I had a client present with Horner’s syndrome that made me think it appropriate to check all their cranial nerves. That made me realise I didn’t have a good recall of each cranial nerve function and appropriate test. So back to the books and I thought that I would share with you what I have learnt. Firstly yes, there are still 12 paired cranial nerves and here are some ways to clinically test. I was looking for quick tests that could be performed in the clinic, and I may well have missed a couple of easier ones. Please let the group know of your best/easiest test for each CN via the blog. Thanks. I Olfactory Sense of smell, but don’t use...

Hi In preparation for the upcoming range of vestibular workshops and courses, I have been looking around and collating information that I have found useful and perhaps you will also. I am sure this list amounts to only a feather on the chook's back in regards to what is out there, so I would really appreciate you adding additional resource links at the end of this blog post. Much appreciated. Upcoming courses that are available include; Vestibular Introductory WorkshopVestibular Basic 5 day CourseVestibular Advanced 3 day Course and while some of these might seem awhile away, people are already enrolling such is the popularity. Currently the first Introductory Workshop in December, is 50% full. Vestibular Resources Videos Anatomy Eye Movement and...

Hi Faulty Needles & Clinical Relevance You maybe aware of the current discussion about needle quality and based upon some of the high resolution needle tip pictures , wondered how far we have advanced forward from stone needles, in this area of technology. The discussion has picked up after publication of research in the current edition of Acupuncture in Medicine, titled “Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles” by Xie YM, Xu S, Zhang CS, et al. (Acupunct Med Published Online First: doi:10.1136/acupmed- 2013-010472). You can see the abstract here and because it is open access you can see full paper here. In this paper, needles from 2 of the ‘most commercially available’...

Hi Do you enjoy a treasure hunt? I recently found this 'treasure map' and had quite a bit of fun looking up family and friends names, to see how much money was sitting in a bank waiting for them to claim. Finding Unpaid Monies – Little Pots of Gold Did you know there maybe stashes of cash, that for one reason or another, you don’t know about and are waiting for you to claim? There are different government organisations that hold this information. At a federal level it is organised by ASIC (Australian Securities and Investment Commission) and it seems at a state level it is organised by the relevant Treasury department (State or Territory). At a federal level, go to...

Hi Past readers of my blog 'Creating Clinical Success' will know about my past incursions into the realm of achilles tendinopathy. If you missed out here are the blog links; clinical-kit-30-9-2013-achilles-tendinopathyclinical-kit-5-11-2012-achilles-tendonopathy Researchers MARC STEVENS and CHEE-WEE TAN have just published a paper in Journal of Orthopaedic & Sports Physical Therapy titled "Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial". The research comparison taken in this paper looked at the standard protocol of 180 eccentric heel drops cf. a Do-As-Tolerated protocol for 6 weeks. The short time frame is a bit of a weakness, as 12 weeks is standard. They used the The Victorian Institute of Sport Assessment-Achilles (VISA-A) as the...

Hi Another Possible Mechanism of Action for Dry Needling Dr. Ben Wand blogged on the Body in Mind site recently about a research project, that his team has just published in British Journal Sports Medicine. Method They looked at 25 people with chronic low back pain who were enroled in a randomised cross-over experiment. They compared the effect of acupuncture (using 14 needles in commonly agreed TCM points for back pain) delivered when sensory discrimination was optimised (by asking participant to locate on a picture where their needles were placed) to acupuncture delivered when it is not optimised (asked participant to relax and ignore the needling), on movement-related back pain immediately after each intervention. Outcome They reported that the average pain...

Hi Possibly my first presentation of Quadratus Femoris apart from the other ones that I have missed …… Clinical Presentation 51 year old male commercial painter with 2/7 Hx of pain. Not sure about cause of onset but had been painting a residential home (ladders, squatting, awkward positions) , plus moving around furniture day prior. Went to bed okay, slight sore in AM that increased as day progressed. Pain developed slowly and was described as a strong ache in R lumbar, lateral buttock with radiation to lateral thigh and hadn’t gone in the past 2/7. No PNN sensations. Over 24 Hr supine was fine, sidelying either side increased pain, walking was fine, but sit to stand or sitting increased painHad tried...

Hi Webinar cf. Course With the increasing profusion of information online plus greater demands on personal time, consideration is made about whether to attend a course or in some way gain the information via an online format. I certainly seek out a lot of information for my research online, not much shopping for IR cameras, access to research articles or experts in Esperance. When it comes to clinical education there are many reasons why I prefer to attend a course in person. The main one is that I am seeking to learn and therefore integrate or change a current clinical behavior. It maybe that I have recognized a skill set I need to develop – say occupational health or neurological treatment...

Hi Happy New Year and Welcome to 2014 Interesting Lower Quadrant Research Article Li J, Zhang J-H, Yi T, Tang W-J, Wang S-W, and Dong J-C. Acupuncture treatment of chronic low back pain reverses an abnormal brain default mode network in correlation with clinical pain relief. Acupuncture in Medicine 2013. URL: http://aim.bmj.com/content/early/2013/12/02/acupmed-2013-010423.abstract Abstract Summary Background Acupuncture is gaining in popularity as a treatment for chronic low back pain (cLBP); however, its therapeutic mechanisms remain controversial, partly because of a similar improvement in sham acupuncture control groups (but both sham and verum improve significantly more than 'usual care'). Resting-state functional MRI (rsfMRI) has demonstrated aberrant default mode network (DMN) connectivity in patients with chronic pain, and also shown that acupuncture increases DMN...

Hi I recently received this email from Tenielle Henson (with thanks), which coincided with a systematic review of the related literature, that I thought would be relevant, and of interest to a wider audience. “ I enjoy getting your news & research updates and having a read through. But I wonder if you have any info on the use of dry needling in pregnant women. As far as I was aware, all was okay as long as the patient had blood pressure managed & wasn't anywhere near the foetus & in general was asymptomatic for any vascular or neural related illness. However, I have a friend who is in the very early stages of pregnancy & who has an Achilles issue...

Hi Miracle Muscles and Neuropraxia When a client presents with noticeable weakness or other ‘hard’ neurological findings; abnormal sensation (temperature, light touch, pinprick), not just altered sensation or absent reflex, often I find clinicians jump to implicate a central nerve root involvement (dermatonal) without considering peripheral nerve compression or a somatic source. I think this just reflects the strong emphasis of our undergraduate training. This case report looks at the cubital tunnel and flexor carpi ulnaris as a source of peripheral nerve compression. No mention in this report is made of the anatomical variation anconeus epitrochularis, that would cause the same situation and as no MRI was conducted we are none the wiser as to which muscle was actually involved. You...

Hi, Over the past few months I have been in communication with the WA Health Department in an attempt to clear up the situation of what regulations dry needlers and acupuncturists need to be aware of in WA. While physiotherapists and chiropractors are registered under Australian Health Practitioners Regulation Authority (AHPRA), in WA there is also a separate "Skin Penetration Code of Practice” (the Code) written in 1998 and based upon a NH&MRC 1986 document. The base NH&MRC document has since been updated several times, most recently in 2011. The Skin Penetration Code of Practice specifies who the code covers and specifically who it excludes. It reads; "APPLICATION OF THIS CODE, This Code applies to:a) All persons who perform skin penetration...

My first rant I have been using PC Tools Internet software for many years on all computers and been really happy. It turns out that recently it was 'purchased/morphed' by Symantec (the dark lord :<). Somewhere in the transition Symantec has decided to roll Nortons and PC Tools into one and cancelled my subscription with PC Tools so now it doesn't work. I contact PC Tools by live chat and they say I need to deactivate my license with Nortons before they can activate the PC Tools one again (even though I have never paid Nortons money nor subscribed to any of their programs). I phoned Nortons and after being transferred and then waiting 25 mins I hung up and start...

Infection Control Report Version 2.0 Following the recent release of the 2013 Immunisation Handbook Guidelines and the new AHPRA Chinese Medicine Board guidelines I have updated my "Infection Control in Dry Needling and Acupuncture Report" to include this latest information. Expanded to 20 pages, it contains new sections on managing needle stick injuries, necessity or not of swabbing and correct swab disposal. New members will receive the full report when first joining - see here Existing Bronze Members can download it from Member > Resources > Resources Gateway > Documents > AAP Education documents >2103 Infection Control in Dry Needling & Acupuncture Report_LR. Remember to log in first! If you have any questions regarding the content, please let me know. All...

   In researching information for my presentation Masqueraders (see All Has Not Been Quiet On The Western Shore!) at this years APA Conference in Melbourne, I noticed the exceptionally poor prognosis when diagnosed with pancreatic cancer.   Sure more people die from lung cancer, but if you are diagnosed with pancreatic cancer, your 5 year survival rate is basically less than 5% and this figure has hardly changed in the past 30 years. The poor survival rate relates back to the method of diagnosis that is poorly specific, expensive and only detects cancer late in the disease process - too late really for effective therapy.   That may all be about to change as the result of some ingenuity and heavy...

Hi All Has Not Been Quiet On The Western Shore! Apologies, no Clinical Kit as spare time in the past few weeks have been tied up with preparation for presentations at the APA conference. Kinda newbie at this stuff, and it seems to take a fair chunk of time pulling together all required information. If you are also going to be there in October, would love to catch up. Masqueraders The hidden aspects of tumors presenting as musculoskeletal presentations has been one of my most popular blogs series (30,000 total + hits) series. I was fortunate enough to be studying Manips in Perth, 1992 at Curtin, when Mr Gregory Grieve visited. He presented a talk of the same name and raised...

Hi Background Last month the American Medical Association sparked headlines when it voted to officially classifyobesity as a disease. The question of whether obesity is a disease or not to me is pointless, there is no universally agreed definition of what constitutes a disease and solutions are way more positive. However, it importantly turns up the public discourse around the subject, especially as obesity recently overtook smoking as the leading cause of preventable death in the world. Obesity is a growing problem (excuse the pun), with an estimated 10,000 deaths per annum in Australia attributed to excess weight. “Obesity and overweight are widely prevalent in the Australian population, and this prevalence is quickly increasing.1 In 2004-05, more than half of Australian...

Strong research evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, breast and colon cancers, and shortens life expectancy. You may have heard this music as it is often repeated and has become somewhat like elevator music, heard but not understood. So how about we crank up the bass a bit; “more people die from inactivity in the world compared to those dying from cigarette smoking”. What! Sitting on the couch is more deadly than sucking a cig? Yup. A series of papers published in the medical journal The Lancet, details the deadly impact on health of being inactive. In fact, the papers suggest that...

Knee osteoarthritis (OA) affects more than 250 million people around the world and is an important factor contributing to a loss of early lifestyle and later independence. In 2013, arthritis and musculoskeletal conditions are one of the national health priority areas in Australia. In association with knee OA, meniscal tears are very prevalent, with the medial compartment most commonly affected. Arthroscopic knee procedures are common in Australia with over 100,000 performed annually. These are predominately to address meniscal and arthritic problems. Katz et al 2013 (1) examined 351 symptomatic patients, 45 years of age or older with a meniscal tear and imaging evidence of mild-to-moderate knee osteoarthritis. The primary outcome measure was the physical-function scale of the Western Ontario and McMaster...

Comparing PRP, Saline and Steroid injection Reference Link Am J Sports Med. 2013 Jan 17. Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline: A Randomized, Double-Blind, Placebo-Controlled Trial. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark. BACKGROUND:Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. PURPOSE:To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline,...

I am currently enjoying the gentle sound of rain falling onto our tin roof. Awesome. For the farm it means new grown grass in 2-3 weeks and that means happy cows. Actually, the cows are calving and that is how I happen to be lying down writing this blog. About 4 years ago a cow gave me a happy handshake to my right knee. After the initial phase of pain and swelling, it settled down to a grumbling meniscal issue that flaredup whenever I enjoyed my passion - running. It took a good 6 months of grieving until my acceptance arose, phoenix like with the sun and I started to seriously consider swimming for cross training. Now I regarded swimming as...

An example of using acupuncture to treat central nerve sensitisation using a contra lateral limb approach. Acupuncture treatment of phantom limb pain and phantom limb sensation in a primary care setting Acupunct Med. 2012 Dec 6. [Epub ahead of print]http://www.ncbi.nlm.nih.gov/pubmed/23220713 AbstractA 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within...

In English, collective nouns referring to groups of animals are often colorful and unusual; for example, a school of whales, hover of trout, murder of crows, or my favorite, a parliament of owls.

A catch up on some of the new changes and opportunities available for you in 2013

Hi We have just completed an Advanced Upper Quadrant Course in Perth and an interesting piece of information surfaced, that I felt was worth sharing with the wider clinical group. It is in relation to compression of the ulna nerve in the cubital tunnel. One of the course attendees, Ray Jongs from Sydney, works exclusively in the upper limb trauma and rehab arena and pointed out that there is a muscle present as an anomaly in approximately 20% of the population, that can cause compression to the ulna nerve (in addition to the FCU). Its called anconeus epitrochlearis. I have attached a link to a good 20 page review paper that looks at a wide variety of such anomalies in the...

One challenging aspect of being a primary contact practitioner, is being aware of red flags; fractures, infections, inflammatory conditions and tumors, which may enter your clinical door unknowingly.

Following some recent questions about trigger point treatment and associated documentation, I have developed these themes for others interested in dry needling and acupuncture.

Have you ever felt constrained by your drawing skills or the proforma program available in your clinic when prescribing a home exercises program?

Have you had clients come back, demonstrating 'one of your exercises', but you had never taught it!

I just recently completed a great 6 days in Perth teaching 2 Introductory/Refresher courses and one Advanced Lower Quadrant Course.

for those interested in the upcoming AAP Education Advanced Lower Quadrant, Adelaide and Perth courses,

I have just posted up a couple of links to  videos for upper quadrant course techniques;

1. Subscapularis 

2. Upper Trapezius

I have also just added some extra dry needling resources for Bronze members under the AAP Education section.