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Questions & Answers
+ 1. Your state of mind is an important factor in your perception of pain. A soldier who was seriously wounded in battle may feel no pain at the time. Why does he only feel pain afterwards?
His mind is focused on fighting and away from the physical pain. Even though it is the same physical wound, after battle the pain will be unbearable, because his focus is now on the pain and not on fighting. In India, practitioners of yoga are able to avert their minds from pain by concentrating on other things. As a result, they can achieve great endurance, such as lying on a bed of nails. In these instances, it’s thought that the brain is prevented from acknowledging the unpleasant significance of the pain messages it receives.
It is wrong to dismiss pain as being only in the mind; the more you focus on pain, the worse it becomes.
Depending on its location, intensity and duration, pain can provide a clue to diagnosis.
‘Phantom pain’ frequently occurs after amputation. The brain continues to register pain in the stump as if it was from the lost limb.
Pain can have a psychological effect; prolonged severe pain progressively erodes the mental ability to cope with pain. As a result, your personality changes as you focus on the pain, and perceive it as becoming increasingly worse. That is why it is wrong to dismiss pain as being only in the mind.
+ 2. What is Myofascial pain syndrome?
The main innovation of Travell’s work was the introduction of the myofascial pain syndrome concept (myofascial referring to the combination of muscle and fascia). This is described as a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Travell and followers distinguish this from fibromyalgia, which is characterized by widespread pain and tenderness and is described as a central augmentation of nociception giving rise to deep tissue tenderness that includes muscles. Studies estimate that in 75–95 percent of cases, myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimetres in diameter, found at multiple sites in a muscle, and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable, and electrically active muscle spindles in general muscle tissue.
+ 3. What do you know about Acupuncture trigger points?
Acupuncture, trigger points and musculoskeletal pain:
A scientific approach to Acupuncture for use by doctors and physiotherapists in the diagnosis and management of myofascial trigger point pain. Peter Baldry Elsevier/Churchill Livingstone:
Musculoskeletal pain can be simply and effectively treated by Acupuncture. Building on a thorough review of the scientific evidence available, he provides a detailed and practical account of the different forms of musculoskeletal pain and the specific ways in which Acupuncture can be applied effectively to trigger points to alleviate this pain. Case studies are included to aid diagnosis and choice of treatment.
+ 4. What do you know about Medical Acupuncture?
The text provides a detailed reference on Acupuncture treatment. Based on a thorough review of scientific data, this resource provides a practical introduction to, and exploration of Acupuncture in its various Western applications. Up-to-date and scientific, it draws on the latest studies, and distils the knowledge and wisdom of leading authors and medical Acupuncture practitioners.
+ 5. What do you know about Biomedical Acupuncture?
Biomedical Acupuncture for Sports and Trauma Rehabilitation: Dry Needling Biomedical Acupuncture for Pain Management
Synthesizing biomedicine and traditional Acupuncture, this clinical manual allows medical professionals to learn Acupuncture and implement it into practice. Biomedical Acupuncture for Pain Management explains the biomedical mechanism of Acupuncture, as well as the non-specific nature of Acupuncture and its neuropsycho-immunological modulation. This straightford system of Acupuncture—termed INMAS by the authors—provides a quantitative method to predict the effectiveness of treatment for each patient and an individually adjustable protocol for pain patients.
Introduction to the Integrative Neuromuscular Acupoint System (INMAS), as well as the Homeostatic Acupoint System (HAS), help western-trained Acupuncturists understand classical techniques.
A sixteen-point evaluation method provides a reliable quantitative method to accurately arrive at prognosis.
Clinically relevant, integrative treatment approach in user-friendly language.
Detailed tables, photos, and line drawings to help readers understand the anatomy, symptomatic signs, and clinical procedures.
Clear chapters, organized by regional condition, for easy readability and flow. Case studies to assist with application of concepts in clinical practice.
Unique, clinical procedures for pain management, with sections on examination and needling methods.
Two appendices for quick reference of acronyms, abbreviations, and the twenty four homeostatic acupoints.
Up-to-date information on the latest techniques, including a chapter on electro-acupuncture.
+ 6. What do you know about Biomedical Acupuncture for Sports Trauma Rehabilitation?
Written by widely respected Acupuncture expert Yun-tao Ma, PhD, LAc, Biomedical Acupuncture for Sports and Trauma Rehabilitation shows techniques that will enhance athletic performance, accelerate recovery after intensive workouts, speed trauma rehabilitation after injuries or surgeries. Evidence-based research is used to support the best and most effective techniques, with illustrations showing anatomy, injury, and clinical procedures. Unlike many other Acupuncture books, this book uses a Western approach to make it easier to understand rationales, master techniques, and integrate biomedical Acupuncture into your practice.
“Finally, a well-referenced, common sense approach to dry needling in sports medicine that discusses maintenance, overtraining and the effect of the stress response in athletes. This is a long-awaited book that will leave you feeling comfortable with a technique that is useful not only for athletes, but for all patients of your practice.”
“For any clinician involved with assisting athletes recover from injury, as well as providing services to enhance physical performance, this text will be indispensible. This book is a major accomplishment in the field of sports injury and treatment of musculoskeletal and neurological pain.”
1 Explores Acupuncture treatments for sports injuries in the acute phase, rehabilitation and prevention.
2 Includes Acupuncture for performance enhancement and injury prevention, emphasizing pre-event Acupuncture used to help increase muscle output, assist with pre-competition stress, and prevent soft tissue injury.
3 Provide evidence-based research projects to show the science behind the best and most effective techniques, based on the author’s background in neuroscience and cell Biology and his thirty five years of clinical Acupuncture experience.
4 Offers an overview of the science of biomedical Acupuncture, including the mechanisms of Acupuncture, Anatomy and Physiology of acupoints, and discussion of human healing potential.
5 Uses terminology and concepts familiar to Western-trained health professionals; making the material easier to understand and incorporate into practice.
6 Covers useful techniques, including those that increase muscle force output, joint flexibility and stability; prevent sports injuries like muscle sprain, tendonitis, bone strain, stress/fatigue fracture and bone spurs; reinforce muscle output for specific sports; normalize Physiology of dysfunctional soft tissues; predict treatment response; reduce physiological stress; use the new Vacuum Therapy for deep tissue dysfunctions; and balance the biomechanics of musculoskeletal system.
+ 7. What do you know about Dry Needle Treatment?
Dry Needling, also known as Biomedical Acupuncture, is the latest treatment available in Colette Minehane Physical Therapy Clinic.
Dry needling uses thin needles to achieve its aim. The needles make lesions in the soft tissue of the body. Both the needles and lesions that the needles induce activate the body’s built-in survival mechanisms. These mechanisms normalize homeostasis and promote self-healing within the body. This process consists of two parts, the central and the peripheral mechanism.
In relation to the central mechanism, the lesions stimulate the parts of the brain that activate the principal survival systems, i.e. the nervous, endocrine, immune and cardiovascular systems. This helps with the normalization of the physiological activities of the whole body.
In the case of peripheral mechanism, the needling and the resulting lesions trigger physiological reactions around the needling sites that involve all four survival systems in desensitizing and repairing the damaged tissues. When an area is needled, a number of survival reactions kick in including reactions of the cardiovascular and immune system. These reactions desensitize the painful nerves and repair the soft tissues that have been damaged.
Dry needling can be used to treat the following:
1 Acute and chronic pain
2 Lower Back and Neck Pain
3 Sports Injuries
4 Dysfunction caused by muscle problems
5 Sinus problems
7 Nerve problems
8 Joint Problems
9 Old or Unresolved injuries
10 Restoration of the Balance
11 Homeostasis of the Body
Dry needling is a very effective treatment in its own right, but is even more effective when combined with other treatments such as deep tissue massage, physical therapy, electrotherapy and manipulative therapy.
+ 8. What is Phonophoresis (Therapeutic Ultrasound) and where is it typically used
What is Therapeutic Ultrasound?
Therapeutic Ultrasound is a method of stimulating tissue beneath the skin’s surface using sound waves. It is a very high frequency massage that can penetrate up to 4 inches below the surface of your skin.
The sound waves are high in frequency, between 800,000Hz and 2,000,000Hz. The sound can’t be heard by humans or animals. Humans can only hear sounds up to about 20,000Hz. This high frequency sound, like medicine, affects fine molecules and cells in the body and causes them to move.
How ultrasound energy is transferred into the body is a function of many factors. The frequency of the ultrasound waves is actually opposite to how deep they will penetrate the body. A 1MHz ultrasound will penetrate about 4" below the skin whereas a 2MHz ultrasound unit will only penetrate about 2". While a low frequency means deeper penetration, using a frequency too low will mean that the waves are too wide to properly move the molecules. For therapeutic applications, 1MHz is the optimal frequency for both effect and penetration.
Where is Phonophoresis Typically Used?
Phonophoresis is used by Physical Therapists and Chiropractors in the treatment of localized physical injuries. As a cutting edge technology, phonophoresis is currently being studied for the use of medication.
Conditions Treated With Phonophoresis:
• Post-injury condition (dislocations, distortion of joints, inflammation of muscles, tendons, etc)
• Pain in rheumatic diseases
• Low-back pain of neurological origin (i.e. root pain, discopathies, sciatica)
• Ankle/Shoulder/Calf/Neck Sprains and Strains
• Post-Exercise Recovery (when the workout goes too far)
• Bursitis and similar inflammatory ailments
• Carpal Tunnel Syndrome
• Foot/Toe Sprains/Achilles Sprains and Strains
• Hip Sprains, Thigh Sprains/Strains
• Ligament Strains
• Plantar Fascitis (Heel Spurs)
• Rheumatoid Arthritis
• Shoulder Capulitis
• Supraspinatus / Infraspinatus
• Tarsal Tunnel Syndrome
• Tendonitis (acute or chronic)
• Achilles Tendonitis, Golfers Elbow
• Tension Headaches
• Upper and Lower Back Strains
• Wrist/Hand/Elbow/Shoulder Sprains and Strains
+ 9. Are non-epileptic attacks common?
Non-epileptic attack disorder (NEAD) occurs in around 2 or 3 people in every 10,000. This means that in a typical town with around 300,000 people (such as Cardiff, Wigan or Doncaster) there will be about 60 to 90 people who have NEAs.
Of all the people who come into hospital with attacks, which do not settle quickly, nearly half turn out to have NEAs.
About 1 in 6 people newly referred to specialist blackout clinics turn out to have non-epileptic attacks.
+ 10. Can I still claim benefits for NEAD?
People who have attacks, whatever the cause, may be able to claim benefits depending upon the effect the attacks have on their life.
If you have received benefits or been unable to work because you thought you had epilepsy, this should not change simply because your seizures have a different cause. NEAs are real attacks which can be disabling.
There is a good chance that with the right treatment your attacks will improve and you may be able to work again in the future. Sometimes returning to work helps people get better.
If you have not worked for a while it may be difficult suddenly to return to work. Increasing your hours gradually (perhaps with extra help from work colleagues at first) may help you to build up your confidence.
+ 11. Can I drive with NEAD?
There are no specific rules about NEAD and driving. However, if your attacks involve a sudden loss of awareness with no warning then you should not drive.
In the United Kingdom, you should inform the Drivers and Vehicle Licensing Authority (DVLA) who will make a decision about whether you will be allowed to continue to drive (or when you can start to drive again) on a case by case basis.
If your attacks stop in the future you will be able to apply to the DVLA to reclaim your driving licence.
+ 12. How common is total allergy syndrome?
Doctors do not regard total allergy syndrome as a separate disease in itself, although there are extreme forms of allergic susceptibility. The term ‘total allergy’ is a misnomer, since even the most severely affected patients can tolerate certain foods. But however the disease is classified, it is clear that only a very few people with allergic tendencies ever develop a sensitivity to more than one or two substances.
+ 13. Neuro-endocrine disruption and Fibromyalgia
Patients with Fibromyalgia may have alterations of normal neuro-endocrine function, characterized by mild hypocortisolemia, hyperreactivity of pituitary adrenocorticotropin hormone release in response to challenge, and glucocorticoid feedback resistance. Low insulin-like growth factor 1 (IGF-1) levels in some fibromyalgia patients have led to the theory that these patients may actually have a different, treatable syndrome, adult growth hormone deficiency. Other abnormalities include reduced responsivity of thyrotropin and thyroid hormones to thyroid-releasing hormone, a mild elevation of prolactin levels with disinhibition of prolactin release in response to challenge and hyposecretion of adrenal androgens.
These changes might result from chronic stress, which, after being perceived and processed by the central nervous system, activates hypothalamic corticotrophin-releasing hormone neurons. Chronic overactivity of these neurons could disrupt normal function of the pituitary-adrenal axis and cause an increased stimulation of hypothalamic somatostatin secretion, which, in turn, could inhibit the secretion of other hormones.
+ 14. Treatment of Plantar fasciitis
Treatment options for plantar fasciitis include rest, massage therapy, stretching. weight loss, night splints, motion control running shoes, physical therapy, cold therapy, heat therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases.
+ 15. There are different types of pain
For instance, skin pain is usually localized and may be of a pricking or burning quality. Internal pain is more variable, but tends to be less localized and is perceived as deeper and often duller.
’Referred pain’ originates in one organ or area but is felt in another. This is because the messages from these organs are received and analyzed by parts of the spinal cord that also deal with the areas where the pain seems to be coming from.
For example, pain coming from the heart may be felt in the chest but also in the jaw and left arm, as the pain messages spill over in their spinal analyzing centres into neighboring zones.
When an arm or a leg has been amputated, the nerves remain in the stump. Initially, the brain will register pain from the stump as if it were coming from the lost limb. This phenomenon is known as ‘phantom pain’. After a while, however, the brain usually reorganizes its perceptions so that any pain felt from the stump actually comes from there.
+ 16. Craniosacral therapy during and after pregnancy can be beneficial in the following ways:
—It eases the physical discomfort of pregnancy
—In some cases, it can help stabilize a threatened miscarriage
—It helps to prepare the mother’s body for the demands of labour
CST helps the recovery afterwards both physically and emotionally by balancing hormonal levels, dealing with areas of scarring, restoring the uterus to its natural position and reducing the pelvic strain
+ 17. The Issue of Costs for Autism therapy
Autism therapy is costly because of the individualized nature of the therapy. Even group sessions have to be kept small. Yet, the fees are already heavily subsidized by the government and voluntary welfare organizations.
Sometimes, families realize that what is being provided by such schools may not be enough if their children were to attain some measure of independence in life. Private offerings of acceptable (and government pediatrician recommended) therapies can easily amount to higher funds a year. Biomedical therapy typically falls within this range.
+ 18. What does Hyperbaric oxygen therapy involve?
Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. HBOT is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with hyperbaric oxygen therapy include serious infections, bubbles of air in your blood vessels, and wounds that won’t heal as a result of diabetes or radiation injury.
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