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MCA In Touch: October 2017
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In this issue:

Save the Date for the 2018 MCA Convention

Mark your calendars and plan to join us March 15-17, 2018, at the Minneapolis Marriott Northwest in Bloomington!

Featured Speaker

Dr. Scott BergmanDr. Scott Bergman is a Chiropractor, Board Certified Naturopath and a Certified Functional Medicine Practitioner in Walnut Creek, CA. Since 1993 he has been the director of Chiro Kinetics, an integrative health clinic combining Chiropractic Care, Rehabilitation, Pilates, Core Yoga Therapy, Functional Medicine and Biological Resonance. For over 25 years, Dr. Bergman has been presenting health, nutrition and fitness information internationally to a variety of business, education, social, and community groups.

Optimal Movement Outside the Adjustment

By Angela Graper, DC, CACCP and Katy Sudlow, ACSM- EP, M-HYI

As chiropractors, we often talk about proper posture, but what does that mean for us? Are we finding time to optimize our movement outside of getting adjusted? We were designed to move. Our bodies give us signals that it is time to move when we are uncomfortable. We should get in tune with our body to hear this signal rather than ignore it. As doctors, we may spend a significant amount of time sitting while we finish patient notes. You have likely heard that “sitting is the new smoking”, but we want to stress that being in any one position for a long time is not ideal. Can you sit differently throughout the day so your note-taking and relaxation time is less sedentary? Our goal is to provide you with several alternate positions as you finish your notes to improve your movement patterns. These ideas can then also translate into recommendations for your patients.

Modified Squat

Modified Squat

Since we sit so much in a ninety degree angle, our ankles are probably not ready for a full foot squat. For this, we raise up our heels to allow our body to relax in the position. We used a half foam roller here, but a rolled up yoga mat or stack of blankets may be helpful for you. You can also sit on something low with your knees/feet at this type of angle to ease into it, particularly during pregnancy. A bosu ball is a nice height for this modification.

The goal is to shift your weight to your heels so your knees can glide back and eventually come back over your ankles rather than far over the toes. Start slowly and think of ways to use a squat during the day such as picking items up, sweeping, eating a snack, or changing a diaper. If you start to tuck your pelvis by bringing your pubic bone forward and getting rid of your lumbar curve, you are too far down and should prop yourself up more. You can also adjust height to your workspace if needed by putting the keyboard on a large book or bringing the computer to an ottoman or coffee table height.

Half Squat/Kneel

Half Squat/Kneel

This is a great way to work and one of Katy’s favorites! You can use a prop by putting a pillow/blanket/bolster under your hips to put less pressure on the kneeling knee. If you have a laptop you could put it on the ground because who says you have to work at your desk? If you’re food prepping, you could move a cutting board to the ground to chop veggies.

Depending on the position of your foot under your buttocks, you could stretch out the foot arches or focus on allowing that knee to bend to the full angle. Take notice if any tension comes into your shoulders, neck, or anywhere else, and try to relax. If you cannot relax or your pelvis is tucked, bolster yourself higher. These alternate positions get easier as your joints get used to using the full extent of their ranges of motion and the muscles ease into the movement.

Psoas Stretch

Psoas Stretch

In many workout classes you will see this pose in a deeper lunge, pushing your weight forward toward the front knee. Instead, keep your hips in the middle of your legs directly underneath your torso. If you do not feel a stretch, put a little more weight into the back thigh moving forward just a bit. The ASIS of the pelvis should always stay in line with the pubic bone. The bottom of the ribcage at the midclavicular line should also be in a straight line with the ASIS and pubic bone. Ideally, you can also bring your ears back over your shoulders in all of these positions. For extra cushion, place a towel or a blanket under your knee.

Other movements to consider

Move out of a chair as if you are coming out of a squat instead of using the common method of quads and low back. Your knees will be directly over ankles rather than forward over your toes.

Pivot your entire body to get out of car instead of moving one leg out as you go to stand. The latter stresses the knee, as well as the symphysis pubis particularly during pregnancy.

When climbing stairs, take the time to push through your heel (if the size of the stair allows) instead of pushing off on your toes. You will feel your glutes engage rather than just your quadriceps and the knees will not have as much pressure.

Start thinking about how you move throughout the day and if it is sustainable. Could you do this movement over and over without suffering injury, or is your body compensating to allow you to move in this way?

Additional reading materials

Alignment in the car:

Other ways to sit:

Why Chiropractors Should Care About Tongue Ties

By Angela Graper, DC, CACCP, DC, CACCP

Do you treat infants and children in your practice? Do you see nursing moms? If you don’t currently, would you like to? If you answered YES to any of these questions, this article is for you!

By the time you read this article, it is likely that you have heard the term tongue tie or lip tie. Ankyloglossia, otherwise known as tongue tie, is an unusual shortening and thickening of the lingual frenulum; a normal structure located between the tongue and the floor of the mouth. This frenulum can restrict the tongue’s normal movements. It can also affect the way a child eats, swallows, and speaks, as well as interfere with breastfeeding. Sometimes ankyloglossia may not cause enough functional problems to warrant intervention, while other times it may require a revision or release.

For chiropractors that treat infants, this is very important to have on our radar as there seem to be a significant increase in tongue and lip tie cases in chiropractic clinics. The absolute reason as to why is unknown at this time. However, we have a few guesses: midline defects due to MTHFR mutations, GMO’s, chemical exposure in our food supply and daily lives, and more. Whatever the reason may be, it seems tongue and lip ties are becoming more common in babies.

Being able to identify a tongue and lip tie during the initial infant examination is of infinite value to the mother who may be struggling with nursing or has already given up on nursing, but still struggles with a fussy baby. Many of the common symptoms of a tongue and lip tie are the very reasons that bring an infant into the chiropractor’s office. So, it makes sense to integrate this very quick evaluation into our examination.

The graphic at the right lists some of the common symptoms of a tongue and/or lip tie. (Click the image to download a PDF of the chart.) This is an opportunity to ask the mother more questions during the infants assessment to uncover what’s really going on. Because this information is fairly cutting edge, you may be the only person who has properly diagnosed and assessed a tongue tie for this infant and you are in a position to give the mother some hope for her fussy baby and some answers as to why they are struggling.

We have to keep in mind that many other medical providers are not trained to properly evaluate tongue or lip tie and they are unfortunately uninformed of the newest information regarding identification and examination. There are actually 4 types of tongue tie, and the tie that most pediatricians look at is a type 1, the most visible one. Type 3 and 4 tongue ties are assessed mostly by function of the tongue and assessment of the tissue itself and can’t be diagnosed visually. It’s quite important to assess a tongue tie by getting your fingers into the infant’s mouth to feel the tissue, assess the tongue’s function and assess baby’s sucking pattern.

Once you suspect a tongue tie, it is imperative that you refer the mother to an appropriate practitioner for revision. There are a handful of pediatric dentists in the Twin Cities metro area who evaluate and revise tongue ties via laser, rather than just using a scissors. Laser revision has better outcomes and seems to be the best option that we currently have for revision.

Chiropractic care before and after revisions is of utmost importance. Paying close attention to the cranial bones, upper cervicals, jaw and muscles surrounding these areas will be pertinent for treatment of babies that have tongue ties and after they have had the frenulum revised. Craniosacral therapy and lactation support is also highly recommended for after care for the baby.

This topic is very new and seems to be constantly changing. Please take the time to get educated. The MCA offers a webinar on tongue tie evaluation, and there are many other local resources out there to assist you and your patients should you find yourself wanting to learn more. Educating yourself on this topic will allow you to provide hope to infants and nursing mom’s in your practice, and grow your pediatric practice to the next level.

New Medicare Cards are Coming

By Lyle Coleman, DC

Beginning in April of 2018 CMS Medicare will begin rolling out new cards for all Medicare enrollees. The new card will have a unique identifier in alpha numeric form for everyone. For security reasons Social Security numbers will not be used. This is a massive project that will take months to complete.

Follow these steps to prepare for this change:

  • Make sure your software will accommodate the new number and format.
  • Inform your front office staff to check for new cards and numbers and update records as the process proceeds.
  • During the roll out period, both numbers for each patient will be accepted on claims.
  • For questions refer to the Transition to New Medicare Numbers and Cards fact sheet.

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