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VOLUME 31, NUMBER 10
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A Freebie
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
The Massage Profession Must Continue to Evolve
Evolution is defined as any process of formation or growth, development, as well as a process of gradual, peaceful, progressive change or development by Dictionary.com.
Muscles as Team Players
Synergistic dominance occurs as "helper" muscles are recruited to take over function when a "prime mover" muscle fails, much like when a football coach calls in the substitute players when a key player is injured.
Help in Understanding Parkinson's, Part 2
In part one of this series from the April issue, I presented an understanding of Parkinson's disease (PD), its symptoms and current medical treatment.

Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Key Nutrients for Maintaining Musculoskeletal Health
As a chiropractor, I fully appreciate the amazing potential of manual therapy. Whether that therapy is a chiropractic adjustment, therapeutic massage, or some of the many other effective body work options; people generally have a wonderful response.

Healing Leaders

Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.


Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Judge Lifts Stay of Florida PIP Injunction
Circuit Court Judge Terry P. Lewis lifted an automatic stay of a temporary injunction against the Florida Personal Injury Protection law.
Dealing with Painful Foot Injuries, Part 2
In part one of this two-part series, published in the April issue, we began talking about foot pain and discussed several different injuries that affect that area of the body. Now we're going to move on to give you practical tips for soothing the feet.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Freeing the Heart: Protection of the Hip and Shoulder Joints
As we continue with this current series of articles on Freeing The Heart, if we consider the basic physiology of the human circulatory system, it seems evident that when the heart and lungs reach full expansion with a minimum of resistance, the heart will eject more blood and at a greater velocity.
The Power of Inhalation: Diffusing Essential Oils
When using essential oils as part of a massage practice, most of the focus goes on properties that can help relieve muscles and joints when applied topically.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Massage Helps Hospital Patients Manage Pain
The authors of this publication, Adams and colleagues, suggest pain management within the acute care setting is a focus of empirical study by researchers, healthcare facilities and accreditation organizations throughout the United States.
Creating Lucrative Private Retreats that Heal You and Your Clients
Imagine that you've just wrapped up your most profitable day ever, leaving your treatment room with a check in hand for $1,500. How many clients would you have to see to earn that much in a day? Fifteen at $100 a session? Ten at $150? Six at $250?
What's Your Story?

It's all too simple, yet essential. The universal question that often times we're asked by clients when we start a massage session. At least, with the chatty ones looking for conversation.


Creative Strategies to Boost Your Business
Years ago I realized the truth behind the saying that the definition of insanity is doing the same thing over and over and expecting a different outcome. I find that so many people, either personally or professionally, are "insane" by that definition.
Adventitious Tissue Structures of Elevated Tissue Density
A 12-year-old boy was brought into my clinic complaining of pain in his right heel, which impaired his ability to participate in sports, even to walk normally.
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Neurogenic Inflammation, or Why a Tennis Elbow Did Not Respond

By Warren Hammer, MS, DC, DABCO

Epicondylopathies (tennis elbow, golfer's elbow) usually fall into the realm of "tendinosis," which is a chronic pain syndrome with minimal to no inflammation. Why then do some cases persist with chronic pain and not respond to soft-tissue methods? Techniques such as friction massage, Active Release®, Graston Technique® and other methods often prove to be effective; then there are cases that do not respond and may necessitate surgery.

There are a variety of possibilities, two of which may be just excessive tendinosis degeneration or neurogenic inflammation. This article will discuss the latter.

We usually think of the primary afferent sensory fibers as only supplying the spinal cord with nociceptive stimuli, but these same fibers, when irritated, have efferent effects causing vasodilation, plasma extravasation, edema, hyperaemia and erythema. These nerves create this by releasing proinflammatory neuropeptides. Significant neuropeptides such as substance P (SP) and calcitonin gene-related peptide (CGRP) lead to what is known as neurogenic inflammation.1,2 Due to the fact that nearly all tissues in mammals, including humans, are innervated by afferent sensory neurons, this neurogenic inflammation can occur ubiquitously throughout the body.3

Ljung, Alfredson and Forsgren4 evaluated both the medial and lateral epicondyles and found out that the mechanical stress on the tendons attaching to the condyles stimulated a release of SP and CGRP, indicating a neurogenic inflammatory origin. Since inflammatory cells have not been utilized in histopathological studies of tendon insertions in epicondylopathies, it has been hard to explain why steroids at times reduce the pain. Because sensory nerve cells have glucocorticoid receptors, and steroids influence the effects and the levels of SP and CGRP, they are able to reduce neurogenic edema. The effect of soft-tissue methods on neurogenic involvement hopefully will be determined in the future.

It has also been found that lumbosacral ligamentous structures have primary afferent fiber innervation and secret proinflammatory neuropeptides from their distal processes. This creates the neurogenic inflammatory processes5 that may explain chronic back pain.6

References

  1. Mayer EA, Raybould H, Koelbel C. Neuropeptides, inflammation, and motility. Dig Dis Sci, March 1988;33(3 Suppl):71S-77S.
  2. McDonald DM, Bowden JJ, Baluk P, Bunnett NW. Neurogenic inflammation. A model for studying efferent actions of sensory nerves. Adv Exp Med Biol 1996;410:453-62.
  3. Herbert MK, Holzer P. Neurogenic inflammation. I. Basic mechanisms, physiology and pharmacology. Anasthesiol Intensivmed Notfallmed Schmerzther, June 2002;37(6):314-25.
  4. Ljung B-O, Alfredson H, Forsgren S. Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus. Studies on tennis elbow and medial epicondylalgia. J Orthopaedic Research 2004;22:321-327.
  5. Levine JD, Fields HL, Basbaum AI. Peptides and the primary afferent nociceptor. J of Neuroscience 1993;13:2273-2286.
  6. Vleeming A, Moondy V, Snijders C, Dorman TA, et al. Movement, Stability and Low Back Pain: The Essential Role of the Pelvis. New York, Churchill Livingstone, 1997:29.
On a side note, in May, Dr. Tom Hyde and I attended the European Chiropractors' Union meeting in Cyprus. The program of the meeting dealt with chiropractic techniques; Dr. Hyde and I represented Graston Technique. Representing Active Release was Dr. Michael Leahy. The three of us and our wives did some sightseeing, and in the course of events, my medial meniscus became involved. Dr. Hyde took this photo of Dr. Leahy treating my meniscus problem. I was greatly relieved and was able to continue our tour, thanks to Doc Leahy. The meniscus adjustment will appear in the 3rd edition of my text, to be published at the end of the year. The photo was shot at an over-2000-year-old Greek amphitheater on Cyprus.

Warren Hammer, MS, DC, DABCO
Norwalk, Connecticut

www.warrenhammer.com

Click here for more information about Warren Hammer, MS, DC, DABCO.

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