Over
time the human body can and will experience static malalignments that alter the
optimal resting length and tension of the muscles within the musculoskeletal
system. Common static malalignments include joint fixation and myofascial
adhesions that lead to or can be caused by poor posture.
Joint
dysfunction (a.k.a. hypomobility) is one of the most common causes of pain in the
human body.[1][2]
Once a joint has lost its normal range of motion, the muscles around that joint
may tighten to minimize the stress at the involved segment (altering the length-tension
relationship) or become overactive to prevent movement and further injury(altering the force-couple
relationships).[1][2] This process initiates the cumulative injury
cycle which subsequently alters normal movement patterns and leads to
structural and functional inefficiency.[3][4][5]
[1]
Janda V. Muscles and Motor Control in Cervicogenic Disorders. In: Grant G, ed.
Physical Therapy of the Cervical and Thoracic Spine . New York, NY: Churchill
Livingstone; 2002:182-199.
[2]
Lewit K. Muscular and articular factors in movement restriction. Man Med .
1985;1:83-85.
[3] Sahrmann
SA. Diagnosis and Treatment of Movement Impairment Syndromes . St. Louis, MO:
Mosby; 2002.
[4] Chaitow
L. Muscle Energy Techniques . New York, NY: Churchill Livingstone; 1997.
[5] Sahrmann
SA. Does postural assessment contribute to patient care? J Orthop Sports Phys
Th er . 2002;32:376-379.
Your body’s
motion is controlled by the neuro-musculo-skeletal system. This motion system
is broken down into three groups based upon the function of the various tissues
within your body. The first group is known as the Active Subsystem which
consists of the muscles that create motion. The second group is known as the
Passive Subsystem which consists of the skeleton, ligaments, tendons, fascia,
and other connective tissue that hold your body together. The third group is
the Control Subsystem which consists of the brain, spinal cord, nerves, and
mechanoreceptors that control the motion of your body.
These
three subsystems must work together for normal, healthy motion. Even if you
have strong healthy muscles you cannot maintain overall wellness if your
Passive and Control subsystems are not as equally strong. Therefore if you are
trying to lift something without integration of these subsystems you will unable
to move any more weight than your muscles, joints, or nerves will allow. Balanced and full motion allows joints and
muscles to move smoothly and keep you moving well as you age.
The doctors at Life in Motion Chiropractic and Wellness approach treatment with three
principles in mind. The first is motion; problems with this affect all three of
the body’s subsystems. To effectively help a motion problem treatment solutions
must address the mechanical and neurological issues involved and our doctor’s
approach to this threefold:
- Chiropractic manipulative therapy unlocks, restores, and maintains joint motion. Joint
mobilization reduces restrictions and other posture and motion distortions. In
fact, freeing a compressed nerve or restoring motion can affect other parts of
the body via the Control Subsystem.
-
Myofascial therapy lengthens tight muscles and breaks up ligamentous and
fascial adhesions. Other benefits of this form of therapy can be pain relief,
which also affects the Control Subsystem, improved circulation, and general stress
reduction.
-
Therapeutic exercise, during which we teach you how to properly stretch
tight/facilitated muscles and strengthen weak/inhibited muscles.
Secondly,
we look for compensatory movement patterns in the body’s chain of motion. Your
body type, injuries, and lifestyle habits train you, over time, to
involuntarily and without thinking move your body in a unique pattern of motion
using your stronger muscles. Your joints and ligaments stretch in the direction
they are used and subsequently adhesions form along unused paths of motion. Therefore,
you begin to move along the path of least resistance, just as a piece of paper
bends along a crease the tissues of the body literally groove and fold in the
way they are being used. As these mechanically inefficient patterns of poor
posture and unbalanced motion progress, a “pain cycle” is created, the result
of which is a continuous loop of increased body stress, joint degeneration,
chronic pain, and recurring injury.
The
solution, which is the third principle of treatment at Life in Motion Chiropractic and Wellness, is the implementation of “the motion cycle” through
the use of postural retraining which helps to form new “life habits” and trains
the body to move with conscious, full range of motion. Free, balanced motion
reduces joint stress, relieves pain, and restores flexibility subsequently
breaking the “pain cycle”.
The
goal of treatment at Life in Motion Chiropractic and Wellness is to restore
balance, flexibility, and control which instills self-efficacy and helps to
keep your body moving naturally, feeling good, and aging well.
Our
office continues to receive shocked and, on occasion, agitated feedback from
prospective patients who call our office that are either under-insured or have
a policy with a company we don’t participate with when we inform them of our
cash rate fee schedule. These folks feel that our rate(s) for care are high or,
on occasion, exorbitant and state that they will seek care elsewhere. The fact
is that our fee schedule is simply something we have no control over.
For ANY healthcare provider that
participates with insurance company reimbursement for services rendered they
are required by federal law (i.e.
Health Insurance Portability and Accountability Act) to adopt a cash rate fee
schedule that is comparable to the reimbursement rates of the insurers they
participate with. To do so otherwise (i.e. discount their fees for cash paying
patients) is known as a “dual fee schedule”. This unfortunately is illegal and to do so would open any healthcare provider up to
litigation from the insurance company(s) for insurance fraud.
The doctors at Life in Motion
Chiropractic and Wellness are also
everyday consumers and we would relish the opportunity to provide those
individuals who are under-insured or possess policies we don’t participate with
a discounted rate(s) for care but due to federal statutes our hands are tied.
The only way we would legally be able to provide any discount is to simply stop
our participation with health insurance companies and we entertained this idea
at the end of 2016. The feedback we received from most of our current insured
patients was not favorable and therefore we decided to maintain our involvement
with third-party payers (i.e. BC/BS, UHC, UPMC).
In
closing, we encourage everyone to petition their local government
representatives with your thoughts about the healthcare conundrum in the United
States and request that they begin to allow healthcare providers more latitude
with their billing practices so that we can truly make healthcare affordable for everyone!
NOTE: The one
service that we do offer in our office that is not covered by health insurance
and therefore allows us to set our own fee is myofascial therapy (i.e.
massage). If you feel that your particular problem is related to muscular
tension/pain our rates for strictly myofascial therapy is $1/minute with a 15
minute minimum however you can schedule appointments for up to one hour.
Here
is the LINK
for more information on this service.
An
extensive amount of research has been conducted on the effects of massage
therapy. Research data has shown that massage produces measurable biological
effects and may have an effect on the immune system.[1]
While some of this scientific evidence is preliminary it has shown that massage
can also help with back pain, neck pain, headaches, extremity pain and may
improve quality of life for people with depression, cancer, HIV/AIDS and when
utilized appropriately and provided by a trained professional, massage therapy
appears to have few risks.[2]
Massage
therapy focuses on the muscle and other superficial soft tissues of the body to
help alleviate tension, inflammation, and pain via the application of manual hands-on
techniques. The goal of massage is to establish and maintain good physical
condition and health by normalizing and improving muscle tone, promoting
relaxation, stimulating circulation, and producing therapeutic effects on the
respiratory and nervous systems.[3]
So what is massage therapy?
Swedish
massage utilizes long strokes, kneading, deep circular movements, vibration,
and tapping.
Deep
tissue massage focuses on certain painful, stiff "trouble spots" in
your body and utilizes slow, deliberate strokes that focus pressure the
muscles, tendons, or other tissues deep under your skin and provides relief
from chronic patterns of tension and injuries such as back sprain.[4]
Structural
massage, also known as myofascial release, manipulates the soft tissues within
the body using different angles and degrees of physical pressure to stretch and
guide fascia to a place of easier movement.[5]
Research has shown that this style of massage produces positive effects on
pain, anxiety, depression, fatigue, and stiffness in those suffering with
fibromyalgia.[6]
Myofascial trigger point therapy is most effectively utilized in the treatment of chronic
and acute pain. Postural holding patterns, emotional stresses and work-related
muscular usage all contribute to areas of contracted muscle that develop firm
nodules or taut bands know as trigger points which most of the time we aren’t even
aware of. When pressed, trigger points are painful and are associated with pain
elsewhere in the body and without direct intervention to eliminate them will
not go away on their own.[7]
So
what exactly does medical research say about massage?
-
Massage therapy helped reduce pain, improve function, and decrease the use of
anti-inflammatory medication more effectively than usual medical care[8]
in people with chronic low-back pain.[9]
- Massage
therapy led to statistically significant improvements in neck pain severity,
pain-related disability and function, and in one study participants reported a
14% decrease in the use of pain medication.[10][11]
- A
2012 study found that a 60 minute massage once per week exhibited significant
improvements in pain, function, and global response compared with those
receiving usual care medical care for osteoarthritis of the knee.[12]
Aside
from the research conducted by the NCCIH there have been other studies that
have found myofascial therapy to also be an effective form of treatment for
conditions such as tension type headache [13][14][15][16],
temporomandibular joint (a.k.a. TMJ) pain[17],
and chronic shoulder pain.[18]
Chronic
muscular restriction can inhibit essential physiologic processes such as blood
flow, lymphatic drainage, nerve conduction, and cellular metabolism which can,
over time, affect our overall health. The primary reason for the therapeutic
effects of massage therapy is that it increases blood flow in small vessels that
has been impeded due to muscle tension and that leads to better and faster
recovery around the muscle tissue which in turn improves the range of motion,
reduces swelling, and has pain-reducing properties.[19][20]
Dr. Konrad provides treatment
via chair massage, during which myofascial therapy is performed over the clothing
in a forward seated position as seen here,
Chair Massage
or on a flexion-distraction therapy table for cases in which a more deep tissue approach is warranted.
Aside from this he can also apply a range of modalities to supplement this hands-on therapy which include:
Heat or Ice Application
Muscle Stimulation
Hot Stone Massage
Instrument Assisted Soft Tissue Manipulation
Kinesio Tape Application
Here a short summary of Dr. Konrad’s formal training in myofascial techniques:
[1] Rapaport
MH, Schettler P, Bresee C. A preliminary study of the effects of a single
session of Swedish massage on hypothalamic-pituitary-adrenal and immune
function in normal individuals. (http://www.ncbi.nlm.nih.gov/pubmed/20809811)
The Journal of Alternative and Complementary Medicine. 2010; 16(10):1–10.
[2] Field,
Tiffany, PhD, Andrea Furlan, MD, Karen Sherman, PhD, Partap Khalsa, DC, and
John Killen, MD. "Massage Therapy for Health Purposes." National
Center for Complementary and Integrative Health. U.S. National Library of
Medicine, 06 Sept. 2016. Web. 21 Sept. 2016.
[3] Fritz,
Sandy. "Chapter 2." Mosby's Fundamentals of Therapeutic Massage. 4th
ed. St. Louis, MO: Mosby/Elsevier, 2009. 30-33. Print.
[4] Keifer,
David, MD. "Massage Therapy Styles and Health Benefits." WebMD.
WebMD, 01 Aug. 2016. Web. 21 Sept. 2016.
[6]
Yuan SL, Matsutani LA, Marques, AP. Effectiveness of different styles of
massage therapy in fibromyalgia: a systematic review and meta-analysis. Man Ther. 2015;(2):257-264
[7] Finando,
Donna. "What Is the Difference Between an Acupoint and a Trigger Point?
Part 1." MASSAGE Magazine. Massage Magazine, 08 Dec. 2008. Web. 01 Mar.
2017.
[8]
Usual care for low-back pain may include medication, other forms of physical
therapy, back exercises, and education.
[9]
Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types
of massage and usual care on chronic low-back pain: a randomized,
controlled trial. (http://www.annals.org/content/155/1/1.abstract?aimhp) Annals
of Internal Medicine. 2011;
155(1):1–9.
[10]
Sherman KJ, Cherkin DC, Hawkes RJ, et al. Randomized trial of therapeutic
massage for chronic neck pain. Clinical Journal of Pain. 2009; 25(3):233–238.
[11] Sherman
KJ, Cook AJ, Wellman RD, et al. Five-week outcomes from a dosing trial of
therapeutic massage for chronic neck pain.
(http://www.ncbi.nlm.nih.gov/pubmed/24615306) Annals of Family Medicine.
2014;12(2):112–120.
[12]
Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the
knee: a randomized dose finding trial. PLoS One. 2012; 7(2):e30248.
[13] Doraisamy,
Magesh Anand, Charles Prem Kumar & Anshul, and Chandran Gnanamuthu.
"Chronic Tension Type Headache and the Impact of Myofascial Trigger Point
Release in the Short Term Relief of Headache." GJHS Global Journal of
Health Science 2.2 (2010): 239-44. Web.
[14] Fernández-De-Las-Peñas,
César, and Carol A. Courtney. "Clinical Reasoning for Manual Therapy
Management of Tension Type and Cervicogenic Headache." Journal of Manual
& Manipulative Therapy 22.1 (2013): 45-51. Web.
[15] Quinn,
Christopher, Clint Chandler, and Albert Moraska. "Massage Therapy and
Frequency of Chronic Tension Headaches." American Journal of Public Health
92.10 (2002): 1657-661. Print.
[16] Ferna´ndez-de-las-Pen˜
as, Cesar, Maria L. Cuadrado, and Juan A. Pareja. "Myofascial Trigger
Points, Neck Mobility, and Forward Head Posture in Episodic Tension-Type
Headache." Headache 47 (2007): 662-72. Print.
[17] Miernik,
Marta, Mieszko Więckiewicz, Anna Paradowska, and Włodzimierz Więckiewicz.
"Massage Therapy in Myofascial TMD Pain Management." Advances in
Clinical and Experimental Medicine 21.5 (2012): 681-85. Print.
[18] Bron,
Carel, Arthur De Gast, Jan Dommerholt, Boudewijn Stegenga, Michel Wensing, and
Rob Oostendorp. "Treatment of Myofascial Trigger Points in Patients with
Chronic Shoulder Pain: A Randomized, Controlled Trial." BMC Medicine.
BioMed Central Ltd., 24 Jan. 2011. Web. 30 Jan. 2017.
[19] Goats
GC: Massage – the scientific basis of an ancient art: part 2. Physiological and
therapeutic effects. Br J Sp Med 1994, 28(3), 153–156.
[20] Smith
AR Jr.: Manual Therapy: The Historical, Current, and Future Role in the
Treatment of Pain. Sci World J 2007, 7, 109–120.
Your
spinal column, which consists of 24 bones known as vertebrae and the interlaying
discs, protect your most delicate and important system, your central nervous
system, and impingements within the joints of your spinal column can contribute
to a number of health problems and ailments.
The
spinal cord is the first relay site in the transmission of information to the
brain regarding a peripheral stimulus that causes pain. Sensory signals are
transmitted from the periphery by primary nerve fibers into the dorsal horn of
the spinal cord where wide dynamic range neurons are housed. Wide dynamic range
neurons are responsive to thermal, chemical, and mechanical sensory input as
well as a broad range of intensity of stimulation from the peripheral nerves. They
steadily increase their firing rate as the stimulus intensity rises into the very
unpleasant range. Therefore adverse stimulation of wide dynamic range neurons can
lead to altered body image[1]such
as:
Feeling
like your back or neck is “swollen”
Feeling
of “stiffness” despite normal range of motion
Alteration
of the body’s natural ability to maintain good posture in relation to the
surrounding environment at rest and during motion
An
effective solution to maintaining optimal wellness is chiropractic care. Chiropractic
is like brushing your teeth, it's something you need, just like regular dental
hygiene, to maintain the life of your spine, because regular activities, poor
posture, chronic sitting, and improper ergonomics can contribute to your spine
functioning less than optimally.
Research
published in a June 2004[3]and
subsequent May 2007[4]edition
of the Journal of Manipulative and
Physiological Therapeutics examined the integration of allopathic[5], osteopathic,
chiropractic and various forms of alternative and complementary medicine versus
conventional strategies alone at a health maintenance organization (HMO) in
metropolitan Chicago. The data complied was based on 70,274 member-months[6]over a
seven-year period and they found that the integrative care model resulted in:
Subsequently,
a National Health Interview Survey was conducted in 2012 which provides the
most comprehensive information on the use of complementary health approaches in
the United States. National estimates were derived via data collected from
34,525 adults aged 18 and over regarding wellness-related reasons for
consumer’s utilization of supplementation, yoga, and spinal manipulation. The
results of this survey were published on November 4, 2015 by the National Center for Complementary and
Integrative Health (NCCIH) and they found that:
Over
50% reported using spinal manipulative therapy (SMT) for wellness
While
over 65% reported using spinal manipulation for treating a specific health
condition
However,
the most common responses from those using SMT for general wellness or disease
prevention was:
It improved
overall health
Spinal
manipulation “made them feel better.”
In
fact, approximately 40% of those who reported utilizing chiropractic care
stated that they experienced reduced stress, better sleep, and/or an easier
time coping with health problems after receiving spinal manipulative therapy.
This
data substantiates the fact that the traditional medical model of healthcare is
beginning to wane. Today’s healthcare consumer is now more focused on the
effects that physical and psychological stress has on our bodies and the therapeutic interventions that address the mind-body connection are beginning to receive
some much deserved attention as well as implementation. Chiropractors clearly
have a greater role in your health and wellness than just treating sore backs.
Chiropractic care should be considered an invaluable
tool to assist you in not only feeling well, but to also help you maintain an optimal level of
wellness.
[1] Nijs
J, et al. “Nociception affects motor output: a review on sensory-motor
interaction with focus on clinical implications.” Clin J Pain.
2012;28(2):175-81
[2]
Jull, et al. “Cervical musculoskeletal impairment in frequent intermittent
headache. Part 1: Subjects with single headaches.” Cephalalgia 2007; 27:793-802
[3] Sarnat,
Richard, and James Winterstein. "Clinical and Cost Outcomes of an
Integrative Medicine IPA." Journal of Manipulative and Physiological
Therapeutics. U.S. National Library of Medicine, June 2004. Web. 08 Feb. 2017.
[4] Sarnat,
Richard, James Winterstein, and JA Cambron. "Clinical Utilization and Cost
Outcomes from an Integrative Medicine Independent Physician Association: An
Additional 3-year Update." Journal of Manipulative and Physiological
Therapeutics. U.S. National Library of Medicine, May 2007. Web. 08 Feb. 2017.
[5] This
is the principle of mainstream medical practice, as opposed to that of
homeopathy.
[6] The
number of individuals participating in an insurance plan each month. Member
month is calculated by taking the number of individuals enrolled in a plan and
multiplying that sum by the number of months in the policy.
[7] The
total number of days a patient stays in a hospital after admission to the
hospital for a sickness that requires 24-hour nursing care and medication.
