Spinal Stenosis

Physiology Research Assignment by Mike Thompson

OVERVIEW: Narrowing of the dimensions of the spinal canal is called spinal stenosis. The spinal canal is present inside the vertebral bones; it contains the spinal cord, nerve roots and blood vessels supplying the spinal cord and nerves.

The vertebral bones form the vertebral column (back bone). The reduction in the size of the spinal canal can compress the spinal cord, nerve roots or blood vessels that supply the spinal cord. Spinal stenosis is common in the lumbar level and rare in the thoracic region.

 

CAUSES: Spinal stenosis is often caused by spinal degeneration that occurs with aging. Degeneration is believed to begin in the intervertebral disk where biochemical changes such as cell death and loss of water content lead to progressive disk bulging and collapse. This process leads to an increased stress transfer to the posterior facet joints, which accelerates cartilaginous degeneration, hypertrophy, and osteophyte (bone spur) formation; this is associated with thickening and buckling of the ligamentum flavum.

 

The combination of the ventral disk bulging, osteophyte formation at the dorsal facet, and ligamentum flavum hypertrophy combine to circumferentially narrow the spinal canal and the space available for the neural elements. This compression of the nerve roots of the cauda equina leads to the characteristic clinical signs and symptoms of lumbar spinal stenosis.

 

Also, degenerative spondylolisthesis narrows the spinal canal and symptoms of spinal stenosis are common. Any forward slipping of one vertebra on another (spondylolisthesis) can cause spinal stenosis by narrowing the canal. If this forward slipping narrows the canal sufficiently, and impinges on the contents of the spinal column, it is spinal stenosis by definition. If there are associated symptoms of narrowing, the diagnosis is confirmed.

 

SIGNS AND SYMPTOMS: Spinal stenosis symptoms include:

• pain
• weakness
• tingling of the legs
• "radiation down the posterior part of the leg to the feet."

Additional symptoms in the legs may be fatigue, heaviness, numbness, leg cramps, and also bladder symptoms. Symptoms are most commonly bilateral and symmetrical, but they may be unilateral; leg symptoms are usually more troubling than back pain.

 

DIAGNOSIS: Some patients can have a narrowed canal with out symptoms, and do not require therapy. Stenosis can occur as either central stenosis (the narrowing of the entire canal) or foraminal stenosis (the narrowing of the foramen through which the nerve root exits the spinal canal). "The normal lumbar central canal has a mid sagittal diameter (front to back) greater than 13 mm., with an area of 1.45 square cm. Relative stenosis is said to exist when the anterior-posterior canal diameter is between 10 and 13 mm. Absolute stenosis of the lumbar canal exists anatomically when the anterior-posterior measurement is 10 mm. or less.

Plain x-rays may or may not show spinal stenosis. CT (computerized tomography) scans are much more useful for diagnosis. The preferred method of diagnosis is MRI (magnetic resonance imaging) for all areas of the spine. The detection of spinal stenosis confirms only the anatomic presence of a stenotic condition. This may or may not correlate with the diagnosis of spinal stenosis which is based on clinical findings of neural disfunction, motor weakness, bowel and bladder dysfunction, hyperreflexia and muscular atrophy.

Radical Acceptance

Want to listen to this post? Now you can on our Podcast Channel:



Ever have an insight that made you feel so inspired you wanted to dance and jump around?  This is one I had the other day, and my heart felt so incredibly peaceful as I was pondering it.  I'll share:

Insight 11-6-11 while reading “Narrative Medicine” by Lewis Mehl-Madrona - an excellent book that I thoroughly enjoyed!

Wow - the Spirit of “Disease” changes, transforms, and spiritually grows just like we do. We are yin and yang to each other, necessary partners in our spiritual evolution. When we humans truly heal from a “disease”, we become a better person – clearer, more passionate about life, more compassionate to others.

And when we heal, the “disease” also heals and transforms into something better. I don’t think it just goes away or dissolves. But if we kill it as if it’s the enemy have we temporarily thwarted its spiritual growth along with our own?

As true healing begins, we might realize “disease” as a teacher, offering us valuable life-changing lessons that we haven’t understood in any other way. And maybe this is also the beginning of unconditional love the spirit of the “disease” has never known – or longs to know – or needs to know. As we stop hating it and begin appreciating it for the many ways it is changing our lives for the better, maybe it is our love and acceptance that teaches the “disease” to be free of its bonds of hatred, negativity, and loathing, and it moves closer to becoming one with unconditional love and oneness, just like we also do. What if….. this is the way to “eradicate disease”?

Application of Massage Therapy Project

Introduction
This project is to apply our learning's of massage therapy to help someone and demonstrate the benefits that massage can have on a persons life and health.  For my client I have provided 6 massages all at a length of 1.5 to 3 hours based on their desire at the time over the course of about 10 weeks.

Interview and chief complaint
I first had a interview/discussion with my client regarding their feelings day to day, general likes/dislikes, problems and possible complaints to address.  One of the main things I discovered is the client was very demanding of theirself day to day and because of that has a very high stress level.  Many of their mood changes were based upon work performance and completing tasks.  The client is going through many changes in life at the moment.  Based on this information and our discussion we determined the chief complaint to be stress.

Treatment options
I discussed some of the different massage protocols we have gone over in class and different techniques that may work to help relieve stress.  Over the clients lifetime they have only experienced 2 professional massages so we decided to stick to the general relaxation pattern and make modifications as necessary.  The client did suggest one of their favorite parts to massage was the head, neck and face massage so we decided to extend the time on that.

Procedure
Over the 10 week time period we completed 6 massages all ranging from 1.5 hours to 3 hours.  For all the massages we decided to stick to the regular plan, here and there we made modifications when areas needed more attention.  The desire for a thorough head massage was present through all the massages.  The client requested 3 things most often and those are head massage, abdomen massage and work on the bladder meridian.  After we learned the bladder meridian pattern and I added it to one of the massages the client requested that pattern be in the future massages.  Most notably in the bladder meridian the client enjoyed the foot massage, working the bladder meridian in the foot massage almost instantly put the client to sleep each massage.

Results
Over the course of the provided massages here are the most notable changes the client and I were able to identify:

    Reduced level of stress
    Improved quality of sleep
    Increased activity level
    Improved eating habits
    Improved flexibility
    Increase level of energy
    Reduced irritation from joint in foot
    Faster recovery of pulled muscles

All in all the project was enjoyable and it was great to discover the benefits of massage and help another experience a higher state of well being.

Learning Oriental Medicine with Massage

I am a recent student of Alaska Institute of Oriental Medicine and this is a brief summary of my experience in learning massage with oriental medicine.  Just to give you an idea of our schedule for learning massage I will outline our class schedule for you.  

There are basically two halves of school, in the first half we learn anatomy and physiology in the mornings and massage in the afternoon until we have completed the basic massage table and chair patterns and completed anatomy and physiology.  The second half of school we spend our time on oriental medicine and applications to massage practice with some specific patterns to help correct biological and physiological problems.

Learning this material in this order lets us full grasp the massage techniques and then teaches us why were doing what were doing and how we can improve what we are doing for ourselves and the clients. 

When learning oriental medicine you start to see how different parts of the body are connected and can influence one another.  You also see how you mind, mood, food, environment and other things can influence your health and state of being.  

With this knowledge you can help people significantly more with basic massage just by understanding their pain better.  Someone may experience frequent pain in a specific area on their body or experience a loss of energy and not have any explanation as to why.  

With oriental medicine you understand that areas of the body are connected and can influence one another, the pain may be referred from blockage in another part of the body or the energy loss could be something so simple as breathing properly and aligning posture.

In class we also learn basic qigongs and their application to a healthier mind and body.  We can advise and teach these to others as well as use them ourselves for self maintenance which is another thing that oriental medicine has brought to our practice.  

Self maintenance is the most important part of massage practice in my opinion.  By learning proper body mechanics, qigong and tai chi we as massage therapists can maintain our own bodies so that we are able to practice massage effectively while keeping our own bodies healthy and safe from damage.

We are not by any means certified doctors in oriental medicine after learning this material but that's one of the great things about oriental medicine.  Even with a brief understanding you can still see a profound change in your understanding of healthy living and its application to massage.  Although if you are ambitious enough to further your study with oriental medicine there is plenty of room to grow and further your understanding.

A students experience with the moxibustion belly bowl

I am a recent student of the Oriental healing arts center and this is a brief entry on my experience with the moxibustion belly bowl that we were given the opportunity to try in class.  Something to keep in mind when reading this is that I am a 25 year old male at about 195lbs and I have a fairly high level of energy prior to trying the belly bowl so my experience my differ from others depending on your own body.

The experience starts with assembling a belly bowl with a stick of moxa.  The belly bowl is a rubber cylinder with a metal frame that suspends the burning moxa stick above your skin where ever you decide to place it, mine was located directly above my belly button.  In class we set up massage tables to lie upon while trying this, we started by lighting the moxa stick and laying down on a table with the belly bowl in place.  From here I took deep full breaths and relaxed into the table.  

About half way through I started feeling sensations in my lower abdomen that would travel out to the rest of my body.  The feeling was almost an electricity or something similar to a double shot mocha, like my metabolism was being revved up.  By the end I felt almost a little sick but that quickly went away after leaving the class and getting into the rest of my day.  I noticed the rest of the day that my appetite had significantly increased and I had much more energy than normal.  I participate in alot of outdoor sports and I was amazed at how much I was able to endure in one day energy wise.  This increase in energy and metabolism lasted for about 3 days as far as I could tell.

After the first experience I decided I throughly enjoyed the belly bowl and did several other sessions before the end of school.  For someone with relatively low energy i strongly recommend trying this form of moxibustion, for those that already have a high level of energy I recommend that if you try this it may be a good idea to try this for half a moxa stick at first and possibly a full stick later after you experience a little first.

Essential Oils - Tips on Good Books

People often ask me to recommend a good resource for researching and using essential oils. There are so many great books out there, but here are my top suggestions. These are also some of the main textbooks I recommend in my On-line Essential Oil Certification Course. I have no financial interest at all in any of these. Links are provided for your convenience.

For a total beginner, I like any of Valerie Ann Worwoods books, such as “The Complete Book of Essential Oils & Aromatherapy”. Her books are filled with exact recipes that let you begin to play around with making blends. Once you get the feel for it, you can change them a little to be more personal for you. I compare this to cooking – you get a great recipe out of a book and make it for dinner. Everyone likes it, but the next time you make it you add a little more of this and less of that, plus your own secret ingredient because that’s how YOU cook. But you have to start somewhere.

It’s very important to do research on the essential oils you are using. You should always know what they do, methods of use, cautions and contraindications. The main book I pull off my shelf for this is “Essential Oils for Healing and Ascension” by Kathryn Sharp. This book provides an alphabetical listing of essential oils with bulleted information on the physical, emotional, and spiritual properties of each oil, and the information applies to any brand of essential oils.

A great companion to this book is “Aromatherapy Guide for Healing and Ascension” also by Kathryn Sharp, also applies to any brand. This book gives an alphabetical list of symptoms, with a list of suggested essential oils for each one. In this way, you can look up – for example – anxiety. From the list of suggested oils, you can see which ones you already have in your stock to use, or maybe get an idea of one or more you want to buy and try out. You can go back and use the Essential Oil guide to read specific details about each oil on the list to help make your decision about which one(s) would be best to use.

Kathryn is my inspiration and original teacher in essential oils. Literally living an essential oil lifestyle, she has put many years of work, experience, and direct knowledge into her books and I can’t speak highly enough of them. Her books are self-published and well worth every cent! Click on the links above to order directly from her website, or if you’re local to Anchorage stop by Alaska Institute of Oriental Medicine. I try to keep a set in our bookstore.

For more advanced research, I like “Medical Aromatherapy” by Kurt Schnaubelt. I love his scientific background and strong attitude about health and healing. His book is a little more technical by going into the chemistry of essential oils, but this is great information you can use to back up many claims of effectiveness. He also outlines a number of important essential oils, and has a section on their application to a variety of symptoms. I have used his recommendations with great success. (UPDATE: 2012, his latest book, The Healing Intelligence of Essential Oils is a wonderful reference.)

My newest favorite is “The Essential Oil Cookbook” (now re-named as “Weigh Less, Eat Like Royalty”) by Menkit Prince. The author is an Australian woman with a background in Oriental medicine. Her recipes are incredibly delicious! What a fun and healthy way to use essential oils.  If you want to really explore the many benefits of essential oils that go beyond putting them on your skin or smelling them, you need this book! 

Hope this helps you out!

Cynthia McMullen is a Master Massage Therapist, Internationally Certified in Aromatherapy, and teaches outstanding courses in Oriental bodywork, Five Element Nutrition, and Essential Oils at Alaska Institute of Oriental Medicine, Acupuncture & Massage Therapy

Learn tons of great information from my On-Line Essential Oil Course series. You can study here at our school in Alaska from anywhere in the world!

How To Do an Energetic Reading for Oriental Bodywork

Want to listen to this post? Now you can on our Podcast Channel:



This is the type of bodywork I teach in the Oriental medicine portion of our massage program. First we turn symptoms into an energetic picture. Then we decide how to balance the energy in the form of acupoints, meridians and Qi by using Qigong, massage, acupressure, and various tonifying or sedating techniques. We modify all of this into an incredible 1-hour healing massage – specially tailored to our individual client.
It is my goal to make sure that the clients I work with – and those that my students work with - feel incredibly nurtured, cared for, and supported by this type of bodywork. My students are wonderful souls that grow and spread this beautiful art – they learn so much and never cease to inspire me!


Example 1: Client presents with a headache, wants massage which usually helps it go away.

This is an example of my thought process:
Q: Where is the headache?
A: (points to left side of head, occipital area)
My note: Gall Bladder-20 (Feng Chi) is blocked.

Q: Does the pain radiate down your back or up into the head?
A: Up into the side of my head.
My note: Gall Bladder meridian is too full on that side. Excess Liver Qi rises up and affects the left side more strongly. I need to clear the Gall Bladder Meridian and open the Liver Shu Points on the back.


Q: How often do you get headaches like this?
A: Almost once a week. It’s been this way for probably 5 years – just work related stress, you know.
My note: Chronic Liver Qi stagnation from a frustrating job. I expect the Earth meridians (Stomach and Spleen) to be deficient, probably damp. Need to tonify Earth in the lower legs – will use the combination of Spleen-6 (San Yin Jiao) and Stomach 36 (Zu San Li).


This is enough information for me to start the massage. I’ll know more when I actually put my hands on the person and can feel what is going on.


Additional notes:
Lots of stagnation (knots) in the upper traps and levator scapulae – most noticeable energy blockage at Governing Vessel-14 (Da Zhui). This means to me that there is an obstruction of Yang energy. Sometimes in a female, this can mean that at some earlier point in life a man did something traumatic (physically, emotionally, or spiritually) to her. Forgiveness in some form is necessary – possibly forgiveness of the self first, and forgiveness of the spirit-being of the offender. Sometimes in a male, this can mean that there is a frustration and unfulfillment in the Yang energy – for example, feeling as if desired bold adventure that makes you feel alive is gone forever due to present circumstances. Some kind of outlet for bold yang is necessary – a martial arts class would be great. Of course, it could also be something totally different and very unique to the individual. (It is not my place to resolve the issues of forgiveness or unfulfillment that I have noted – I only note them as a reference point. It would be my intention to release the blocked energy and allow a natural flow of events to unfold from that – giving the client complete control over the experience and their own resolution or denial of the energy.)

As I am massaging the arms I feel an energetic tingling in my Lung and Large Intestine meridian. This is telling me that I need to address the Metal energy in the client. I add a Tui Na pain path using the acupoints: Large Intestine 11, 10, 9, and 4.

In the legs, as I suspected, the Spleen meridian feels deficient and empty. I hold Spleen-6 and Stomach-36 together while emitting Qi until I can feel an energetic pulse take form.

At the end of the massage, after opening the Liver Shu points and dispersing the accumulation at Da Zhui the headache is fully released, client leaves very happy.

Example 2: Client presents with anxiety attacks, receives regular massage because it helps.

In this case I will elaborate on the 2 main circumstances I noted and what they meant to me. Note that this is highly specific and individual circumstances may vary. This case study is for example only.

First, I always place my hands on a person’s abdomen to feel where in their body their breath goes – or doesn’t go. This is extremely valuable information and can influence an amazing number of health symptoms.

When I placed my hands on the client’s abdomen, their breathing dramatically changed. It went from being full and deep – very relaxed and almost asleep – to silent – superficial – completely still. This is a very alert and protective breath – fear related – has the feel of being intensely worried on a deep level. Hmmmm………Very interesting. When I release my hands and begin massaging their legs, their breath goes back to full and deep. The client seems completely unaware of what just happened.

On their back, the Spleen Shu Acupoints were stagnated to the size of golf balls. This is a huge blockage of Earth energy – energy of the Center.

When the Center is blocked, the kidneys and heart cannot communicate. On their own, the kidneys resonate with fear. When they communicate (are energetically connected) with the heart, everything is OK – the warmth and strength of the heart keeps the fear balanced. On the other side, the heart needs a strong anchor (kidneys) or it is so yang it floats away and you see things like heart palpitations and disturbed racing thought patterns. You get doom in the kidneys mixed with an out-of-control heart = anxiety.

The blockage of Earth is cutting off the communication between the heart and the kidneys. Whatever this is needs to be addressed first – then we’ll see if the line of communication realigns on its own or if it needs to be repaired. Both are do-able.

So what is it? Specifically I don’t know yet – but it will show itself when it’s ready to be resolved. On a more generic level I know that Earth has to do with how we feel about ourselves, our home, the people we live with, the geographical area where we live, our work, our relationships (on all levels), our relationship with the Earth – and especially the nutrition that Earth provides in the form of food, and even our relationship to the universe and our sense of purpose.

Further bodywork will involve a very nurturing touch, working to gently disperse the Earth stagnation, and ensuring that the heart and kidneys are communicating again. The details of how to do this are part of the “art” of healing bodywork and will vary from therapist to therapist. We might all use the paint of Oriental medicine, but we all paint with a slightly different style, and we can all create our own beautiful painting!

Cynthia McMullen, LMT, is a Master Massage Therapist at The Oriental Healing Arts Center, and is the Oriental Bodywork course instructor for our 800 Hour Massage Therapy Program.  She has been doing this type of energetic bodywork since 1999.