A simple exercise which can strengthen the intrinsic muscles of the foot and help to correct foot overpronation is the short foot exercise. This exercise strengthens the adductor hallucis (hallucis refers to the big toe) muscle (Fig. 4), in particular. The following steps are followed to perform this exercise:<br />
<br />
<br />
<ol>
<li>Sit upright with both feet flat on the floor. Alternately, the exercise can be performed standing on the foot to be exercised. This is more advanced.</li>
<li>Raise the arch of your foot by bringing your big toe towards your heel. The trick is to do this without curling your toes. Your emphasis is on lifting the arch away from the floor.</li>
<li>Hold for 5-10 seconds. You can perform this exercise multiple times. </li>
</ol>
<div>
While this exercise is helpful, foot overpronation often involves other structures not only in the foot. These include muscle imbalance in the lower leg, knee and thigh, hip and low back. Comprehensive work with these structures is often necessary for lasting effects. Evaluation and treatment of these contributing muscle imbalances along with treatment of associated injuries are what your certified Sports Medicine Acupuncturists<span style="font-family: "liberation serif" , serif;">® work with.</span></div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-52794522527297634632016-08-23T17:31:00.007-04:002023-10-10T09:03:54.467-04:00High Hamstring Tendinopathy<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">High Hamstring Strain and High Hamstring Tendinopathy</span></h1>
<div style="line-height: 100%; margin-bottom: 0in;">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCpr8PJDi50Jn8sFqgREU4zAKvvR2opKWqqQxmNT33slezjf_JVUJgTU6afuo4YJCAQEbElPdKfhCGZ4HjB56arteztRU4e7SAS-x9cXd-aX1I0rb6FI21SGw3Tx0etqtkmQlTRH2ldcON/s1600/football-1537789-cropped-blogsize.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCpr8PJDi50Jn8sFqgREU4zAKvvR2opKWqqQxmNT33slezjf_JVUJgTU6afuo4YJCAQEbElPdKfhCGZ4HjB56arteztRU4e7SAS-x9cXd-aX1I0rb6FI21SGw3Tx0etqtkmQlTRH2ldcON/s320/football-1537789-cropped-blogsize.jpg" width="172" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig 1: Common mechanism of<br />hamstring injury</td></tr>
</tbody></table>
High hamstring
strain and/or pain at the attachment of the hamstrings (referred to
as high hamstring tendinopathy or proximal hamstring tendinopathy) is
a common complaint among runners and athletes who are involved in
kicking sports such as soccer. The pain is experienced at the region
of the sit bones (the ischial tuberosity) and is aggravated with
sitting and with activities such as running and kicking. The pain can
be sharp, aching, and sore, and it can be described as a pulling
sensation. This injury can be very slow to heal and has a high
frequency of recurrence.
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
The hamstrings
frequently become injured in their eccentric phase of contraction.
What this means is that in activities such as kicking a soccer ball or football, or in the leg swing during running, the hamstrings are lengthening
(and the quadriceps are contracting and shortening). Although the
hamstrings are lengthening, they fire to slow down or decelerate the
motion (Fig.1).
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
Understanding this
mechanism of injury is crucial for Sports Medicine Acupuncturists<span style="font-family: "liberation" serif , serif;">®</span>
such as myself, as this informs clinical inquiry. Are the quadriceps
and other hip flexors short and overactive placing the hamstrings in
a chronically taut and lengthened position (Fig. 2)? This would need to be
addressed to allow adequate healing. Or, are the hamstrings
chronically in a shortened position? Both of these situations could
be an underlying cause of hamstring strain recurrence and in both
situations the patient would complain of 'tight' hamstrings. In the
first instance these 'tight' hamstrings are pulled taut like a rubber
band overstretched (a very common occurrence), while in the second
they are in a short and tight positions. However, treatment strategies for these two instances would be very different.
<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicQLAEN2kTsmiCPAS6zgSryMPEPg-eDXc_wh6SdSzpfCiQwtfxzA6YVQqQEoYHrGjoRZqN5b-WkToays9tO_bUZ9XGOPj9OOnqR7KEof4NbJ-rHQ4lK6ciid9XAYOfj4jEw83rfep6VmcK/s1600/Quadriceps+-+Hamstring+Ratio.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicQLAEN2kTsmiCPAS6zgSryMPEPg-eDXc_wh6SdSzpfCiQwtfxzA6YVQqQEoYHrGjoRZqN5b-WkToays9tO_bUZ9XGOPj9OOnqR7KEof4NbJ-rHQ4lK6ciid9XAYOfj4jEw83rfep6VmcK/s400/Quadriceps+-+Hamstring+Ratio.png" width="296" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 2: Schematic illustrating hamstrings being pulled in a chronically overlengthened position. Patients would complain of chronically 'tight' hamstrings in this case as they are chronically pulled taut. </td></tr>
</tbody></table>
<br /></div>
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<tr><td class="tr-caption" style="text-align: center;">Fig. 3: Modified from Netter's <br />Atlas of Human Anatomy</td></tr>
</tbody></table>
When patients
complain of this pain, it is also important to properly assess which
structure is actually injured. While many patients come in to clinic
complaining of high hamstring strain, two other structures frequently
mimic this pain. The lower fibers of the gluteus maximus overlie the
hamstrings at the region where high hamstring strain occurs. When
this muscle is the culprit, there is a palpable taut band that can be
felt in these fibers from about the region of the coccyx to the
attachment of the hamstrings. Also, the adductor magnus, the most
posterior muscle in the adductor group which is on the medial thigh,
attaches very close to the hamstrings and pain associated with this
muscle can mimic high hamstring strain (Fig. 3). Both of these muscles create
a slightly different 'flavor' of pain and can have characteristic
signs and symptoms reported by the patient; this allows an astute clinician to find the fixed site of pain and
treat it properly for the
quickest healing time.
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<br />
<div style="line-height: 100%; margin-bottom: 0in;">
Besides these
sources of pain, referred pain is <span style="line-height: 100%;">also</span><span style="line-height: 100%;"> </span><span style="line-height: 100%;">a possibility and needs to be
considered. Referred pain may come from the lumbar spine, from the
sacroiliac joint, or from trigger points in the gluteal muscles, the
low back, or even the lower portion of the hamstrings. The clinician
must be thorough during evaluation and patients should make sure that
their practitioner, whether an MD, acupuncture physician,
physical therapist, or massage therapist, has the understanding and
training to properly assess and evaluate the condition. Proper
assessment of all the factors leads to proper treatment. Proper
treatment leads to faster and more profound healing.</span></div>
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-25777105227363232252016-08-10T23:53:00.006-04:002023-10-10T09:04:04.809-04:00Cupping Relieves Pain, Speeds Healing<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Cupping as a Treatment for Pain and Accelerant to Healing.</span></h1>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpsONyZFSV6cZ57eEAp26pCgke7SqO3bv0WU_nFUwfO9W9ipOIxnhDp2lizCy9Q32JPr4UbD4Ksvq477EJhGiju-aTtj8TrVm_L_f43MNiENlSwm7Z302v6cb9mvvpLOvO_3VmHVB6LO4y/s1600/Cupping-During.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpsONyZFSV6cZ57eEAp26pCgke7SqO3bv0WU_nFUwfO9W9ipOIxnhDp2lizCy9Q32JPr4UbD4Ksvq477EJhGiju-aTtj8TrVm_L_f43MNiENlSwm7Z302v6cb9mvvpLOvO_3VmHVB6LO4y/s320/Cupping-During.jpg" width="224" /></a></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;"><br /></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">From
the start of the 2016 Olympics in Rio, cupping has been in the news.
Athletes such as Michael Phelps have all been 'spotted' with very
regular circular bruise-like marks. It seems that the Olympics are
fast becoming the signature event for introducing the world to
alternative treatment modalities that, while popular among top
athletes, are little known among the general public.</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk7QdxC9VB8p7t5ki2feDpAEt74kchwPjbT8DRlnCBGoola84dPuFI2TrOI1MFMIK3udtslujzvDV6UROQhvEOIB9xx_ss-St_tUWev8_mRhiyQzQxjVOhAwfiu_luAxtcDlKZzuAas4BF/s1600/Kerri_Walsh%252C_Overhand_Serve.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk7QdxC9VB8p7t5ki2feDpAEt74kchwPjbT8DRlnCBGoola84dPuFI2TrOI1MFMIK3udtslujzvDV6UROQhvEOIB9xx_ss-St_tUWev8_mRhiyQzQxjVOhAwfiu_luAxtcDlKZzuAas4BF/s200/Kerri_Walsh%252C_Overhand_Serve.jpg" width="118" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image By Craig Maccubbin <br />
(Flickr: Overhand Serve) <br />
[CC BY 2.0<br />
(http://creativecommons.org/<br />
licenses/by/2.0)], <br />
via Wikimedia Commons</td></tr>
</tbody></table>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">The
most obvious example was in the 2008 Beijing Olympics, where beach
volleyball powerhouse duo Kerri Walsh and Misty May dominated their
increasingly popular sport. Keri Walsh had a very colorful elastic
tape on her shoulder—and Kinesiotape's webpage hits went up from
about 600 views per day to 345,000 per day! Elite athletes had been
using Kinesiotape before this, but it was not usually visible under
their gear. Given that the women's beach volleyball uniform is a
basically a bikini, this tape became very visible. Since then,
Kinesiotape has become widely used by a wide range of health
practitioners, and by athletes from professionals to weekend
warriors.</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">Jumping
forward to this year, we see that legendary swimmer Michael Phelps is
bringing wide attention to another frequently used ‘alternative’
practice. But what is it, and what is it for?</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhha8xPhxEC6JPgJHMvgUFE5oPTVNDIfaqJu-ZiKQjgQk-Ilzuw-rqdRV9uqcaX6g5PJkJhTVnV8VfN0BeXL0yxKExMU53KZjPyrHAWBiCWtHEP-FaXmMIWgbzNgCok9Qb0fVgnDjQa4BDR/s1600/Michael_Phelps_conquista_20%25C2%25AA_medalha_de_ouro_e_%25C3%25A9_ovacionado_1036410-09082016-_mg_0000_01.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhha8xPhxEC6JPgJHMvgUFE5oPTVNDIfaqJu-ZiKQjgQk-Ilzuw-rqdRV9uqcaX6g5PJkJhTVnV8VfN0BeXL0yxKExMU53KZjPyrHAWBiCWtHEP-FaXmMIWgbzNgCok9Qb0fVgnDjQa4BDR/s320/Michael_Phelps_conquista_20%25C2%25AA_medalha_de_ouro_e_%25C3%25A9_ovacionado_1036410-09082016-_mg_0000_01.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">By Fernando Frazão/Agência Brasil [CC BY 3.0 br <br />
(http://creativecommons.org/licenses/by/3.0/br/deed.en)], <br />
via Wikimedia Commons</td></tr>
</tbody></table>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">Cupping
has its roots in ancient Chinese medicine, and has also been
practiced in ancient Egypt and the Middle East. Cupping uses fire to
create a vacuum in glass or bamboo cups, which are then adhered to
the skin. The fire (usually in the form of a cotton ball soaked in
alcohol) is held in the cup, thereby using up the oxygen and creating
a vacuum. The fire is then removed from cup, and the cup is quickly
placed on the skin. There are also vacuum pumped plastic cups and
silicon suction cups available which do not require the fire to
create a vacuum. In either case, the cups are left on for about 5-15
minutes. It’s also possible to do “moving cupping,” in which
the cups are moved over tight tissue.</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">There
are many possible uses of cupping in Chinese medicine, but treating
sore muscles from overuse and accelerating healing is what athletes
such as Phelps are looking for. When muscles become overly tight, the
added tension compresses capillaries—the very delicate, microscopic
blood vessels where oxygen and nutrients are exchanged between the
blood and the body's tissues, and where metabolic waste products move
from the tissues to the blood. This compression reduces blood flow
and oxygen to the muscles; as with any tissue that is not getting
adequate oxygen, pain and soreness and reduced healing time follows.</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">Cupping
decompresses the muscles and their connective tissue layers while
pulling stagnant blood to the surface. This stagnant blood is what is
observed as the purplish circle, which looks like a very symmetrical
bruise and lasts about a week. The amount of discoloration is
determined by the amount of suction, the amount of time the cups
remain in place, and by the amount of stagnation that was there in
the first place. As the stagnant blood is pulled to the surface,
fresh, oxygenated blood can move into the muscle, which can relieve
pain and increase healing time.</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">Many
people wonder if it hurts, which is not surprising since the mark
looks like a bruise, and cupping may be momentarily uncomfortable,
depending on the patient. The resulting discolored mark, however, is
not painful, and patients are often unaware of it if it is on their
back or some other spot they can’t see. I caution them to let their
partners know to expect it and not be alarmed at how dramatic the
mark looks until the discoloration diminishes. Not surprisingly, as
the procedure is repeated, the amount of discoloration is less each
time as the amount of stagnation and compression is reduced.</span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrIX_ajxO6Udr2XEZAq5YfdZMTAbA8XBWvhOSu8AVN5fwSPEVcxHFwdBrcKTIglbJaoAv_YyNgHeS248RQh4RwVF5DtXjsMsunPU5UXf8gBI0EDAuo3tnbjpx_WhlryySoiAFGvWo0SnRb/s1600/pix-cupcolors.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="123" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrIX_ajxO6Udr2XEZAq5YfdZMTAbA8XBWvhOSu8AVN5fwSPEVcxHFwdBrcKTIglbJaoAv_YyNgHeS248RQh4RwVF5DtXjsMsunPU5UXf8gBI0EDAuo3tnbjpx_WhlryySoiAFGvWo0SnRb/s640/pix-cupcolors.jpg" width="640" /></a></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;"><br /></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">There
are variations to placing the cups on the body and having them remain
in place. A small amount of lubricant can be placed on the skin
before adhering the cups. The cups can then be moved while
maintaining suction. Or, the cups can be adhered to a region that is
particularly tight and the patient can be asked to perform slow
movements while the practitioner manipulates the cups. All of these
techniques can further serve as a type of myofascial release
(manipulation of the muscle and fascia) which can increase blood
flow, decompress the tissue, and restore proper range of motion. The
big difference is that, compared to deep tissue massage strokes,
which push down on and compress the muscles and connective tissue,
cupping lifts and </span></span><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;"><i>decompresses</i></span></span><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">
the muscles and connective tissue.</span></span></div>
<div style="line-height: 0.16in; margin-bottom: 0in; margin-top: 0.19in; orphans: 2; widows: 2;">
<span style="font-family: "times new roman" , serif;"><span style="color: black;"><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">Cupping
has some positive research to back it up,</span></span></span><span style="color: black;"><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">
</span></span></span><span style="color: black;"><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">though
it is not extensively researched and more good quality studies would
be helpful for cupping to be accepted in the mainstream of medicine.
It is shown to have few adverse effects, and those that are reported
are mild.</span></span></span><span style="color: black;"><sup><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">
1,2,3</span></span></sup></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="color: black;">
</span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: "calibri" , serif;"><span style="font-size: 13pt;">If
you are an athlete
and looking to reduce healing time and increase performance, call
your local acupuncturist today to give cupping a try. You may find
that Michael Phelps is onto something!</span></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: "calibri" , sans-serif;"><span style="font-size: 12pt;">References:
</span></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: "calibri" , sans-serif;"><span style="font-size: 12pt;">1.
Cao,
Huijuan, Xun Li, and Jianping Liu. “An Updated Review of the
Efficacy of Cupping Therapy.” Ed. German Malaga. <i>PLoS
ONE </i>7.2
(2012): e31793. <i>PMC</i>.
Web. 11 Aug. 2016. </span></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: "calibri" , sans-serif;"><span style="font-size: 12pt;">2.
Kim,
Jong-In et al. “Cupping for Treating Pain: A Systematic
Review.”<i>Evidence-based
Complementary and Alternative Medicine : eCAM </i>2011
(2011): 467014. <i>PMC</i>.
Web. 11 Aug. 2016. </span></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: "calibri" , sans-serif;"><span style="font-size: 12pt;">3.
Mehta, Piyush, and Vividha Dhapte. "Cupping Therapy: A Prudent
Remedy for a Plethora of Medical Ailments." <i>Journal of
Traditional and Complementary Medicine</i> 5.3 (2015): 127-34. Web. </span></span></span>
</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-25612938693913119692016-08-06T17:28:00.008-04:002023-10-10T09:04:18.456-04:00Levator Scapula Neck Pain<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Levator Scapula Disfunction Can Cause Pain and Stiff Neck Syndrome</span></h1>
<div style="line-height: 100%; margin-bottom: 0in;">
Next week I will be
teaching a class at the Florida State Oriental Medical Association (FSOMA) Annual Conference. The class will discuss neck pain and
stiffness and will specifically highlight acupuncture and manual
therapy techniques to treat the levator scapula, a muscle which
frequently causes neck pain and stiffness and pain in the shoulder
blade region.</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmB0kmK_y0Rbn2pIzJiYzBaOjCWUpYzzuH1MpY_KfhmntYQcmsg4Vx60OMBKokuNGSJUIagIriHL-1c91isX63QGn4TyiL7kIB5ngmbA3WU104J35yQ-YNyB5NcGDWkoOEPwTjHULnKYd1/s1600/levator+scapulae.png" style="margin-left: auto; margin-right: auto;"><img border="0" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmB0kmK_y0Rbn2pIzJiYzBaOjCWUpYzzuH1MpY_KfhmntYQcmsg4Vx60OMBKokuNGSJUIagIriHL-1c91isX63QGn4TyiL7kIB5ngmbA3WU104J35yQ-YNyB5NcGDWkoOEPwTjHULnKYd1/s400/levator+scapulae.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 1 A (left) and 1 B (right): Images from Myofascial Pain and Dysfunction: The Trigger Point Manual, by Drs. Janet Travell and David Simons,</td></tr>
</tbody></table>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="line-height: 100%;"><br /></span></div>
<div style="margin-bottom: 0in;">
<span style="line-height: 100%;">The levator scapula, seen in Fig. 1 A, is a muscle which stretches from the upper neck to the upper part of the shoulder blade. Not </span><span style="line-height: 16px;">surprisingly</span><span style="line-height: 100%;"> based on its
name, the levator scapula elevates the scapula. But it also rotates bends it sideways. Both of these movements
basically move the shoulder blade closer to the neck on the same
side. When this muscle develops <a href="https://blog.ideal-balance.net/2015/12/trigger-points-common-cause-of.html">trigger points</a> (painful nodules
within the muscle), it can cause quite a lot of pain and neck
stiffness. This pain pattern is illustrated in the Fig. 1B and as can be
seen, the pain concentrates at the base of the neck and frequently
spreads to the medial border of the scapula. Patients often state
that they feel the pain between the shoulder blades. The neck
frequently becomes stiff, and pain is worse when patients turn the
head to the side of the pain, as in looking over the shoulder.</span><br />
<span style="line-height: 100%;"><br /></span>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKXxIHJoQ5dAr5B245tEhctxVQYqjebE4pC-O8__wN09mHqZLLFOFvyoAWAfVt4RIHiCEu9rc7v3DciWIvL_pcNAMYJMPzvvMWAjkmmPoQZZ_3fSFuWIKACtIT4ItvseYrUrGgNKUrOj0j/s1600/busy-office-ol-answer-the-phone-blog+size.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKXxIHJoQ5dAr5B245tEhctxVQYqjebE4pC-O8__wN09mHqZLLFOFvyoAWAfVt4RIHiCEu9rc7v3DciWIvL_pcNAMYJMPzvvMWAjkmmPoQZZ_3fSFuWIKACtIT4ItvseYrUrGgNKUrOj0j/s400/busy-office-ol-answer-the-phone-blog+size.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 2: Neck position which shortens the levator scapula and can lead to pain.</td></tr>
</tbody></table>
<span style="line-height: 100%;"><br /></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<div class="separator" style="clear: both; text-align: center;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj45uJhwLhgsL-7IV2FxWGSxFxqQebGmgmaXQJY2XTtzBLc8h4rfYsfdNJmjORaKJ18zytnCiCoMFhv8qkeYFUxgOK74KNzuHVNZnPl5UFpAnh-xL_0KjrndrWjjIXKihrNjfDz7Ndt2ahw/s1600/ga+assymetry.png" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj45uJhwLhgsL-7IV2FxWGSxFxqQebGmgmaXQJY2XTtzBLc8h4rfYsfdNJmjORaKJ18zytnCiCoMFhv8qkeYFUxgOK74KNzuHVNZnPl5UFpAnh-xL_0KjrndrWjjIXKihrNjfDz7Ndt2ahw/s400/ga+assymetry.png" width="166" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 3: The imbalance in the pelvis<br />
and legs, causing an elevation on<br />
of the right ilium which frequently<br />
contributes to an <span style="font-size: 12.8px; line-height: 100%;">elevation of the </span><br />
<span style="font-size: 12.8px; line-height: 100%;">left shoulder </span><span style="font-size: 12.8px; line-height: 100%;">girdle. This can</span><br />
<span style="font-size: 12.8px; line-height: 100%;"> cause </span><span style="font-size: 12.8px; line-height: 100%;"> pain and </span><span style="font-size: 12.8px; line-height: 100%;">stiffness in </span><span style="font-size: 12.8px; line-height: 100%;">the </span><br />
<span style="font-size: 12.8px; line-height: 100%;">left neck.</span></td></tr>
</tbody></table>
This can be a
chronic condition, or it can come on suddenly. It is not uncommon for
people to wake with this pain after a night's sleep in an awkward
position. A cold draft on the neck while sleeping is also frequently
reported by patients. This pain can be quite distressing as it interferes with activities such as driving and makes it difficult to find a
comfortable position.<br />
<br />
In chronic cases, it is found that
patients often perform an activity that repetitively shortens this
muscle. A common example is a busy office worker, student or parent holding a phone to their ear with their shoulder. Awkward computer workstations, poor
sitting posture, poor breathing, and even imbalances affecting the
leg length (more on this in a different post) can contribute to pain
in the levator scapula (Fig. 3)</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<br />
<div style="line-height: 100%; margin-bottom: 0in;">
Local acupuncture
techniques can be an excellent way to address the muscle directly to
release muscle contraction. In addition, acupuncture along the related channels and to muscles that
are part of the dysfunction, myofascial release (a deep tissue
type of massage) to lengthen bound muscles and connective tissue, and
corrective exercises to address posture are all tools that can
greatly reduce pain and improve range of motion in the neck and treat
this 'stiff neck syndrome.'<br />
<br />
A self-help exercise is described below. This can be performed several times a day and should not cause pain or aggravation of symptoms. Use your judgment and consult your physician if you have any doubts.<br />
<br />
This exercise is described as if there is pain at the <span style="line-height: 100%;">base of the neck on the left side, which is worse when turning to the left. The directions can be reversed for pain occurring on the right side.</span><br />
<br />
1) Lie face-up or sit upright in a chair with your feet on the floor.<br />
2) Gently turn your neck towards the painful side (to the left) to the point just before it hurts (this may be only a small turn in severe cases).<br />
3) Place the hand opposite the painful side on your cheek (right hand on the right cheek) and gently, with very little force, turn the head back into the palm (to the right). There should be no movement, and this is an isometric contraction. In other words, you are resisting the gentle turn with your palm and not allowing any movement. Hold this position for about 6 seconds.<br />
4) Relax for about 1 second, and then see if you can turn more towards the painful side (to the left). Still stop before there is actual pain and do not attempt to turn more than your body will allow.<br />
5) Repeat steps 3 and 4.</div>
<div style="line-height: 100%; margin-bottom: 0in;">
</div>
<div style="margin-bottom: 0in;">
<div style="line-height: 100%;">
<i><br /></i></div>
<span style="line-height: 100%;">Note: This exercise is most useful in acute problems when there is severe pain and difficulty turning the neck. The goal is to </span><i style="line-height: 100%;">GENTLY </i><span style="line-height: 100%;">tease out movement. Many times, the body perceives that there is danger to the joints (maybe you fell asleep in a position that was stressing the joints of the neck, for instance) and there is a reflexive spasm to </span><span style="line-height: 16px;">guard</span><span style="line-height: 100%;"> and prevent movement. Trying to stretch aggressively and forcefully will often aggravate the condition more in these situations, as the neck muscles such as the levator scapula will contract more to guard the area. In more chronic cases, stretching and range of motion exercises can be employed.</span></div>
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-15859118042530216572016-01-19T23:29:00.006-05:002023-10-10T09:04:32.545-04:00Frozen Shoulder and Related Conditions<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Supraspinatus tendinopathy, bicipital
tenosynovitis, infraspinatus myostrain, and subscapularis myostrain can often be diagnosed as Frozen Shoulder.</span></h1>
<div style="line-height: 115%; margin-bottom: 0.14in;">
<br />
“Frozen shoulder” is a common diagnosis given for those
experiencing shoulder pain, stiffness and a decrease in mobility.
True frozen shoulder, which is called adhesive capsulitis, refers to
a condition where there is a buildup of scar tissue in the joint
capsule of the shoulder. There exist several other conditions which
often get called “frozen shoulder,” but those can be more
precisely differentiated. The most common of these conditions that I
see in clinical practice are: supraspinatus tendinopathy; bicipital
tenosynovitis; infraspinatus myostrain; and subscapularis myostrain.
Each of these involves different structures, has variation in pain
patterns and referrals, and, more importantly, requires a different
treatment for a successful outcome.</div>
<div style="line-height: 115%; margin-bottom: 0.14in;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3GPSC6nc3KUhgfVBXXMIGNxAwSj7r6f2mo_mvf_xz5twpG6kM7f84avJWE6fS2VpM15Army8Mq0CNojamfGK9nqh5QiJNGTe-6HQSkP_PxZoHux3gxjJ06ECBZ51YqB62IkxoIyZt5Wcn/s1600/shouldpainredblogsize.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3GPSC6nc3KUhgfVBXXMIGNxAwSj7r6f2mo_mvf_xz5twpG6kM7f84avJWE6fS2VpM15Army8Mq0CNojamfGK9nqh5QiJNGTe-6HQSkP_PxZoHux3gxjJ06ECBZ51YqB62IkxoIyZt5Wcn/s320/shouldpainredblogsize.png" width="320" /></a>Frozen shoulder
and related conditions affect many people of different ages and they
affect both men and women. Those between 40-60 years of age are more
frequently afflicted with shoulder problems, and women experience
shoulder pain much more frequently than men. 2-5% of the population
in this age demographic will experience this problem. There is
evidence showing that hormonal changes during menopause are linked to
the greater frequency of shoulder pain experienced by women.
</div>
<div style="line-height: 115%; margin-bottom: 0.14in;">
These conditions
may be caused by trauma or they may come on insidiously, in which
case there seems to be no apparent cause, although it’s possible
that postural imbalances, age, nutritional deficiencies, changes in
hormone levels, diabetes, Parkinson’s and other conditions may be
contributing factors. Proper differentiation is crucial when treating
so that mechanism of injury can be determined, target tissue can be
assessed and treated, postural disparities can be corrected, and
proper use of medicinals can be employed (herbals, nutraceuticals, or
pharmaceuticals depending on the scope and treatment philosophy of
the physician). In Sports Medicine Acupuncture®, this is extremely
important as the injury or cause of pain will guide the proper use of
acupuncture, myofascial release (a type of clinical, deep tissue
massage), corrective exercises, and herbal medicine prescription.</div>
<div style="line-height: 115%; margin-bottom: 0.14in;">
I will discuss
the four main causes of shoulder pain and stiffness in future posts
and will link these blog posts together. Again, these conditions are:</div>
<ul>
<li>
<div style="line-height: 115%; margin-bottom: 0.14in;">
Supraspinatus
tendinopathy – an inflammation or irritation with fibrosis (extra
fibrous tissue) of the tendon of the supraspinatus (one of the
rotator cuff muscles). Tearing (either partial or full) may be
present;</div>
</li>
<li>
<div style="line-height: 115%; margin-bottom: 0.14in;">
Bicipital
tenosynovitis - an inflammation or irritation with fibrosis of the
tendon sheath of the biceps brachii muscle;</div>
</li>
<li>
<div style="line-height: 115%; margin-bottom: 0.14in;">
Supscapularis
myostrain - a pain pattern caused by trigger points affecting the
subscapularis muscle (another of the rotator cuff muscles);
</div>
</li>
<li>
<div style="line-height: 115%; margin-bottom: 0.14in;">
Infraspinatus
myostrain - a pain pattern caused by trigger points affecting the
infraspinatus muscle (yet another of the rotator cuff muscles).</div>
</li>
</ul>
<div style="line-height: 115%; margin-bottom: 0.14in;">
For all of these
conditions, mechanism of injury will be discussed (mechanism of
injury describes the underlying causes of the injury), treatment
options will be explored, and self-help corrective exercises will be
discussed.</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-33495753193562367032016-01-04T22:20:00.007-05:002023-10-10T09:04:44.525-04:00Foot Pain and Plantar Fasciitis<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Treatment of Foot Pain Caused by Plantar Fasciitis and Plantar Fasciosis.</span></h1>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWvxsr364Bn7XrydHIklVWfVnS2FjdCv53WDXklp4qXKE_XiaCdf9-dFPqggRwOBAKkEP_3g10LnIvGkYaRiDqMZAs-tzKdFvh2a0vCrW3aGlNd-JhVt_4LcF8f6PIm7xojl6YiZM_HXaP/s1600/Jogging_couple_-_legs.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWvxsr364Bn7XrydHIklVWfVnS2FjdCv53WDXklp4qXKE_XiaCdf9-dFPqggRwOBAKkEP_3g10LnIvGkYaRiDqMZAs-tzKdFvh2a0vCrW3aGlNd-JhVt_4LcF8f6PIm7xojl6YiZM_HXaP/s320/Jogging_couple_-_legs.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 1: Ed Yourdon [CC BY-SA 2.0 <br />
'(https://creativecommons.org/licenses/by-sa/2.0)], <br />
via Wikimedia Commons</td></tr>
</tbody></table>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
The
new year is here and many people are going to be starting new
exercise regimens as part of their resolutions. Some of those
starting exercise programs that involve running will develop pain on
the plantar surface of the foot (the bottom of the foot) and will
develop plantar fasciitis. If the pain persists, the condition may
well be reclassified as plantar fasciosis. This post will discuss
these two related conditions, will look at self-help techniques, and
will discuss treatment options with acupuncture, deep tissue massage,
and herbal therapy so that you can quickly get back to becoming more
fit in 2016.</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkBwbwJ2tIzMWz-9kj4VQMsl5ulFyydrsEugtdT1oVrgArVxLOiOzlLpqB5atCVb8IbP-BpGbqilrw2-fN1m1tLU_0hDTu5La7ctOjA_devcMNUAx_1Nxm-1XWpoPtIdGl7PAw0RhkGKEX/s1600/Plantar+fasciitis+Sobotta.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkBwbwJ2tIzMWz-9kj4VQMsl5ulFyydrsEugtdT1oVrgArVxLOiOzlLpqB5atCVb8IbP-BpGbqilrw2-fN1m1tLU_0hDTu5La7ctOjA_devcMNUAx_1Nxm-1XWpoPtIdGl7PAw0RhkGKEX/s400/Plantar+fasciitis+Sobotta.png" width="225" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 2: Image from: Sobotta's Atlas and<br />
Text-book of Human Anatomy 1909.<br />
This author uses the term <span style="font-size: 12.8px;">Plantar </span><br />
<span style="font-size: 12.8px;">aponeurosis for Plantar fascia</span></td></tr>
</tbody></table>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
Plantar
fasciitis and plantar fasciosis are common pain syndromes involving
the plantar surface of the feet, and, since this problem affects us
when we are weight-bearing (standing, walking, running, etc.) it is
an especially annoying problem. This condition results in pain at the
attachment site of the plantar fascia to the calcaneus (heel) as seen in Fig. 2. One of
the hallmark symptoms of plantar fasciitis, at least in the early
stages, is pain with the first few steps in the morning or upon
rising after sitting for a long time, though it can become more
severe over time and the pain can persist during weight-bearing
activities.</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
First
off, it is important to understand the difference between plantar
fasciitis and plantar fasciosis. This is rarely discussed, even by
most physicians, but it is very important when considering treatment.
For plantar fasciitis, the suffix <i>-itis</i> means inflammation,
so this would imply that there is an inflammation of the plantar
fascia. In the very early stages of pain of the plantar fascia, this
could very well be the case. This would be especially evident if
someone starts a new exercise regimen that involves weight-bearing
activities such as running, jumping, martial arts, etc. Conventional
medical treatment might consist of corticosteroid injections or the
use of NSAIDs (non-steroidal anti-inflammatory drugs) to reduce the
inflammation. In my clinic I would consider a Traumeel injection
and/or would use herbal medications that have an anti-inflammatory
action. Other treatment strategies will be discussed below.</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
For
those suffering from chronic pain of the plantar fascia, the
inflammation model is likely not correct. There is a significant
amount of research now which shows that inflammatory cells are often
not present in these types of chronic pain conditions which affect
connective tissues such as tendons and aponeurotic structures (such
as the plantar fascia). Usually these signs of inflammation are no
longer present after about two to three weeks after the initial
tissue insult.
</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSq1lkPJgJxhoUnODfsnqfECLbtw1SuivWyQgpsrt0YIvPFpBRimTTSUk5Wre570Wd5Bxka36AS00mtsmf-48FUQGe41LduQA_s9hji4ZnHatqwq7_rt05sssqXt64U6-3B-m7d7qa7Oxz/s1600/Needle+schematic+for+plantar+fasciitis.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSq1lkPJgJxhoUnODfsnqfECLbtw1SuivWyQgpsrt0YIvPFpBRimTTSUk5Wre570Wd5Bxka36AS00mtsmf-48FUQGe41LduQA_s9hji4ZnHatqwq7_rt05sssqXt64U6-3B-m7d7qa7Oxz/s320/Needle+schematic+for+plantar+fasciitis.png" width="123" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 3: Image modified from:<br />
Phulvar (Own work) [CC BY-SA 3.0 <br />
(https://creativecommons.org/licenses/by-sa/3.0)], <br />
via Wikimedia Commons</td></tr>
</tbody></table>
Researchers
and, increasingly, some physicians are now referring to chronic pain
associated with the plantar fascia as plantar fasciosis. The suffix
<i>-osis </i>indicates a
diseased state, in this case involving a degenerative process which
results from a decreased blood flow to this tissue. This decreased
blood flow is caused by an increase in scar tissue and fibrosis
(fibrous tissue buildup) of the region. For these chronic cases,
breaking up this scar tissue and actually causing a mild inflammation
in the area is necessary to bring an adequate supply of blood to the
region. Acupuncture and deep tissue massage techniques such as
myofascial release are very effective for accomplishing this,
especially when combined.</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpUsFVQwC3t_qjnfxQWWrJuDc58fnsAxmIoimQOFCTHbTxbCeHGqFAzeONdI5d8Rpf-VHU60B-2i_6lhWtRQ04-E5w2vOkeXYjl2t4HIj8op6BFBJo0tK0y9RFEGRT_JTW1TqEY1COtw6s/s1600/foot.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="134" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpUsFVQwC3t_qjnfxQWWrJuDc58fnsAxmIoimQOFCTHbTxbCeHGqFAzeONdI5d8Rpf-VHU60B-2i_6lhWtRQ04-E5w2vOkeXYjl2t4HIj8op6BFBJo0tK0y9RFEGRT_JTW1TqEY1COtw6s/s320/foot.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 4: Deep myofascial release to the attachment of the plantar fascia. <span style="font-size: 12.8px; line-height: 115%;">Very little to no lotion is used and the a slow gliding movement is </span><span style="font-size: 12.8px; line-height: 115%;">used to break up fibrous adhesions. This is especially effective after </span><span style="font-size: 12.8px; line-height: 115%;">acupuncture.</span></td></tr>
</tbody></table>
In
either case, whether the pain is acute or chronic, the localized
treatments described above are just one aspect of recovery from these
painful conditions. It is crucial to look at strain and tension
patterns in the legs, especially the calves, and it is also necessary
to look at how weight transmits through the foot.</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh5bdyKEQfBsTyfQafcRMravEaRcDRA9M1TNc4KHrJCJVPNoCvqT2Qo65eXpBM2f1PIvoQl62UE3PPEVcJ-1lpPAABLUXhS9kj1pBnogBSBGT9XySJweC2jOntAaEchROBDDl9KD9QzhSF/s1600/overpronation.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh5bdyKEQfBsTyfQafcRMravEaRcDRA9M1TNc4KHrJCJVPNoCvqT2Qo65eXpBM2f1PIvoQl62UE3PPEVcJ-1lpPAABLUXhS9kj1pBnogBSBGT9XySJweC2jOntAaEchROBDDl9KD9QzhSF/s1600/overpronation.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 5: Foot overpronation. This image also<br />
illustrates <span style="font-size: 12.8px; line-height: 115%;">inhibition of the gluteus medius </span><br />
<span style="font-size: 12.8px; line-height: 115%;">and minimus </span><span style="font-size: 12.8px; line-height: 115%;">leading to an elevated right ilium. </span><br />
<span style="font-size: 12.8px; line-height: 115%;">Due to this, </span><span style="font-size: 12.8px; line-height: 115%;">the knee moves in during weight </span><br />
<span style="font-size: 12.8px; line-height: 115%;">bearing </span><span style="font-size: 12.8px; line-height: 115%;">and </span><span style="font-size: 12.8px; line-height: 115%;">the foot overpronates.</span></td></tr>
</tbody></table>
Over-pronation
(a collapse into the medial arch of the foot) is a common
contributing factor. In addition, restriction in the muscles of the
calf (the gastrocnemius and soleus) are very often contributing
factors. When these muscles are restricted, they transmit too much
pull on the Achilles tendon during walking, which prevents proper
ankle movement and requires the foot to undergo too much movement to
make up the difference, therefore overstretching and irritating the
plantar fascia.
</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
Stretching
these calf muscles to return proper flexibility can be very helpful
for plantar fasciitis. Improving flexibility here allows proper ankle
movement and takes the strain off the plantar fascia. Besides this,
the calf muscles are continuous with the plantar fascia via their
fibrous connective tissue components. These muscles and the plantar
fascia are on the same fascial plane, so increasing flexibility and
suppleness in the muscles will reinforce an increase in suppleness at
the plantar fascia.</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
For
chronic cases, self-massage can be a helpful tool. I give a very
simple, yet useful, self-help technique to patients suffering from
plantar fasciitis. When waking in the morning, but before getting out
of bed and stepping on the foot, I recommend using the thumb to
perform a circular massage at the attachment of the plantar fascia to
the calcaneus (heel bone). This is the most common site of pain and
inflammation; the goal of this circular massage is to warm up and
create suppleness in the plantar fascia before putting an abrupt and
forceful motion through it by stepping on the foot. For many people,
doing this every morning (and even after sitting for several hours)
is very helpful. However, for more recalcitrant pain and dysfunction,
this will not be enough and other measures need to be looked at.</div>
<div class="western" style="line-height: 115%; margin-bottom: 0.14in;">
A
combination of acupuncture and deep myofascial release to these and
related regions yields excellent results and is often necessary when
dealing with the pain associated with plantar fasciitis. If it is
painful to stand and walk, exercise becomes difficult and people
become more sedentary, leading to other health complications. It is
essential to deal with this problem so that you can do all the things
that are important to you and start your new year off right.</div>
<br />
<div align="left" class="western" style="line-height: 115%; margin-bottom: 0.14in; orphans: 2; widows: 2;">
<i>Note: In Sports Medicine Acupuncture® we first assess the
condition to see if it is truly plantar fasciitis. There are many
other conditions which can cause pain in this region and they need to
be ruled out. Included are tarsal tunnel syndrome and tibialis posterior tendinopathy. Proper treatment of these conditions will be much more
successful if the condition can be properly diagnosed.</i></div>
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-57145032795058133752015-12-07T23:41:00.010-05:002023-10-10T09:04:55.500-04:00Muscles of Mastication<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Muscles of Mastication (Chewing) and Their Relationship to TMJ Disorder, Headaches, and Sinus Pain</span></h1>
<div class="MsoNormal">
There are three muscles of mastication (chewing) which can be involved with a host of symptoms. Most notably, these muscles are often involved with TMJ disorder (also referred to as temporomandibular joint disorder, or TMD), but also can be a strong contributing factor to headaches, tooth pain and sensitivity, and sinus pain. In the case of tooth pain and sinus pain, painful trigger points in these muscles can often go undiagnosed and can lead to unnecessary dental or sinus surgery, as the muscles are rarely considered with pain in the teeth or sinuses. In the majority of the cases of dysfunction, patients present with a head forward posture (discussed in a <a href="https://blog.ideal-balance.net/2015/12/head-forward-posture.html">previous blog post</a>) and this should be addressed for long term relief of pain associated with these muscles.<br />
<br />
Acupuncture/Traditional Chinese Medicine is one of the best treatments for a host of problems that derive from dysfunction in one or several of these muscles. It can directly target the site of pain and dysfunction while also examining why these muscles are dysfunctional. Beyond that, it can add a different perspective for problems that cause a host of problems for patients.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgXBo46N14lq-MRlORYsFCJRofMZ83rtMvhLLERB9ttbJtzHtblBX61Z-gWyj2kCYdcy8omvCSBkqTIR4E_UGHkrz0BSSwXOOlGzkPOCT_SvMukiZMRDACojS2gVoxyqLSWU8W_UcmxFs/s1600/Masseter+Layers+and+Acupuncture+Points.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgXBo46N14lq-MRlORYsFCJRofMZ83rtMvhLLERB9ttbJtzHtblBX61Z-gWyj2kCYdcy8omvCSBkqTIR4E_UGHkrz0BSSwXOOlGzkPOCT_SvMukiZMRDACojS2gVoxyqLSWU8W_UcmxFs/s400/Masseter+Layers+and+Acupuncture+Points.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 1: The Masseter muscle and commonly used acupuncture points<br />
used to treat <span style="font-size: 12.8px;">pain and dysfunction with this muscle.</span></td></tr>
</tbody></table>
The masseter muscle is one of these muscles of the jaw. The
masseter consists of a superficial and deep layer. Both can be palpated (pressed) directly and both are easily accessible with an acupuncture needle (Fig. 1). Trigger points frequently form in this muscle, and they can refer to the teeth (causing pain that is mistaken for problems with the teeth), the eye (contributing to headaches), the ear (contributing to tinnitus or ear ringing).<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6p0B7TppLX6R1V_Dn_BxmFIJIUiPAmcnL1Iq1fU_5QFH5lZbBYaeS67PRiopEl7jhqYmsqwXOZNmhZ_Qnamzj9JnYXXlaqW74UXYb-EsOgH5OjFx22gKKNqAqO7mIdV36ms8UKtxOgoU/s1600/Masseter+TrPs+Mirror+Image.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6p0B7TppLX6R1V_Dn_BxmFIJIUiPAmcnL1Iq1fU_5QFH5lZbBYaeS67PRiopEl7jhqYmsqwXOZNmhZ_Qnamzj9JnYXXlaqW74UXYb-EsOgH5OjFx22gKKNqAqO7mIdV36ms8UKtxOgoU/s320/Masseter+TrPs+Mirror+Image.png" width="277" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig 2: Masseter Trigger Points with their pain referral patterns. Image from Travell and Simons'<br />
<i>Myofascial Pain and Dysfunction: The Trigger Point Manual. </i>The red indicates where pain is felt<br />
when hypersensitive nodules or trigger points develop in this muscle.</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgY3dA1ZdWsN0nOOJW8BeTlqUD9uNK1d_ZE5K385E5VLX_n2uk1zpWrV4bf4MXktdAO-V3JaofyKgLJhEFWa_KDt7Pc5BevKcjqDG4UTLzkJsflj5XfgEGgryTOXgz8hpe5-eEPQj7Q2y8/s1600/Pterygoids+and+Tensor+Veli+Palatini.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="315" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgY3dA1ZdWsN0nOOJW8BeTlqUD9uNK1d_ZE5K385E5VLX_n2uk1zpWrV4bf4MXktdAO-V3JaofyKgLJhEFWa_KDt7Pc5BevKcjqDG4UTLzkJsflj5XfgEGgryTOXgz8hpe5-eEPQj7Q2y8/s400/Pterygoids+and+Tensor+Veli+Palatini.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 3: Lateral and Medial Pterygoids. Image from<br />
<i>Netter's Atlas of Anatomy</i></td></tr>
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The pterygoids are also jaw muscles and consist of the medial and the lateral pterygoids. These muscles cannot directly be pressed except from inside the mouth. Occasionally I release these muscles by putting on surgical gloves and accessing them in just this way. They can also be reached with an acupuncture needle which, due to its thinness, can reach places that a hand cannot. In this case, the needle does not need to access these muscles through the mouth to reach them but can be inserted on the outside and advanced through spaces between two bones to reach painful trigger points (Fig. 3).<br />
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<div class="MsoNormal">
The medial pterygoid refers pain deep to the ear and to the throat. This can interfere with swallowing and contribute to soreness in the throat. This muscle also has an interesting relationship to a muscle called the tensor veli palatini, which, when you yawn or open your mouth, pulls the eustachian tube open and allows drainage and pressure normalization of the middle ear. Tightness of the medial pterygoid can block this function and can be a major contributor to ear stuffiness (barohypoacusis) and can contribute to otitis media.<o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6pOpo5GaCa_bUZtQF-A4WADRSDikMZk2XsWQZj9gGQXJhuHIGpg0o5MDip8aWAtyyhyphenhyphenSlk-kI-p2IFsQN4faxYXTF7PLkr3rPU5mCy7XGfuzmmu7WQyMmCbdc17hUbHX2ZvhW_QRSOyg/s1600/Lateral+pterygoid+TrP+referral.png" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6pOpo5GaCa_bUZtQF-A4WADRSDikMZk2XsWQZj9gGQXJhuHIGpg0o5MDip8aWAtyyhyphenhyphenSlk-kI-p2IFsQN4faxYXTF7PLkr3rPU5mCy7XGfuzmmu7WQyMmCbdc17hUbHX2ZvhW_QRSOyg/s200/Lateral+pterygoid+TrP+referral.png" width="175" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. 4: Lateral pterygoid TrP referral pattern.<br />
Image from Travell and Simons' <i>Myofascial<br />Pain and Dysfunction: The Trigger Point Manual</i></td></tr>
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<div class="MsoNormal">
The lateral pterygoids refer pain deep into the maxillary sinus and to the TMJ. Pain in this muscle is frequently a contributing factor to sinus pain and/or TMJ dysfunction.</div>
<div class="MsoNormal">
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The final muscle involved with chewing is the temporalis muscle which, as the name implies, is in the temple region. Like the masseter, this muscle can be directly pressed and easily accessed with an acupuncture needle. This muscle frequently contributes to headaches.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtA_KMM1Z9UWWJbAYofhe2tB_6fAU4eoy0eD1QRqkyDkylt9P1hp7lRGVzxSX_6kj4Uad-JMGMFnhtf-6cd4GqNZBNVzoKD0cvfQ9FHyH-cx62z_2umI2n5pfFVmNT-w9S6hdBCNwI5r64/s1600/Temporalis+TrP.jpg" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtA_KMM1Z9UWWJbAYofhe2tB_6fAU4eoy0eD1QRqkyDkylt9P1hp7lRGVzxSX_6kj4Uad-JMGMFnhtf-6cd4GqNZBNVzoKD0cvfQ9FHyH-cx62z_2umI2n5pfFVmNT-w9S6hdBCNwI5r64/s400/Temporalis+TrP.jpg" width="336" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig 5: Temporalis TrP referral pattern. Image from Travell and Simons' <i style="font-size: 12.8px;">Myofascial</i><br />
<i style="font-size: 12.8px;">Pain and Dysfunction: The Trigger Point Manual</i> </td></tr>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-6039508565638776382015-12-04T17:05:00.018-05:002023-10-10T09:05:05.294-04:00Two Blogs<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Splitting My Blog Into Two Blogs to Allow for Specialized Focus</span></h1>
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Starting in the Fall of 2015 I committed myself to regular blog posting. I had two primary things in mind for this. First, I wanted to provide educational information for my patients and the public. Second, I wanted to provide educational material for practitioners of Traditional Chinese Medicine, especially those interested in working more with sports injuries and orthopedic conditions.
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For the first goal, I wanted to provide information that would help educate the public, primarily related to my area of expertise which is sports injuries and orthopedic conditions. And, I wanted to give some insight into how acupuncture, manual therapy, herbal medicine and other things practiced as part of Traditional Chinese Medicine can help prevent, improve and manage these conditions.
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For the second goal, that of writing for professionals, my plan was to take material from lectures I have given in Manhattan and San Diego with the Sports Medicine Acupuncture Certification program run by AcuSport. This material is on the sinew channels, secondary channels in the meridian system described in Chinese medicine, and is derived from work I have been doing first as a Structural Integration practitioner and then as an Acupuncture Physician. The blog posts are the first step in a process that will lead to a book. The steps for me include producing lecture notes, writing blog posts, refining much of this information for published articles, and then further refining this for a published book.
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Since these two goals are somewhat hard to synchronize in a blog, I have made the decision to have two separate blogs. One will be for patients and the public, which will remain here. The second will be oriented toward professionals and will explore the sinew channels in much more anatomical detail. This will be found at <a href="https://www.sinewchannels.com"><b>sinewchannels.com</b></a>. These two blogs will be linked by tabs at the top of each blog so that those interested in both can move back and forth between them.</div>
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-68924395974881146782015-12-02T17:50:00.015-05:002023-10-10T09:05:17.441-04:00Head Forward Posture<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">The Head Forward Posture and Health Ramifications</span></h1>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkeRKTEXl_6PfyRXPAQ2DKFtX0ToPlk22FvgwtqV_bbqg3h2iA_JK_MzPxsHKnIOx_4JTm8aZ9NrGNeiws0B63Q9O5s-JtMsfmetxIShysu4GE7QssLfeQQUlQzznX3wI9ItFYs19Owys/s1600/head+forward+posture.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkeRKTEXl_6PfyRXPAQ2DKFtX0ToPlk22FvgwtqV_bbqg3h2iA_JK_MzPxsHKnIOx_4JTm8aZ9NrGNeiws0B63Q9O5s-JtMsfmetxIShysu4GE7QssLfeQQUlQzznX3wI9ItFYs19Owys/s320/head+forward+posture.png" width="253" />
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<div>One of the most common postural disparities I see is a head-forward posture. In <i>The Physiology of Joints, Volume III</i>, French surgeon and anatomist Adalbert I. Kapandji states that for every inch the head goes forward it gains an additional ten pounds of weight in terms of strain on the posterior neck and upper back muscles. The average weight of the head is about 4.5-5 kg (10-11 pounds) and, in a balanced posture, it is supported evenly amid the muscles of the neck. With a head-forward posture, this balanced support is disrupted, and the posterior neck and upper back muscles then become increasingly more overloaded (and painful) with every additional degree of head-forward posture. With the head an inch forward (neutral is considered as consisting of the ear aligning over the acromion process which is the highest point of the shoulder) this means that the posterior neck and upper back muscles have to support about 20 pounds of weight all day. At 2 inches forward, this becomes about 30 pounds. With Americans spending more and more time behind the wheel, in front of computer screens, glued to cell phones and tablets, and performing other activities which lend themselves to this already common posture, it is not surprising that we frequently see so many problems attributed to this posture.
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The following are common complaints that involve a head-forward posture:
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<b>Generalized neck pain and shoulder pain caused from muscle overuse</b>: As stated above, for every inch the head moves forward, it gains an additional 10 pounds of weight in terms of strain on the posterior neck and upper back muscles. What this means is that the muscles of the posterior cervical spine are working overtime, day in and day out, and for a prolonged time. It is just a matter of time before they start to cry out for some attention and that usually comes in the form of aches and pain. Specifically, the upper trapezius, levator scapula, and splenius cervicis are frequent muscular contributors to neck discomfort; they not only produce pain, but reduce range of motion and can contribute to stiffness, including stiffness which makes it difficult to turn the neck. Generally, restriction in the upper trapezius manifests in reduced range of motion and discomfort towards the end of the range of motion when looking in the opposite direction, while restriction in the levator scapula often causes pain when looking to the same direction. However, sometimes all three of these muscles can become spasmed, making it very difficult to turn the neck in any direction without considerable pain.
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And it is not just the muscles which are involved with neck pain from a head-forward posture. The strain in the posterior neck from the additional load signals fibroblasts to produce more extracellular matrix to support this area. Fibroblasts are specialized cells that produce the building blocks of fibrous connective tissue, such as collagen fibers and a sticky, syrupy substance called proteoglycans (a protein-carbohydrate based molecular structure). Prolonged strain (such as years of bracing against the extra weight of having the head forward) stimulates production of this extra material which can be easily felt as dense, ropy, fibrous bands in the upper back and neck region. It is the body’s attempt to add more support to a region that has additional demands placed on it. Local massage, acupuncture, or other treatments applied directly to the painful tissue may temporarily help make this dense, stagnant tissue feel better, but the posture as a whole needs to be addressed if there is to be any hope of long-lasting relief.
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg49FUK8QJHTKjuo6MUtTfpnbgWEDu14cAwC4kxDHPALr_M626PUoQQwzahlpb7Zq5Nf6hmQSOteHog6kWwC4goznS4vsnIkCccr7FypkXmSZ2KbzQYoi1tKEIGuAV4B-K6NGWms6iA5Tw/s1600/cervical+facet+referrals.png" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;">
<img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg49FUK8QJHTKjuo6MUtTfpnbgWEDu14cAwC4kxDHPALr_M626PUoQQwzahlpb7Zq5Nf6hmQSOteHog6kWwC4goznS4vsnIkCccr7FypkXmSZ2KbzQYoi1tKEIGuAV4B-K6NGWms6iA5Tw/s1600/cervical+facet+referrals.png" />
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<td class="tr-caption" style="text-align: center;">Cervical facet joint referral patterns.
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Image from: Osteoarthritis of the Spine:
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The Facet Joints, Gellhorn, A.C. et al
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Nature Reviews Rheumatology 9, April 2013
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<b>Facet joint syndrome:</b> This involves a degeneration of the vertebral facet joints, which is usually secondary to degeneration of the intervertebral discs. Cervical disc degeneration is usually exaggerated whenever there is long term hypomobility (limited movement) of cervical spine. While the outer part of the intervertebral disc has a blood supply, the inner part does not and requires nutrition and fluids via diffusion from the outside. So, with any limited movement patterns that persist for a long time, the discs suffer. As one of my tai chi instructor states, “Motion is Lotion,” and this is definitely true for the spine. In addition to the discs, the synovial, freely moveable (at least they should be) joints of the spine can become degenerative and lead to pain, which can affect the neck but can also refer to the head and, even more commonly, between the shoulder blades. This is a commonly overlooked source of pain and patients with a head-forward posture are much more predisposed to it.
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<td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie3lkSOwaork4ITTi1hbTca918FKFRTkRq7zHPmCFLKBBVlsF-l4vK6aV0_M28yaAU5tjvxGhTMcjfkJFNwuGOrkZiYg1WC1pgzmrvkJYDwHn3TULqkSPFkaZsd-HFMFtVCXPv0uK17Xw/s1600/kapandji+facets+highlighted.png" style="margin-left: auto; margin-right: auto;">
<img border="0" height="161" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie3lkSOwaork4ITTi1hbTca918FKFRTkRq7zHPmCFLKBBVlsF-l4vK6aV0_M28yaAU5tjvxGhTMcjfkJFNwuGOrkZiYg1WC1pgzmrvkJYDwHn3TULqkSPFkaZsd-HFMFtVCXPv0uK17Xw/s320/kapandji+facets+highlighted.png" width="320" />
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<td class="tr-caption" style="text-align: center;">Facets joints are the synovial joints between adjacent vertebrae. They can become degenerative and painful with osteoarthritis of the spine. In a head forward posture, the upper cervical facets are often in a closed position while the lower facets are in an open unstable position. Both situations can aggravate the joints and lead to referred pain. This image is from Kapandji's Physiology of Joints.
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrqR0NI41cKgYhxjrPA-JxM9V4S1jadReeAtIOqqXQoq2ExtHSHjjafMXZ37hoUCTz46X6gncUZUh7KJU9TUqpwj5NTZgWq8i5uiFPWao2IwhcAUPdrZ0OT3W_5J_14N_FZfoVdAW4uGs/s1600/splenuis+capitis+4+heads+blogsize.png" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;">
<img border="0" height="128" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrqR0NI41cKgYhxjrPA-JxM9V4S1jadReeAtIOqqXQoq2ExtHSHjjafMXZ37hoUCTz46X6gncUZUh7KJU9TUqpwj5NTZgWq8i5uiFPWao2IwhcAUPdrZ0OT3W_5J_14N_FZfoVdAW4uGs/s320/splenuis+capitis+4+heads+blogsize.png" width="320" />
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<td class="tr-caption" style="text-align: center;">Splenius capitis (close to GB-20) and splenius cervicis
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(at extrapoint Bailao) <span style="font-size: 12.8px;">TrP referral patterns.</span>
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Image from Travell and Simons' Myofascial Pain and
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Dyfunction: A Trigger Point Manual.
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<b>Tension headaches:</b> With cervical (neck) flexion and capital (head) extension, the posterior cervical muscles are in a shortened position, especially the muscles referred to as the suboccipitals. These four deep upper cervical muscles are very common causes of referred pain into the head, contributing to tension headaches. With the movement of the head forward, the eyes would be looking toward the ground if not for these muscles tightening to lift the head, placing the occiput into an extended position relative to the top of the cervical spine. Other muscles, such as the upper trapezius, splenius capitis, splenius cervicis, and sternocleidomastoid (SCM) are also negatively impacted and common contributors to tension headaches.
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<b>Nerve impingements and entrapments:</b> Since disc health is affected by head-forward posture, it can play a role in spinal nerve impingement. In addition, thoracic outlet syndrome (another type of entrapment of neural structures) is often seen with a head-forward posture. Both of these can radiate pain into the upper extremities and be causes of pain in the arms, elbows, forearms or hands.
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Thoracic outlet syndrome involves an entrapment of the brachial plexus, which is the bundle of nerves that exit from the neck and travel to the arms. The brachial plexus can be entrapped as it travels between the anterior and middle scalene muscles (two anterior neck muscles which are shortened in a forward-head posture), between the clavicle and ribcage, and between the pectoralis minor muscle and the ribcage. The head-forward posture is often a contributing factor to all of these, especially as the entire shoulder girdle is involved (more on this in the next post).
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<b>Jaw tension: </b>a head-forward posture places the mandible (lower jaw bone) in a position which stresses and tightens the muscles of the jaw. The position of the head places anterior neck muscles such as the suprahyoids and infrahyoids in an overstretched position. These muscles attach to the mandible and pull down on the lower jaw bone. The muscles of mastication (chewing), such as the masseter, reflexively tighten to hold the jaw close. They then develop trigger points which put pressure on the temporomandibular joint (TMJ).
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<b>Shoulder and other problems:</b> Part 2 of this post will discuss the relationship of the balance of the cervical spine to the shoulder girdle. Because these are so intimately tied to each other, shoulder dysfunction such as supraspinatus tendinopathy, bicipital tenosynovitis, infraspinatus and subscapularis myostrain, and other conditions are often made worse by the strain of a head-forward posture. As we explore the sinew channel relationship described in Chinese medicine, this neck-shoulder girdle relationship will become even more apparent.
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<img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNWhoeEIyruf1cx2cBvG5KBzJRrl3sjK7yO4bRd-VeMttz5uHhu2ynH-U1LSsfGdyXKcU4PuEcyklJo6sxN_I0hNWDRO1UrMxjngMJRZ9OlEy_aavZ-LTi0ECmxEHVhvBmcuqFkw5eVBk/s320/startle+response+bw.png" style="margin-left: auto; margin-right: auto;" width="180" />
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<td class="tr-caption" style="text-align: center;">
Image from <i>Startle as a Paradigm</i>
<br />
<i>for Malposture, </i>by Pierce, F. et al
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Perceptual and Motor Skills, 1964
<br />
<i><b>A)</b> Patient standing upright
<br />
<b>B)</b> Door closes loudly and startles patient. Notice the shortening along the front of the body</i>
</td>
</tr>
</tbody>
</table>
<div>
In addition to shoulder dysfunction, head-forward posture can contribute to other problems elsewhere in the body. This could become a very complex analysis, so I will not give a complete list. However, I will mention some interesting research that explored hamstring flexibility in relation to the suboccipital muscles (which extend the joint between the occiput and top of the cervical spine). This research measured hamstring flexibility and then split the subjects into two groups. Members of one group performed hamstring stretches; members of the other performed stretching to the suboccipital muscles. Surprisingly, the group that received stretching for the suboccipitals alone had a greater increase in hamstring flexibility (13%) than the group receiving hamstring stretches alone (9%). The reason likely has to do with the high concentration of muscle spindles present in the suboccipital muscles and, due to this, the fact that they have such a strong influence on tone throughout the musculature of the back, especially at the hip joint. Consider what happens when someone is startled, and the typical startle response observed. The firing of the suboccipitals might be reflexively tied to the firing of the hamstrings which assists in extending the hip joint. This, along with the shortening in the front of the body, would effectively protect the vulnerable organs.
</div>
<br />
<div>
For acupuncturists, it is worth reexamining the Urinary Bladder sinew channel and noting that it does bind to the occiput, and, therefore would include the suboccipital muscles. Looking for a head-forward posture and addressing shortened suboccipitals would be a worthwhile strategy, not only when treating local dysfunction, but with any strain pattern affecting the Urinary Bladder sinew channel. Addressing this pattern would help focus the selection of effective points to treat according to the principle of “selecting points above to treat below.”
</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-82753541709580531082015-12-02T17:47:00.011-05:002023-10-10T09:05:27.295-04:00The Four Pillars of Chinese Medicine<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Acupuncture is Just One Pillar of Traditional Chinese Medicine</span></h1>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKQ03d73K9BOY_D1L-Jd-_E0RMWeIFGtRfcYaBq_-AFDZ9GND7Ymxir2-dvrRtg_TBNCjuR3YSiAYV_frND9NyXLUk6rpeffNL7GI7PiBOphBFCHpQvE4nP1TFIyxWImJJtnUugsfW2h0/s1600/bigstock_Chinese_Medicine_583752.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKQ03d73K9BOY_D1L-Jd-_E0RMWeIFGtRfcYaBq_-AFDZ9GND7Ymxir2-dvrRtg_TBNCjuR3YSiAYV_frND9NyXLUk6rpeffNL7GI7PiBOphBFCHpQvE4nP1TFIyxWImJJtnUugsfW2h0/s320/bigstock_Chinese_Medicine_583752.jpg" width="214" /></a>
</div>
<div>
Traditional Chinese Medicine (TCM) is a comprehensive medical system from China. While many people are aware of acupuncture, TCM actually incorporates four major avenues or treatment. These are known as “the four pillars” of TCM, and they are: acupuncture; Chinese herbal medicine and dietary therapy; Tuina, which incorporates medical massage and manipulation; and exercise and movement therapy. Your trained Doctor of Oriental Medicine will evaluate your case and prescribe one or several of these treatments depending on what is needed.
</div>
<br />
<div>
<b>Acupuncture</b> involves the use of very thin, single-use, sterilized needles inserted in various locations to regulate body processes. In the West, acupuncture is most often used for pain relief, for which it is very effective. But this is not the full scope of comprehensive acupuncture treatment; it is actually appropriate in a wide range of illnesses.</div>
<br />
<div>
<b>Chinese herbal medicine</b> is based on a vast array of medicinal formulas, which are therapeutically balanced combinations of herbs used to treat patterns of medical disharmony. TCM looks for clinical signs and symptoms of these patterns and then prescribe specific herbal medicinal formulas to treat these patterns. TCM pattern differentiation and treatment with herbal Medicinals can offer a safe and effective natural treatment for illness or can complement your treatment prescribed by your Western MD, in some cases possibly enabling your Western pharmaceutical prescription to be reduced or helping deal with side effects.
</div>
<br />
<div>
In addition to the prescription of herbal Medicinals, dietary recommendations can also be used as part of the treatment. This can include general assistance with weight loss or maintenance, or specific food choices and preparations designed to help you manage an existing condition.
</div>
<br />
<div>
<b>Tuina</b> is a Chinese system of clinical massage and joint mobilization. Tuina is derived from two words; tui meaning to “to push” and na meaning “to lift and squeeze”. Tuina uses light, moderate, or deep pressure to mobilize the body’s structures and joints and restore normal movement. It is primarily used for musculoskeletal conditions, but it can also be employed for other condition such as respiratory or digestive problems. Generally, Tiuna focuses on particular regions such as the neck, back, legs, etc., and resembles more clinical styles of Western deep tissue massage therapy. <i><a href="https://blog.ideal-balance.net/2015/12/teaching-and-tuina.html">Click here</a> to see a previous post about Tiuna.</i>
</div>
<br />
<div>
Finally, <b>Therapeutic Exercises</b> are often prescribed in China to help treat illness and to maintain and improve health. In particular, tai chi (Taiji) and qigong are therapeutic forms of exercise that improve flexibility, circulation and general wellbeing.
</div>
<br />
<div>
When looking for a practitioner of Traditional Chinese Medicine, it is important to understand that many practitioners focus mostly on one or maybe two of these ‘pillars’ listed above, usually based on a practitioner’s specialization. Practitioners focusing on internal medicine might use herbs more extensively while those treating musculoskeletal pain might be inclined to use Tiuna more. In my clinical practice, I specialize in the treatment of sports injuries and orthopedic pain conditions. So, I primarily focus on acupuncture, Tiuna, and corrective exercises to facilitate rehabilitation from injury, and to correct muscle imbalances that contribute to pain conditions. When I prescribe herbal medicine, it is usually a formula (balanced combinations of herbs) to help with the particular pain or injury. Such herbal formulas may help with trauma; they may address how the body deals with inflammation, or they may regulate the nervous system to reduce over-contraction and tightness in the muscles. The herbs basically support the treatment, while the acupuncture, Tiuna and therapeutic exercise prescription specifically target the region of pain and return normal movement to the body.
</div>
<br />
<div>
Another practitioner who specializes in internal medicine might rely much more on herbs, and their acupuncture treatment might be more supplemental. It is important for patients to know what to look for when seeking a practitioner, as not all have equal training and not all have experience that will make them effective in treating all medical problems.
</div>
<br />
<div>
Most TCM practitioners do use these four pillars, but there is no need to be dogmatic about using only techniques that originated in historical China. If a modern or Western-developed treatment protocol is appropriate and compatible with TCM principles, it can be integrated into a Four Pillars-based treatment plan. For instance, to reduce inflammation, I might prescribe a classical herbal formula, but I might also prescribe fish oil supplementation. Also, I frequently use manual massage techniques and mobilization of joints, but much of my training comes from Western bodywork systems such as myofascial release and structural integration (I am certified in both of these via the CORE Institute). On an even deeper level, my acupuncture treatments rely heavily on Western anatomy and Sports Medicine principles. These techniques are taught in <a href="https://www.sportsmedicineacupuncture.com/" target="_blank">AcuSport Seminar Series</a> and the Sports Medicine Acupuncture Certification Program, on whose faculty I serve. My point is that as Chinese medicine becomes more global, it can include insight from many other viewpoints, especially Western medicine, but the heart of the medicine will continue to focus on these four basic pillars of treatment which are designed to return the body to a balanced state of health.
</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-85670819074061494662015-12-02T15:25:00.013-05:002023-10-10T09:05:45.437-04:00Myofascial Release<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">What is Myofacial Release?</span></h1>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfTYbCAWcw52QuQ9feXDPU1pV9zbuRsixPJRfBMlQFK0CNNdsMIzz3V0pOrgOs41bTebRR2CIynEU_lsu8uswjTyZ8BphMSvUGyLwWVTjuAKhV-5HJItxu_XihIcrdIt2wr4nUzwIJev0/s1600/banner.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfTYbCAWcw52QuQ9feXDPU1pV9zbuRsixPJRfBMlQFK0CNNdsMIzz3V0pOrgOs41bTebRR2CIynEU_lsu8uswjTyZ8BphMSvUGyLwWVTjuAKhV-5HJItxu_XihIcrdIt2wr4nUzwIJev0/s1600/banner.png" /></a>
</div>
<br />
<div>
Myofascial release is a deep-tissue work whose focus is to
relieve pain, resolve structural dysfunction, and improve function, mobility,
and posture. “<i>Myofascia</i>” refers to
the combined anatomical system of muscles (“myo”) and fascia.<span style="color: #c00000;"> </span>Fascia is a continuous web of connective tissue found
throughout the entire body, It surrounds every muscle, nerve, blood vessel, and
organ, and holds all these structures together, giving them their shape,
offering support and interconnecting the body as a whole.
</div>
<br />
<div>
Myofascial release has its roots in Connective Tissue
Massage (Bindegewebsmassage) which was developed by Elizabeth Dicke who lived
in Germany in the 1920s and 1930s. This work consisted of light strokes whose theoretical purpose was to
improve circulation in subcutaneous connective tissue, resulting in reflex
action to other parts of the body, including visceral organs.
</div>
<table align="left" cellpadding="" cellspacing="0" class="tr-caption-container" style="margin: 25px 25px 10px auto;"><tbody><tr><td style="text-align: center;"><a 1em="" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-dvvqvefxyA_3sL5ApQ2qbaRxC7J2Ye7xXzqNAOkdjp9hW-chW8txU-AyJ70ycepBHpW6YFGWcej7CckMC4zcoKfyJ_yClWk1KczUZ9lSMZU9slxkvISpRojQ7XuwU4N2w3qudQT8pYo/s1600/abdomen459195.png" margin-left:="" margin-right:="" style="margin-left: auto; margin-right: auto;"><img alt="Hands doing myofascial release massage to a back." border="0" height="135" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-dvvqvefxyA_3sL5ApQ2qbaRxC7J2Ye7xXzqNAOkdjp9hW-chW8txU-AyJ70ycepBHpW6YFGWcej7CckMC4zcoKfyJ_yClWk1KczUZ9lSMZU9slxkvISpRojQ7XuwU4N2w3qudQT8pYo/w320-h135/abdomen459195.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Myofascial Release to the Lower Ribcage</td></tr></tbody></table>
<br />
<div>
The term “myofascial release” was coined by Robert Ward, DO,
(Doctor of Osteopathy) in the 1960s. John Barnes, PT, (Physical Therapist)
adopted the term as designation for his method of freeing fascial restriction,
and this is a popular form of myofascial therapy practiced today.
</div>
<br />
<div>
Another important figure in the development of myofascial
therapies, and someone whose work more directly influences my own, was Ida
Rolf, PhD who taught in the 1960s and 1970s. Dr. Rolf developed a ten-session
series of work that she called Structural Integration and that later was trademarked
as Rolfing<sup>TM</sup>. Dr. Rolf was very influenced by osteopathic
manipulation; through her ten-session series, she sought to re-establish
vertical alignment in the body by manipulating fascial layers. I studied this
work in 2002-2003 at the <a href="https://www.coreinstitute.com/core-courses/core-structural-integration/" target="_blank">CORE<sup>TM </sup>Institute</a> with George Kousaleos and,
upon certification, I continued my education, <a href="https://connectivetissue.com/" target="_blank">studying with Certified Advanced Rolfer Liz Gaggini</a> and also studying with <a href="https://www.anatomytrains.com/" target="_blank">KMI/Anatomy Trains</a> faculty (Tom Myers, James Earls,
and Simone Lindner).
</div>
<br />
<div>
<a href="https://www.touchmedicine.net/" target="_blank">Simone Lindner</a>, while still maintaining a busy teaching
schedule with KMI, is currently serving on our faculty in the Sports Medicine
Acupuncture Certification Program, where she teaches Anatomy Trains principles
in the Fascial Release for Myofascial Meridians (FRMM) course. This has been an
extremely rewarding experience, as I teach in the Anatomy, Palpation and
Cadaver Lab in a two-day course prior to the FRMM course, where I lecture on
the sinew channels discussed in the Chinese meridian system. These have much
crossover with the anatomy discussed in the anatomy trains system.
</div>
<br />
<div>
After my class, Simone then teaches fascial release
techniques to work with these lines to restore structural balance. I assist
with this class and occasionally help relate this information into TCM language
more familiar to acupuncturists. This has been a tremendous amount of fun and a
very educational experience for me personally, as well as for class
participants. Matt Callison (the director of SMAC) and I then follow up and review
some of these techniques in the Assessment and Treatment class, which usually takes
place about a month later. In this class we teach assessment of injuries and
conditions and using the assessment results to build treatment protocols,
primarily geared around acupuncture, but also prominently featuring myofascial
release techniques.
</div>
<br />
<div>
Much of this work, in addition to work from other Structural
Integration practitioners (my original teacher, George Kousaleos, and a current
influence of mine, Advance Rolfer <a href="https://advanced-trainings.com/" target="_blank">Til Luchau</a>) has made its way into a course I am teaching at
East West College of Natural Medicine. I teach many classes there, including
Anatomy and Physiology, Orthopedic Evaluation, and Acupoint Anatomy, but more
and more I have been teaching myofascial release techniques as part of the
Tuina curriculum. The goal is to make this work accessible to acupuncture
physicians in training so that they can improve the therapeutic outcome of
their treatments and more deeply understand the sinew channels and how they
relate to global strain patterns. To see more on this, visit my past blog post
<a href="https://blog.ideal-balance.net/2015/12/teaching-and-tuina.html">Teaching and Tuina.</a>
</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-20108140704671934762015-12-02T15:24:00.010-05:002023-10-10T09:05:56.572-04:00Sports Medicine Acupuncture®<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Teaching Sports Medicine Acupuncture®</span></h1>
<div>
Since 2013, I have been on the faculty of the <a href="https://www.sportsmedicineacupuncture.com/" target="_blank">Sports Medicine Acupuncture Certification Program</a>, teaching first on location in
Manhattan, NYC and currently in San Diego, CA. It is a great honor and
experience to teach with this program, as it is the most in-depth and extensive
program of its kind in the country. I have the opportunity to work closely with
probably the most knowledgeable person in the field of acupuncture and sports
medicine, Matt Callison.</div>
<br />
<div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggvEcXRzjmN64sgekbYNAPb1pM1DXUk9XTZSAj_11qW_RxnvFegG_vXXW55VAoqgJUJl5wAMlLObYNut0ND6lVGy6HTOkU4G6QeiDbQVAmld6NrMCC05YGEWBSyASPa5-SkQ44iC7V_dU/s1600/bigstock_Acupuncture_Needles_580848.jpg" style="clear: left; float: left; margin-bottom: 5px; margin-right: 25px;"><img alt="Acupuncture Needles" border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggvEcXRzjmN64sgekbYNAPb1pM1DXUk9XTZSAj_11qW_RxnvFegG_vXXW55VAoqgJUJl5wAMlLObYNut0ND6lVGy6HTOkU4G6QeiDbQVAmld6NrMCC05YGEWBSyASPa5-SkQ44iC7V_dU/w214-h320/bigstock_Acupuncture_Needles_580848.jpg" width="214" /></a>
Sports Medicine Acupuncture® integrates Traditional Chinese
Medicine principles with Western sports medicine. Practitioners are extensively
trained in the following:
</div>
<ul>
<li>Evaluation of injuries and orthopedic disorders
to find the cause of pain and dysfunction. Based on these findings, treatment plans
are then devised, which include acupuncture, myofascial release (a type of
clinical deep tissue massage), and corrective exercises.</li>
<li>Postural assessment to understand the global
imbalances that can lead to, and/or prevent proper healing of, orthopedic
disorders and sports injuries.</li>
<li>Anatomy in great detail, including cadaver
dissections. This allows for a comprehensive three-dimensional understanding of
anatomy relevant to needle techniques, manual therapy techniques, and
assessment of injuries.</li>
<li>Relating the acupuncture channels discussed in
Traditional Chinese Medicine to anatomical structures, especially continuous
myofascial planes (myo-muscle, fascia-connective tissue).</li>
</ul>
<br />
<div>
Sports Medicine Acupuncture Certification is taught in four modules: 1) the spine; 2) head, neck and upper extremities; 3) low back and hip; and 4) lower extremities. Each module focuses on sports injuries, repetitive use injuries and orthopedic disorders in these regions. This program is designed to provide the most advanced training available in the assessment and treatment of these injuries.
</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-67802490092922065112015-12-02T15:22:00.009-05:002023-10-10T09:06:10.830-04:00Dry Needling and Acupuncture<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Is Acupunture Dry Needling?</span></h1>
<div class="MsoNormal">
I often get asked if I do dry needling. Many acupuncturists
become defensive when asked this, and there is currently some contention in the
fields of acupuncture and physical therapy, as PTs either have it in their
scope of practice to do dry needling (in some states) or are trying to get it added
to their scope (in other states, such as Florida). Many acupuncturists feel
that dry needling is just another name for acupuncture and that PTs are trying
to add acupuncture to their scope. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, what is dry needling and why is there any controversy?
First off, I want to state that this blog post is not intended to state any
profession opinion or get into the politics. Instead, I am going to discuss the
technique, goals, and give a brief history of dry needling.<br />
<br />
<o:p></o:p></div>
<div class="MsoNormal">
Dry needling as a technique and name grew out of work
primarily from Dr. Janet Travell, MD. Dr. Travell, along with her colleague,
Dr. David Simons, MD wrote a very influential two-volume book in the field of
pain management called <u>Myofascial Pain and Dysfunction: The Trigger Point
Manual</u>. In this book, they discussed trigger points (TrPs) which are
defined as hypersensitive spots found in taut bands of muscle <i>(<a href="https://blog.ideal-balance.net/2015/12/trigger-points-common-cause-of.html">click to read more about TrPs</a>)</i>. When palpating
muscles that are dysfunctional, there are notable taut bands. Following these
taut bands, physicians might find a hypersensitive nodule, often in the belly
of the muscle along these taut bands. Pressing these yields hypersensitivity
and often a characteristic referral pattern is noted, many times quite a
distance from the location of the TrP. These two volume books gave a detailed
description of the palpation, signs and symptoms, and pain referral zones of
these TrPs for each muscle in the body. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In addition to clinical information regarding locating and
diagnosing these TrPs, these books also discussed treatment. Many protocols were discussed, but TrP injections were primary treatments outlined in
these books. It became increasingly understood that the mechanism that was at play with TrP injections was the mechanical stimulation from the needle. Most
often what was injected were substances such as lidocaine which served the
purpose of reducing sensation as a relatively thick hypodermic needle probed
into a hypersensitive TrP. Dr. Travell did discuss dry needling, differentiating between using a hypodermic needle to inject a substance versus using a hypodermic needle without injecting a substance (which was, therefore, 'dry needling'). Over time, especially as acupuncture was becoming
more popular in America, other practitioners determined that the use of a thinner
solid filiform acupuncture needle could serve the same purpose.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Actually, in the history of acupuncture in China these
same techniques were discussed, and the Chinese referred to these hypersensitive
nodules as <i>Ashi</i> points. <i>Ashi</i> means something along the lines of
‘That’s it’. Imagine a physician palpating for the source of a patient’s pain
and the patient proclaims ‘<i>Ashi’</i>. The
needle technique involves with needling <i>Ashi </i>points is extremely similar to
those described in TrP injection and dry needling circles. Notably this
involves locating the hypersensitive nodule, inserting a needle, bringing the
needle back to the subcutaneous layer and redirecting the needle. Imagine a
needle pointing to numbers on a clock and, from the same point, the needle
touches 12, 1, 2, 3, etc. This describes the lifting and thrusting technique
discussed in the classics of Chinese medicine. When doing these techniques,
there is a characteristic muscle twitch or fasciculation that is achieved as
the TrP is being deactivated.<o:p></o:p></div>
<br />
<div class="MsoNormal">
This technique can be extremely effective in reducing pain
associated with TrPs which is a very common source of pain. Increasingly, TrPs
are being understood to be a major contributor to pain. Needling TrPs with an
acupuncture needle is one of the most effective tools to treat these. I feel
that acupuncturists are best suited to treat TrPs, as we have the greatest
amount of training with needle technique, and we have the greatest ability to
incorporate this technique into a balanced acupuncture session. However, while
all acupuncturists have had some training on needling sensitive points, those
who have undergone more continuous training with emphasis on a detailed
understanding of anatomy and palpation are going to yield the greatest results.
While not all acupuncturists have this understanding, there is growing movement
within acupuncture circles to incorporate a more detailed understanding of
Western anatomy and utilizing a more integrative approach to treating patients.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-53129543291818519352015-12-02T14:14:00.011-05:002023-10-10T09:06:22.948-04:00Trigger Points and Pain<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Common Musculoskeletal Pain Patterns and Treating with Trigger Point Dry Needling</span></h1>
In upcoming blog posts, I am going to describe common trigger
points (often abbreviated as TrPs), discuss their clinical presentation (when
it hurts, during which movements, how patients describe the pain, etc.) and
pain patterns (where the pain refers to and is experienced by the patient). My
goal is to educate patients on common pain patterns and give a few tips on how
to prevent and alleviate this pain.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A trigger point is defined by Drs. Janet Travell, M.D., and
David Simons, M.D., as a hyperirritable spot in a skeletal muscle that is
associated with a hypersensitive palpable nodule in a taut band (a “taut band”
is a tight area in a muscle). The spot is painful on compression and can give
rise to characteristic referred pain, referred tenderness, motor dysfunction,
and autonomic phenomena. This definition is from their excellent two-volume
book <i>Myofascial Pain and Dysfunction: The
Trigger Point Manual</i>.</div>
<div class="MsoNormal">
<table align="left" cellpadding="10" cellspacing="0" class="tr-caption-container" style="float: left; margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgll29HTBp1KUuBWe2nfqL0lWiz895CgqsJwfdFBUKlJJso2hY0EPdzex9iReIvUc9aSolzjL13ZujcjwtplFYEHk-vSckMJiapy887-vRoySqGQULnQhPUyvFL6FleRvUT-RSbAfCIu5M/s1600/palpating+taut+bands+trigger+points.png" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgll29HTBp1KUuBWe2nfqL0lWiz895CgqsJwfdFBUKlJJso2hY0EPdzex9iReIvUc9aSolzjL13ZujcjwtplFYEHk-vSckMJiapy887-vRoySqGQULnQhPUyvFL6FleRvUT-RSbAfCIu5M/s320/palpating+taut+bands+trigger+points.png" width="216" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig.1 Strumming across the fibers of a muscle<br />
to <span style="font-size: 12.8px;">feel taut bands and following it to locate</span><br />
the TrP. From Travell and Simon's, <br />
<u>Myofascial Pain and Dysfunction</u></td></tr>
</tbody></table>
<br />
What this definition states is that a TrP in a muscle will
be associated with a taut band within this muscle. If TrPs are present in a
muscle and you or a practitioner strums across the fiber direction of that
muscle, there will be a taut, ropy band that is present. Somewhere within this
taut band, usually towards the central belly of the muscle, there will be a
palpable nodule which is often exquisitely tender, especially with pressure applied (Fig.1). Usually, a minimal amount of pressure will elicit this discomfort, if
indeed it is not actively painful with no pressure. In fact, it might be this
active pain that brings a patient in for evaluation.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The interesting thing about TrPs is that they have
characteristic referral patterns which are where the patient experiences the
pain (Fig. 2), either with pressure on the TrP, or, when very active, without. While
this pain is sometimes in the vicinity of the TrP, many times it can be quite a
distance away. This makes assessment and diagnosis somewhat tricky.</div>
<table align="center" cellpadding="10" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghMoJVxTF3MsvmEbxc9N3MCLf9vtQPAyXiwLpUHVEE0XKfdcczrBKrnakiNtMDmG7NIEXldxncDxJb-09P-QgUExgaS1YsHG2U688OjhiEpKdI9ZEPH2moiDKiZgz7sLRZM0xgWIqOg4g/s1600/gluteus+minimus.png" style="margin-left: auto; margin-right: auto;"><img border="0" height="143" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghMoJVxTF3MsvmEbxc9N3MCLf9vtQPAyXiwLpUHVEE0XKfdcczrBKrnakiNtMDmG7NIEXldxncDxJb-09P-QgUExgaS1YsHG2U688OjhiEpKdI9ZEPH2moiDKiZgz7sLRZM0xgWIqOg4g/s320/gluteus+minimus.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig.2 Gluteus Minimus TrP referral pattern which mimics <br />
pain from neural compression causing sciatica. <br />
This is sometimes referred to as pseudosciatica</td></tr>
</tbody></table>
<div class="MsoNormal">
Motor dysfunction caused by trigger points often involves
how this muscle relates to its opposing muscle group (agonist-antagonist). Many
times, the presence of TrPs can cause a muscle to become inhibited and it will
not be able to perform its job effectively. This might be the case when this
muscle, along with certain movements, also helps stabilize a joint.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The last part of the definition refers to autonomic
dysfunction. Some TrPs can cause sweating, goosebumps, they can contribute to
digestive disturbances, and can even contribute to positional vertigo.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is important to note that TrPs appear as a result of
muscle dysfunction and are not a precise anatomical aspect of a muscle. What I
mean by this is that in a healthy muscle, there will be no signs of TrPs. When
a muscle is overloaded due to repetitive use, injury, postural tension, stress,
and other reasons, TrPs can form. Many times, these TrPs can then become a
chronic cause of pain.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
Finally, while TrPs are very common, there are many other
sources of orthopedic pain which can also refer. Spinal nerve impingement,
vertebral joint syndromes, tendinopathies and many other conditions need to be
taken into account whenever evaluating pain experienced by a patient.</div>
<br />
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Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-25637609849840771392015-12-02T13:42:00.011-05:002023-10-10T09:06:33.803-04:00Sciatica & Conditions that Mimic It<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Treating Sciatica and Similar Conditions</span></h1>
<div class="MsoNormal">
I get questions on a regular basis asking if I treat
sciatica. And then, I get further questions asking what I do for sciatica. The
first question is easy. Yes, I treat sciatica. The second question is more
difficult because, sciatica is not a very precise term and can involve many
different but related syndromes. Strictly speaking, these involve irritation of
the sciatic nerve, but there are many conditions such as muscle referrals that
can be classified as ‘pseudo-sciatica’.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Mayo Clinic defines sciatica thus: “Sciatica refers to pain that radiates along
the path of the sciatic nerve — which branches from your lower back through
your hips and buttocks and down each leg. Typically, sciatica affects only one
side of your body.” <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<table align="right" auto="" cellpadding="0" cellspacing="0" center="" class="tr-caption-container" margin-left:="" margin-right:="" text-align:=""><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3e8-W-0_w5u-oiy9Ku5eviq3cVK6PFwyVOl4Pc0LNLLBU7ZyBSElTA68sNiqG5rT-h2JND5k6Zx1Iz1PheIQElHGwBsRnW9WxOeEtblhISTSX_53gfJhtFFn6DoHedlChgLXparRfgzs/s1600/toldt+spine+lateral+view+sm+with+disc+and+nerve+colored+in.png" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3e8-W-0_w5u-oiy9Ku5eviq3cVK6PFwyVOl4Pc0LNLLBU7ZyBSElTA68sNiqG5rT-h2JND5k6Zx1Iz1PheIQElHGwBsRnW9WxOeEtblhISTSX_53gfJhtFFn6DoHedlChgLXparRfgzs/s400/toldt+spine+lateral+view+sm+with+disc+and+nerve+colored+in.png" width="75" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A lateral view of the spine. The <br />
intervertebral disc is highlighted red <br />
and the intervertebral foramen <br />
(Where the spinal nerve exits) is <br />
highlighted yellow. Disc herniations <br />
mostly occur at the region where<br />
the spinal nerve exits the foramen.</td></tr>
</tbody></table>
Pain radiating down the sciatic nerve has many causes, but I
will highlight two. The most common cause is irritation at the level of the spinal nerve where
it is exiting from the spinal cord. Conditions such as a herniated disc,
degenerative disc disease and stenosis can compress part of the nerve.
Depending on the spinal level affected, this could cause pain that radiates
down the side of the thigh and the front/side of the leg to the top of the foot
(this would involve compression of the L5 level); down the front/side of the
thigh to the inside of the knee and to the big toe (this would involve L4); or
down the back of the thigh (this would involve S1). All of these could be the result of trauma, inflammation,
and/or aging and degeneration. I treat these by using acupuncture to
release the deep back muscles at the level of spinal compression, balancing any
postural disparities that might be contributing to compression on the nerve, and ‘opening the acupuncture channels’
which are along the pathway of the pain. In addition, I might use deep
tissue massage techniques, stretches to free the nerves and restore proper
gliding, and corrective exercise that can be used at home to expand the
therapeutic outcome.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The second common cause involves an entrapment of the
sciatic nerve by one of the muscles involved in turning the leg out. This
muscle is called the piriformis and the condition is called piriformis
syndrome. This would involve deep pain in the buttock region and pain radiation
down the back of the thigh. This pain is often worse when sitting, climbing
stairs, or running; usually there is reduced range of motion in the hip joint. Some
authorities consider this syndrome to be common, while others perceive it as uncommon;
this depends on how the syndrome is defined. In most people, the sciatic nerve
sits below the piriformis, but in about 10% of the population, it actually
penetrates through the piriformis muscle. These people would be predisposed to
piriformis syndrome. In the <a href="https://www.sportsmedicineacupuncture.com/" target="_blank">Sports Medicine Acupuncture Certification Program</a> in New York, we dissected a specimen that had just this situation. It was unknown to use if this individual had pain of this sort, but it was a much stronger likelihood. <o:p></o:p><br />
<table align="left" auto="" cellpadding="0" cellspacing="0" center="" class="tr-caption-container" margin-left:="" margin-right:="" text-align:=""><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDUGhA5kXoC7lOcPsdDXZnAyWLsYw3PkC4TeDj_3ubZUrVXQ9BB93LcWhyphenhyphenEfwCORb6xpzT0RHPGcydMMLch1Y_BXb3jLWuyLBFLNt-uGTMTq8FVFFva-BxJQSeDFJkl28_0vskbZx3QS0/s1600/toldt+sciatic+nerve+sm.png" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDUGhA5kXoC7lOcPsdDXZnAyWLsYw3PkC4TeDj_3ubZUrVXQ9BB93LcWhyphenhyphenEfwCORb6xpzT0RHPGcydMMLch1Y_BXb3jLWuyLBFLNt-uGTMTq8FVFFva-BxJQSeDFJkl28_0vskbZx3QS0/s320/toldt+sciatic+nerve+sm.png" width="125" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sciatic nerve exiting below the <br />
piriformis muscle. On some people,<br />
it actually penetrates through the <br />
muscle, predisposing them to symptoms.</td></tr>
</tbody></table>
<br />
While many physicians see piriformis syndrome as occurring
only in this population, others (myself included) feel that a tight and
contracted piriformis can also contribute, regardless of the position. I treat
this condition with acupuncture to release the piriformis and balance the
pelvis, and might also involve deep tissue massage, stretching and corrective
exercises.<br />
<br /></div>
<div class="MsoNormal">
While these are the main conditions that put pressure on the
sciatic nerve, there are many other syndromes that can mimic the pain of
sciatica and can cause an incorrect diagnosis. In particular, hypersensitive
painful spots called trigger points (TrPs) in the muscles on the side of the
pelvis can radiate pain down the leg and mimic sciatica. In particular the
gluteus minimus muscle which is deep in the outside of the hip region is a common
culprit. Sacroiliac dysfunction and spinal arthritis (referred to as facet syndrome) are also pain
syndromes that can refer into the buttocks and legs. Greater trochanteric
bursitis can also radiate into the leg and be confused with sciatica. All of
these conditions require proper assessment. In my practice, I take the time
necessary to perform orthopedic evaluation and use other tools such as
palpation to determine what is causing the symptoms experienced by the patient.
I look at how the posture might be contributing to the condition. I assess
range of motion, what muscles are strong and supporting the structure and which
are inhibited and failing to provide support. And I use Traditional Chinese
Medical diagnosis to assess imbalances in the channel system. All of these findings
then are used to develop a unique treatment plan to relieve the pain of
sciatica.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-5772852666126934242015-12-02T13:39:00.010-05:002023-10-10T09:06:46.079-04:00Teaching and Tuina<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Structural Integration, Myofascial Release and Crossover with Tuina</span></h1>
Yesterday and today I gave exams for the Summer term at East
West College of Natural Medicine where I am a faculty member. This term I
taught some classes that I regularly teach, such as Anatomy and Physiology,
Oriental Medicine Physiology, and Orthopedic Evaluation. The class I enjoyed
teaching the most this term, however, was Tuina.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<table align="left" auto="" cellpadding="10" cellspacing="0" center="" class="tr-caption-container" margin-left:="" margin-right:="" text-align:=""><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTwmTv92W8avmD_g3jLG5oj4Kbp9f-qIDENOqeR2eUjSnY9nm6oHWPRpARsNs6jBdgP49xIM6S7tMoS1PA9enGkK-4YG_XdsggkJ2boXaaanW8-BC3j8VwiHzavu3ZpELFzmtLAtwIuLI/s1600/infraspinatus+MFR+2.tif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTwmTv92W8avmD_g3jLG5oj4Kbp9f-qIDENOqeR2eUjSnY9nm6oHWPRpARsNs6jBdgP49xIM6S7tMoS1PA9enGkK-4YG_XdsggkJ2boXaaanW8-BC3j8VwiHzavu3ZpELFzmtLAtwIuLI/s320/infraspinatus+MFR+2.tif" width="297" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Myofascial Release to the Infraspinatus Muscle</td></tr>
</tbody></table>
<br />
Tuina is a Chinese system of clinical massage and
manipulation/joint mobilization. This class allows me to draw on my clinical
experience with structural integration, which I studied and practiced before
going back to school for Chinese medicine and acupuncture. Many people know
this work as Rolfing, as the original body of work was developed by Dr. Ida
Rolf, PhD. This work uses deep tissue myofascial release applied to shortened,
densified connective tissue and muscles (myo-muscle, fascia-connective tissue)
with the goal of realigning the body and helping integrate movement patterns.
This work is often performed in a ten-session series, with each session having
a particular goal (opening restrictions in breathing, balancing the weight in
the feet, etc.).<br />
<br />
While there are many excellent schools that
teach this work, many talented SI practitioners and Rolfers teach aspects of
this work to therapists who want to apply it to their existing work flow. This
has been my goal with teaching this work at a Chinese medicine and acupuncture
program. I teach how strain patterns tend to manifest in the body, how to assess
for them, and then some manual release techniques and how to include them in
combination with a more integrated acupuncture treatment. What I have found is
that this work syncs very well with acupuncture and Chinese medicine.</div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-60880329900220681052015-12-02T13:37:00.009-05:002023-10-10T09:07:12.828-04:00Iliotibial Band Friction Syndrome<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Iliotibial band friction syndrome is one of the most common cause
of lateral knee pain and is especially prevalent with runners.</span></h1>
<div class="MsoNormal">
<table align="left" auto="" cellpadding="0" cellspacing="0" center="" class="tr-caption-container" margin-left:="" margin-right:="" text-align:=""><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7S7iU6O-UObf_8RUmuJdOAwKMFYzgeU2MEX7cdeCjLOA9iUopD6BfyhngTNvjq451Tt6FLuyb3u47XFJ2UAM6xhE7wJsXKrn9bFMUjesRu5oOZVnXp-dMxEhkYryMEHJ9YFnNctRStTA/s1600/Iliotibial+Band+Friction+Syndrome.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7S7iU6O-UObf_8RUmuJdOAwKMFYzgeU2MEX7cdeCjLOA9iUopD6BfyhngTNvjq451Tt6FLuyb3u47XFJ2UAM6xhE7wJsXKrn9bFMUjesRu5oOZVnXp-dMxEhkYryMEHJ9YFnNctRStTA/s320/Iliotibial+Band+Friction+Syndrome.jpg" width="246" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Iliotibial Band with Highlighted Area of Pain.<br />
From An Atlas of Human Anatomy by,<br />
Carl Toldt, M.D.</td></tr>
</tbody></table>
In iliotibial
band friction syndrome the iliotibial band (ITB), which is a thick connective
tissue structure on the outside (lateral) portion of the thigh, rubs up against the expanded end of the femur (thigh bone). This rubbing occurs at about 30<sup>o</sup>
of knee flexion. Over time, the ITB becomes irritated and can become a cause of
pain when running; this can even become chronic, causing pain at rest.<br />
<br />
<o:p></o:p></div>
<div class="MsoNormal">
Understanding the mechanism of injury helps when determining
how to treat this common cause of knee pain. Many people will state that a
‘tight’ ITB is the cause; actually, this is somewhat incorrect. First, the ITB
is not a muscle and is not contractible, at least compared to a muscle. Second,
it is most often the case that the ITB is taut in ITB friction syndrome. What I
mean by this is that the ITB is often pulled into an overlengthened position.<br />
<br />
<o:p></o:p></div>
<div class="MsoNormal">
To understand this, it is important to understand the role
of the gluteus medius and minimus in pelvic stability. During the weight
bearing phase of the gait cycle, these muscles fire to prevent an excessive
rising of the ilium. If you were to place your hands on your waist and press
down until you feel bone, you would be on the ilium. When walking (or running),
during the weight bearing portion, this bone should not rise too much. The
gluteus medius and minimus are the muscles most responsible for creating this
stability. If these muscles become inhibited and lose the ability to stabilize
the pelvis, it then will rise excessively and structures such as the ITB will
be pulled long with each step. <i>To help
visualize this, you can consider that women naturally have more pelvic movement
and some women (Marilyn Monroe, historically, and many runway models) actually
practice exaggerating this movement for aesthetic reasons.</i></div>
<div class="MsoNormal">
<i><br /></i><o:p></o:p></div>
<div class="MsoNormal">
In the majority of the cases, the side where ITB friction
syndrome occurs is also the side where the greatest degree of inhibition of the
gluteus medius and minimus occurs. This can be assessed with manual muscle
tests which challenge these muscles. In addition, most patients presenting with
ITB friction syndrome will have a raised ilium when assessing standing posture,
and this raised ilium will be on the side of the lateral knee pain. <br />
<br />
<o:p></o:p></div>
<div class="MsoNormal">
Treatment of ITB friction syndrome needs to include some
work to strengthen the gluteus medius and minimus for optimum results. Things
like foam rolling the ITB might help to soften it, but most often work needs to
be on the short and tight adductors on the inside of the leg, and strengthening
corrective exercises should be applied to the abductors such as the gluteus
medius and minimus.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Acupuncture can be extremely helpful as part of the therapy.
Acupuncture to motor points (approximately in the region of the entry site of
the motor nerve into the muscle) can help turn on inhibited muscles, which is
shown by the muscles strengthening after treatment when testing with manual
muscle tests. In addition, acupuncture to motor points of the overactive
antagonistic muscles (adductors in this case) will help reduce tension in these
muscles. This helps strengthen the effects of corrective exercises and allows
quicker recovery time so you can get back out and hit the trails.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992tag:blogger.com,1999:blog-9161540071340835127.post-89200765542566919792015-12-02T13:34:00.014-05:002023-10-10T09:07:29.201-04:00Buzzwords and Health Care Realities<h1 style="text-align: left;"><span itemprop="headline" style="font-weight: normal;">Why I believe Integrative Medicine is the way forward.</span></h1>
<div class="MsoNormal">
<br />
I’d like to take a moment to explain some common ‘buzz’ words related to health and medicine. What do we mean when we say things like conventional medicine, alternative medicine, complementary medicine and integrative medicine?
<br />
<br />
Here’s what many of us in the West grew up thinking of as simply “medicine:” a sprawling doctor’s office complex bustling with people in white coats, stethoscopes and scrubs; large, noisy machines to which you submit for one test or another; taking a small white piece of paper to a pharmacy to exchange for an orange bottle containing Western pharmaceuticals; surgery and other procedures commonly done in hospitals. All of this comes under the umbrella of <i>Conventional Medicine, </i>especially when compared to other forms of medicine that are increasingly being used in the West.
<br />
<br />
In contrast to this very Western-based perspective are medicines such as acupuncture and Chinese herbal medicines, conventionally used in <st1:country-region st="on">China</st1:country-region>, and Ayurvedic medicine in <st1:place st="on"><st1:country-region st="on">India</st1:country-region></st1:place>. These types of medicine, regardless of the fact that they have been used for thousands of years, are not considered conventional medicine here in the West, but instead get classified as Complementary and Alternative Medicine (<abbr title="Complementary and Alternative Medicine">CAM</abbr>).
<br />
<br />
While often grouped together, “complementary” and “alternative” medicines are not really one and the same. “Alternative medicine: implies that it is an alternative to conventional medicine. In other words, the patient would not get a standard conventional treatment, but instead would get an alternative treatment. For instance, acupuncture and herbal medicine might be used instead of removing the gallbladder for cholecystitis (inflammation of the gallbladder, often due to gallstones). Another example might be the use of tuina (deep manual bodywork techniques) and acupuncture to realign the structure, open the joint spaces, and increase the circulation of <i>qi</i> to treat complications due to herniated discs. This might be used as an alternative to back surgery, pain medications, cortisone injections and or physical therapy.
<br />
<br />
On the other hand, “complementary medicine” implies that non-conventional treatments are used as a complement to conventional care. For the herniated disc example, this might be a combination of conventional treatment options, such as pain and anti-inflammatory medication and physical therapy, used in combination with acupuncture and tuina.
<br />
<br />
For the example of gallstones, there is a standard therapy used in <st1:place st="on"><st1:country-region st="on">China</st1:country-region></st1:place> that involves the combined use of Chinese herbal therapy, acupuncture and Western pharmaceuticals, with the goal of expelling these stones. If this was done in the West, the herbal medicinals and acupuncture would be considered complementary medicine.
<br />
<br />
However, the entire combined treatment plan could be referred to as integrative medicine. The <st1:placetype><st1:placename st="on">National Center for Complementary and Alternative Medicine</st1:placename></st1:placetype> defines integrative medicine as medicine that combines mainstream medical therapies and <abbr title="Complementary and Alternative Medicine">CAM</abbr> therapies for which there is some high-quality scientific evidence of safety and effectiveness.
<br />
<br />
Dr. Andrew Weil’s website has a fantastic discussion of integrative medicine and points to several principles inherent in this medicine, such as being inquiry-driven rather than dogmatic in patient interaction, and neither rejecting conventional medicine nor accepting alternative medicine uncritically. Also, integrated medicine should use less invasive and natural options whenever possible, with treatment based not solely on disease eradication, but also on disease prevention and health promotion.
<br />
<br />
And finally, practitioners should develop themselves to become models of health and healing. This is possibly the most important principle; the self-exploration and development thus gained leads to a profound understanding of health and transforms the practitioner’s use of this knowledge to make good clinical decisions and work together with patients toward their ultimate best health.
<br />
<br />
There is much to admire in this model, and I feel that it would greatly help <st1:place st="on"><st1:country-region st="on">America</st1:country-region></st1:place> navigate through the current healthcare crisis. The barrage of discussion on healthcare reform since President Obama was elected has largely been a discussion of how healthcare is paid for, which is a political issue I do not care to get into. However, we need a larger discussion on how healthcare is delivered in <st1:place st="on"><st1:country-region st="on">America</st1:country-region></st1:place>.
<br />
<br />
Despite major advancements in Western medicine over the last century, there are still many places where it fails to deliver good results. Interestingly, many of the best <abbr title="Complementary and Alternative Medicine">CAM</abbr> therapies excel in precisely these areas, and these therapies can achieve results at a fraction of the cost. Using them together in an integrative model allows for better results with fewer and less severe side effects, and lower dosages where pharmaceuticals are used.
<br />
<br />
I think that this next decade will see the medical establishment trying to determine how to integrate the best <abbr title="Complementary and Alternative Medicine">CAM</abbr> therapies with conventional treatment for the overall betterment of patient welfare. At Ideal Balance Center for Acupuncture and Integrative Medicine, we are committed to this integrative model and excited to be part of this transformation in patient care.
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</div>Dr. Brian Lau, AP, DOM, C. SMAhttp://www.blogger.com/profile/09263668049814183896noreply@blogger.com03500 E Fletcher Ave Suite 121, Tampa, FL 33613, USA28.06975 -82.419820399999992-0.24048383617884639 -117.57607039999999 56.379983836178845 -47.263570399999992