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401(k) Plans: They are all the same... Right?
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Written by William H. Black, Jr.   
Thursday, 25 July 2013 20:55
O
ne of the biggest misconceptions in the 401k world is all plans are created equal. Nothing could be further from the truth! It is this misconception that is hurting plan sponsors and plan participants alike.
 
moneytreeAs a full-service Third Party Administration firm (TPA), we welcomed the “full disclosure” of fees promulgated by recent Labor Department regulations. Naïvely, we believed this would open the eyes of plan sponsors to the exorbitant fees charged by the typical mutual-fund sponsored plans, payroll company plans, or any of the other “bundled” plans offered by many in the financial advisory community. Sadly, the disclosures were done in such a way that few took notice.
 
What does it matter? AARP published a survey in February 2011 (http://assets.aarp.org/rgcenter/econ/401k-fees-awareness-11.pdf) that found 71% of those polled thought they did not pay fees on their 401k accounts!
 
We’ve all heard the joke that 401(k) plans are now 101(k) plans because market values have dropped (only recently having rebounded to some degree). Many feel they will have to work longer, work in retirement, save more now, or a combination thereof, to gain lost ground. No one is considering all the costs coming out of their accounts! It is still hidden!
 
According to the Labor Department, there are more than 480,000 plans covering 72 million participants with $3 trillion in Plan assets. More attention to the fees and expenses is imperative.
 
What Can Be Done?
A simple compliance review of the Plan is all that it takes. Consider a recent Plan audit and review what was discovered:
 
Fees Charged:
  • Client thought they were paying the payroll company $500 annually for administration fees.
  • Actual fees were $200 monthly!
  • Difference: $1,900 (200 x 12 months less $500 imagined cost)
Underlying fund fees:
  • Client thought the fees were about 1%
  • Actual charges: 2.5% (not unusual)
  • Difference in percentages 1.5% (2.5% actual charge – 1% estimated cost)
  • Difference in dollars: $300,000 in plan assets x 1.5% = $4,500
Total unknown costs: $4,500 in fund fees + $1,900 in administration fees or $6,400! Think of the cost difference with a plan holding more assets!

Is There Anything Else?

These three views will be an eye-opener and the decision will be clear once analyzed.


Administration costs and fund fees are the obvious problems. However some mutual fund companies, some payroll companies and many of the “bundled” plans typically have a “one size fits all” structure. In other words, there is no individuality. Contrast their designs to a custom designed plan and the differences are dramatic!
 
What are some of the differences?
  • Use of the non-elective Safe Harbor actually reduces costs in most cases
  • The discretionary portion of the contribution is unable to be Cross-Tested, Integrated or Age-Weighted in cookie cutter plans whereas custom plans easily incorporate these features.
  • “Unbundling” or separating the investment portion from the administration function allows for more choice.
The only way to get the full picture is to have a Compliance Review of the Plan. Get three views:
  1. Administration Fees charged by the Cookie Cutter plan compared to fees charged by custom provider, what’s the difference?
  2. Fund fees charged by the Cookie Cutter plan. What are charges with the current fund line-up compared to the custom design alternative?
  3. Allocation of the Employer contribution: how is it allocated in the Cookie Cutter plan, what is the allocation in the custom plan, and what is the difference?
These three views will be an eye-opener and the decision will be clear once analyzed. And don’t think everything is “OK”. Check it out! Plan sponsors and trustees now have a fiduciary requirement to do so. Labor Department audits will be tough.
 
Trustees will be grilled on
  • What funds are in the plan and why?
  • How were they chosen?
  • Using what criterion?
  • When were the investment options last checked against a benchmark?
  • In which quartile do the investment options rank?
  • When were the laggards last replaced?
  • What are the underlying fees being charged and is it reasonable?
This is where it starts!

Do the right thing and have a Plan Audit and Review prepared. On audit you can prove Due Diligence has been considered. It is the cheapest peace of mind available today!
 
William H. Black, Jr. has been in the pension administration business for 34 years. The firm Pension Services, Inc. administers both defined contribution and defined benefit plans, employs an ERISA attorney, an Enrolled Actuary, and complete clerical staff. Bill is qualified to give continuing education to CPA’s in 47 different states. He has spoken nationally and internationally on retirement plans, has been quoted in USA Today, written articles for several industry journals and has appeared on many financial radio shows discussing the topic of retirement and financial matters. He is a much sought after speaker and author.
 
Neck Pain - Manipulation, Medication and More
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Written by Mark R. Payne, DC   
Thursday, 25 July 2013 20:18
neckpain
I
talk to a lot of chiropractors across the country. My business, Matlin Manufacturing Inc., brings me into contact with doctors with a wide range of backgrounds and techniques. The number of techniques and therapeutic modalities used by chiropractors is extremely varied. Almost without exception, the vast majority of chiropractors I’ve spoken with still center much of their treatments for spinal pain around the use of spinal manipulation. Manual manipulation of the spine is most often rendered in the form of high-velocity/low-amplitude (HVLA) adjustments. So in spite of all the observed differences between chiropractors of varying backgrounds, this one commonality seems to remain for the majority of doctors. 
 
I’ve also noticed something else chiropractors have in common. As a group, chiropractors tend to be confident in value of their adjustments. By far, most chiropractors strongly “believe” in the value of the adjustment, and most of the time, that’s probably a good thing. The article covered this month supports the value of adjustments compared to using medications and home exercise. Beyond the author’s published conclusions, though, I think you might find this paper to be thought provoking in terms of where the profession and your practice may be headed in the future. 
 
The Facts:
 
  • This study examined 272 patients (ages 18-65) who suffered from neck pain for 2 to 12 weeks. 
  • Patients were randomly assigned to one of three treatment groups that received spinal manipulative therapy (SMT), medication (M), or home exercise (HE) with advice.
  • The authors sought to determine the relative effectiveness of the three different types of care for both acute and subacute neck pain in both the short and long terms.
  • The primary outcome measured in the study was pain. Assessments were made at weeks 2, 4, 8, 12, 26 and 52 by using a numerical scale from zero (no pain) to 10 (highest severity).
  • Secondary outcomes measured included self-reported disability, general satisfaction, use of medications, and general health status as reported on a health survey. 
  • Spinal adjustments (SMT) were “diversified” type manipulation delivered over a 12-week period by experienced chiropractors. 
  • The specific spinal level to be adjusted was left to the discretion of the provider as determined by “palpation of the spine and associated musculature and the participant’s response to treatment.” Treatment also included advice to “stay active or modify activity” as determined by the practitioner.
  • Medical treatment (M) provided by a licensed physician included NSAIDs, narcotics, and/or muscle relaxants as determined to be necessary by the physician.
  • Home exercise with advice (HE) was provided in two separate one-hour sessions in a university outpatient setting. The program included “simple self-mobilization exercise” of neck and shoulders.
 
Take Home
 
Chiropractic care (SMT) proved more effective than medication both in terms of pain and in most of the secondary outcomes. Home exercise with advice (HE) was a very close second and actually produced “similar short- and long-term outcomes.” In fact, the HE group actually showed the most improvement in terms of spinal motion. Patients in the medication group fared the worst and a number of patients in the M group reported using higher levels of pain medication by the end of the study. 

Home exercise with advice (HE) was a very close second and actually produced “similar short- and long-term outcomes.

 
Many chiropractors utilize both manipulation and exercise. The authors make note of the limited difference in outcomes for the HE group and took pains to point out that “the potential for cost savings over both SMT and medication interventions is noteworthy.” 
 
Obviously it's neat to have evidence supporting the chiropractic adjustment over NSAIDS, pain meds and muscle relaxers. But readers should take note. This paper also highlights the comparable outcomes and significant cost savings of active care/home care programs. Doctors who fail to provide exercise plans for acute/subacute spinal pain may well find their care plans in the cross hairs as plan administrators look continually to cut costs.
 
The study also made me consider that all too often many third parties are only paying attention to pain relief. Unfortunately, that’s also the case with many chiropractors who simply adjust until patients feel better and then “rinse and repeat” whenever another exacerbation occurs. If all we do is relieve pain, then we can hardly blame interested third parties for seeking the cheapest method available. I submit that if the profession hopes to survive and prosper, then chiropractors increasingly will be challenged to show exactly how to produce improved clinical outcomes above and beyond the resolution of pain.
 
Special thanks to our Chiropractic Sciences Contributor Roger Coleman, DC for this interesting article.
 
Reference:
Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1 Pt 1):1-10.
 
Link to Abstract:
 
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.
 
The Extra Costs of Playing the Insurance Game
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Written by Miles Bodzin, DC   
Thursday, 25 July 2013 20:07
W
hen comparing the amount of time it takes to get paid from insurance carriers versus cash-paying patients (on auto-debit plans), there are some factors you need to consider. First, if you look at the number of boxes on a CMS-1500 claim form, there are approximately 60 fields, which means there are 60 opportunities to get it right, or 60 ways to get it wrong. One of the major reasons for claim delays/denials is incomplete and inaccurate patient information. Spelling errors, the wrong birthdate, and transposed numbers are just a few of examples of why a claim can be denied. In some cases the errors may not even be your fault. In fact, the average error rate by carriers for claims processing is 20%. Therefore, if you send out 100 insurance claims every month, you can almost guarantee that 20 of them will be processed incorrectly. Regardless of who is at fault, errors will cause a delay in payment, or even worse, a denial altogether. Cash plans and monthly auto-debits are simple and straightforward with virtually zero error rate, no waiting time for payments, and guaranteed monthly revenue.
 
safe12In addition to the possible mistakes that can be made on the CMS-1500 claim form, you have to consider what potential problems can arise after you have verified a patient’s insurance coverage and benefits. Even after all the correct steps have been followed carefully in the verification process and you have received a verbal and written explanation of benefits, claims can still be denied for payment due to an error on the carrier’s part. When you are accepting an insurance assignment and mistakes happen (e.g., errors in copays or deductible amounts, etc.), if it is discovered that patients actually owe more than what they were told they owed and have already paid (as the result of misquoting benefits), chances of collecting are often slim. Moreover, it can leave patients with a negative reminder of your financial policies. It sometimes becomes a vicious cycle. It can take weeks to discover if the carrier misquoted benefits and as a result, insufficient (wrong) amounts were collected from the patient. This is one reason why the carrier continually reminds us during every step of the verification cycle that "benefit details are not a guarantee of payment!”
 

There is no waiting for payments, no follow-ups, no fighting, no appeals, and no demands for payment.

In addition, all of the administrative time spent chasing after the ever-elusive insurance dollar becomes costly to the practice. More and more chiropractic offices spend too much valuable time each day calling on claims that should have been paid accurately on the first submission. A simple way to eliminate these obstacles and opportunities for errors is to implement more cash plans into your practice.
 
Cash plans and auto-debits are straightforward, simple, and quite often the best option for both patients and your practice. There is no waiting for payments, no follow-ups, no fighting, no appeals, and no demands for payment. Your office staff will be free to spend more time educating patients on the benefits of wellness care, more time promoting and growing the practice, more time doing constructive office tasks, and less time trying to pry those jealously guarded insurance dollars away from the carrier. Most importantly, patients will know their financial obligation (without any surprises) and with the ease and convenience of auto-debits, the benefits far outweigh the risks on every level.
 
Dr. Bodzin is the Founder and CEO of Cash Practice Inc, a web-based company that provides The 4-Step Process for Freeing You From The Shackles of Insurance Dependence.  The Wellness Score, Cash Plan Calculator, Auto-Debit, and Drip-Education Email Systems give the practicing chiropractor tools for implementing the four steps to freedom. Dr. Bodzin speaks internationally on running a cash-based practice for Associations, Parker Seminars, Philosophy Groups and for many of the coaching companies. Dr. Bodzin can be reached at 1-877-343-8950, This e-mail address is being protected from spambots. You need JavaScript enabled to view it or by visiting www.CashPractice.com.
 
Meditation and Chiropractic: A Symbiotic Relationship
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Written by Douglas J. Taber, DC, DAAPM, FAASP, FAAIM   
Thursday, 25 July 2013 19:22
M
editation can be defined as a practice of concentrated focus upon a sound, object, visualization, breathing, or movement, or as attention in order to increase awareness of the present moment, reduce stress, promote relaxation, and enhance personal and spiritual growth. It is a self-directed activity that aims to keep the mind anchored in the present moment by focusing on a single object or breath pattern.
 
meditationThe practice of meditation is a self-directed process that shifts awareness to take focus away from the usual conditioning of our minds and thinking, which is often developed through our habits and usually without conscious intent. When the mind becomes quiet through meditation, a quiet stillness arises from the balance of body, mind, and spirit that, in turn, relaxes our nervous system. When we tap into our inner power by meditation, we can experience a transformation of the body, mind, and spirit.
 
Many consider meditation to be sitting alone quietly pondering, but true meditation is much more than relaxation. It is a state in which the mind is calm and at peace yet completely alert. Rather than “tuning out,” true meditation is a means of “tuning in.” This level of equanimity and centeredness is often referred to as being the “watchful witness of your thoughts.”
 
The practice of meditation dates back thousands of years in the Eastern religious practices of India, China, and Japan. Its resurgence in recent times began when Western medical researchers such as Herbert Benson, MD discovered the healing power of meditative practice. Meditation has been recommended for an array of physical ailments, including stress reduction, anxiety, insomnia, pain, depression, chronic illnesses such as heart disease, cancer, and HIV/AIDS, and overall wellness.
 
Types of Meditation
There are various types of meditation techniques throughout the world, including mindfulness, zazen, Zen meditation, transcendental meditation, kundalini, qigong, guided meditation or guided imagery techniques, heart rhythm meditation, various spiritual meditation or centering prayers, focused meditation, movement or walking meditation, and mantra meditation. The focus of this article is mindfulness meditation with breath as the anchor. It is also the subject of the “Guided Meditations” audio series (available on iTunes and at www.guided-meditationssite.com).
 
Breath Awareness in Meditation
Breathing varies across meditation types with some meditation practices prescribing passive breathing and others using the breath as the sole point of focus when meditating. With this approach, you become aware of how each breath moves in your abdomen and how it feels as it moves in and out of your nostrils or mouth. The practice of breath awareness requires an open mind without trying to change the breathing pattern.

Breath awareness then becomes an anchor for mindfulness meditation. Meditation experts suggest abdominal breathing where the nostrils inhale the breath but the focus is on the belly rising and falling as you inhale and exhale. It is considered more efficient than normal chest breathing because it achieves a greater exchange of air.
 
Beginners can use paced breathing as a concentration meditation practice. A study by Park and Park (2012) found that paced breathing results in increased internal attention, which is a marker of successful meditation.
 
Meditation Postures
Having a good posture for meditation helps you focus on the meditation and ensures that the mind and body are connected. Whether you prefer to sit on a chair or on the floor, your spine should be erect and your body relaxed. Your hands should rest on your lap, palms down. You should be comfortable in the posture you choose for meditation. Sitting erect with the back, neck, and shoulders relaxed is a good posture.
 
The most commonly recommended meditation posture is the lotus position, which is traditionally considered to be the best posture for meditation. Sitting firmly on the floor, your body is erect and head well balanced in this posture. You can meditate longer in this position, but some people experience knee and joint pain with this posture.
 
Science Behind Meditation and Its Effects on the Body
As a doctor of chiropractic, the “above-down-inside-out” viewpoint of the benefits of meditation is often easy for us to understand. As science continues to substantiate the effectiveness of chiropractic manipulation for a variety of ailments, we should also be aware that there is a growing body of evidence for the practice of meditation. The interplay of perception and focus in the area of pain management suggests that meditative practice can be beneficial for a variety of physical ailments. For example, researchers at Stanford University’s Neuroscience and Pain Lab found that as patients watched their own brains react to pain in real-time, they could learn to control their responses. There was strikingly more activity in the brain when patients focused on something distracting instead of the pain.
 
Autonomic Nervous System and Meditation
The autonomic nervous system consists of the sympathetic and parasympathetic nervous systems. It is proposed that meditation can reduce the activity of the sympathetic nervous system while increasing activity in the parasympathetic nervous system. Most meditative activity targets the autonomic nervous system, which in turn regulates organs and muscles in the body and controls the digestive system, breathing, etc. Meditation may affect both sympathetic and parasympathetic nervous systems.
 
The “fight or flight” response is the body’s innate ability to “fight” or “flee” from perceived danger or harm to survival. When under stress due to internal or external situations, the body triggers the “fight or flight” response. This response is built into the brain to guard us from danger. The hypothalamus region of the brain is stimulated during stress and in turn it triggers a nerve cell action that stimulates the release of catecholamines (hormones) into the bloodstream to prepare us to run away or fight. When this occurs, the body undergoes changes causing a significant increase in breathing rate. The pupils dilate and arms and legs are pumped with blood to flee or fight, as required. The perception of pain reduces and we become more aware. Our bodies prepare us physically and physiologically for the situation. The “fight or flight” response creates tremendous movement and exertion and the stress hormones released are metabolized. Once the threat is over, body and mind return to a state of calm.
 
Meditation helps the body release catecholamines and other stress hormones as parasympathetic activity increases in the body. In response to stress, the hypothalamus in the brain is activated and triggers the adrenal gland to produce and release the stress hormone cortisol.
 
Catecholamines are certain chemical messengers that include dopamine, norepinephrine, and epinephrine. The response also affects the heart, lungs, and blood circulation in the body. In a study (Jung YH et al. 2010), catecholamines were measured in meditation and control groups, and it was found that the levels are related to stress levels. The meditation group showed higher scores on positive effect and lower scores on stress compared with the control group.
 
Health Benefits of Meditation
For years researchers have studied the effects of meditation and reported that it calms stress, depression, and anxiety. However, what else might we be gaining from meditation? Data analysis from multiple studies has shown that the effect of meditation is not only a mental process, but surprisingly, a physiological process as well. Meditation has the potential to aid in treating heart disease, depression, and insomnia. Research also suggests that regular meditative practices can reduce pain and enhance the body’s immune system.
 

The interplay of perception and focus in the area of pain management suggests that meditative practice can be beneficial for a variety of physical ailments.

A 1995 report to the National Institutes of Health on alternative medicine concluded that “more than 30 years of research, as well as the experience of a large and growing number of individuals and health care providers, suggests that meditation and similar forms of relaxation can lead to better health, higher quality of life, and lowered health care costs...” Mind-body therapy is the most common form of complementary and alternative medicine used in the United States. Meditation, relaxation, breathing techniques, yoga, etc. are used to treat pain, stroke, headaches, fibromyalgia, epilepsy, and many other neurological diseases. Mind-body therapies focus on the interactions between the brain, mind, body, and our behavior, and how those interactions affect our health and diseases.
 
Most of these therapies are linked to relaxation and, therefore, are beneficial to patients suffering from psychological stress. Mind-body therapies like meditation are easy to utilize due to low associated risk and low cost. The self-directed nature of meditations allows patients to actively manage their treatments. Different meditation types include self-observation of mental activity and mindfulness, which means focusing on internally generated events such as breathing, emotions, and thoughts.
 
Application of Meditation to Neurologic Processes
The most common neurological conditions that mind-body therapies are applied to are pain syndromes. Patients suffering from chronic pain have been treated successfully with meditation. Meditation and other forms of mind-body therapies are used frequently among adults suffering from common neurological conditions such as headaches and general pain.
 
Headaches
Mindful meditation helps control severe headaches and discomfort, and is a cost-effective alternative to pain medications. As chiropractors know, headaches are not attributed to a single pathogenesis, and often involve various dysfunctional mechanisms such as joint dysfunction, myofascial restriction, vascular changes, neurological dysafferentation, and postural sequelae. Meditation alone or in combination with other mind-body therapies has been shown to significantly reduce symptoms of migraine, tension, and mixed-type headaches.
 
Wachholtz and Pargament (2008) studied patients suffering from migraine headaches and investigated if spiritual medicine was effective in enhancing pain tolerance to reduce migraine-related symptoms. They found that people who practiced spiritual meditation had a greater decrease in migraine headache frequency as well as anxiety. The subjects also showed a greater increase in pain tolerance.
 
Back and Neck Pain
Different chronic pain conditions are often relieved with mind-body therapies. Back and neck pain are the most common chronic pain syndromes seen in chiropractic offices, and several studies have focused on the benefits of mind-body therapies to manage spinal pain symptoms.
 
An 8-week mindfulness-based stress reduction program showed significant change in pain intensity among patients suffering from arthritis and back and neck pain (Rosenzweig et al. 2010). A 10-week mindfulness meditation program targeted to train chronic pain patients in self-regulation with pain in the lower back, neck and shoulder, and headache. At the end of 10 weeks, 65% of the patients showed reduction greater than or equal to 50% (Kabat-Zinn J. 1982).
 
Older patients with chronic lower back pain benefitted tremendously from a mindfulness meditation program such as the one featured at www.guided-meditationssite.com. Based on their diary entries, participants described improved attention skills and quality of sleep. Common themes were identified that related to pain reduction, improved attention, and overall well-being, suggesting that mindfulness meditation has potential as a nonpharmacologic agent in the treatment of chronic pain for older adults (Morone et al. 2008). Many study participants noted pain reduction and indicated the methods and processes that were used to reduce the pain, i.e., distraction from pain, pain reduction using meditation, heightened awareness of pain that led them to make behavioral changes, and to develop better coping mechanism to pain. Some of the mechanisms the older adults used to distract themselves are simple and we can all do this to cope with pain. Some focused on other parts of the body while others focused on routine activities.
 
One of the mechanisms the older adults used was to develop a heightened awareness of body sensations that led to behavior change eventually resulting in reducing pain. They were able to recognize pain earlier than was typical by awakened realization of the body’s subtle sensations. This allowed them to intervene before the pain became severe. When the adults are able to cope better, diary entries such as this were common: “The pain is still with me; however, it just doesn’t feel as intense as it was.” Distraction from pain with music, relaxation, prayer, and exercise helped the participants with pain relief. Mindfulness meditation was shown to be effective in relieving pain when the focus is on breathing or concentration was somewhere other than the pain.
 
The equanimity that meditation affords the practitioner with freedom from pain is described by Kabat-Zinn (1982) as “an attitude of detached observation toward a sensation when it becomes prominent in the field of awareness, and to observe with similar detachment the accompanying but independent cognitive processes, which lead to evaluation and labeling of the sensation as painful, as hurt.” It is this focus on relaxation and breath work that I used when designing the audio meditation that I’ve recently made available for download. By sharing this system with your patients, you can make a positive impact on their overall health.
 
Our body naturally wishes to avoid pain and that is translated as anxiety. To be present with pain when it arises is difficult, but with mindfulness we can learn to come to peace with pain. Pain can be debilitating and anxiety resides with the pain to magnify suffering. Learning to differentiate the pain and how the body reacts to the pain is useful in that our reactions do not need to be added to the physical pain.
 
Final Thoughts
Meditation has a long history with a recent resurgence in the healthcare arena. Its philosophies (above-down-inside-out, focus on balance and homeostasis), physical practice (proper posture, diaphragmatic breathing), and growing body of scientific studies (consistent with the evidence-based care paradigm) make it an excellent adjunct to chiropractic patient care. Both disciplines share an art-philosophy-science paradigm that can produce positive changes in the body-mind.

Dr. Douglas J. Taber has been referred to as the scholar-sage of integrated chiropractic care. He is the author of multiple books and articles, and his 2011 release, The Neck Pain Solution: A Guided Healing Approach, was winner of the 2011 International Book Awards. This article is an excerpt from his upcoming book, Here, scheduled for release in late 2013. His recent audio release, Guided Meditations, is available on iTunes and Amazon. For more information, go to www.guided-meditationssite.com. He can be reached for speaking engagements and book signings at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
 
References:

Kox M et al. The influence of concentration/meditation on autonomic nervous system activity and the innate immune response: a case study. Psychosom Med. 2012 Jun;74(5):489-94.

Peressutti C et al. Does mindfulness meditation shift the cardiac autonomic nervous system to a highly orderly operational state? Int J Cardiol. 2012 Jan 26;154(2):210-2.

Peng CK et al. Exaggerated heart rate oscillations during two meditation techniques. Int J Cardiol. 1999 Jul 31;70(2):101-7.

Jung YH et al. The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines. Neurosci Lett. 2010 Jul 26;479(2):138-42.

Jung YH et al. Influence of brain-derived neurotrophic factor and catechol O-methyl transferase polymorphisms on effects of meditation on plasma catecholamines and stress. Stress. 2012 Jan;15(1):97-104.

Lang R et al. Sympathetic activity and transcendental meditation. J Neural Transm. 1979;44(1-2):117-35.

Michaels RR, Huber MJ, McCann DS. Evaluation of transcendental meditation as a method of reducing stress. Science. 1976 Jun 18;192(4245):1242-4.

Infante JR et al. Catecholamine levels in practitioners of the transcendental meditation technique. Physiology & Behavior. 2001; 72:141-6.

Wahbeh H et al. Mind-body interventions. Neurology. 2008;70:2321-28.

Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004 Jan-Feb;20(1):27-32.

Sun TF, Kuo CC, Chiu NM. Mindfulness meditation in the control of severe headache. Chang Gung Med J. 2002 Aug;25(8):538-41.

Sierpina V, Astin J, Giordano J. Mind-body therapies for headache. Am Fam Physician. 2007 Nov 15;76(10):1518-22.

Rosenzweig S et al. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010 Jan;68(1):29-36.

Wachholtz AB, Pargament KI. Migraines and meditation: does spirituality matter? J Behav Med. 2008 Aug;31(4):351-66.

Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982 Apr;4(1):33-47.

Morone NE, Lynch CS, Greco CM, Tindle HA, Weiner DK. “I felt like a new person.” The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. J Pain. 2008 Sep;9(9):841-8.

Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985 Jun;8(2):163-90.

Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982 Apr;4(1):33-47.
 
Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007 May-Jun;8(4):359-75.

Bonadonna R. Meditation’s impact on chronic illness. Holist Nurs Pract. 2003 Nov-Dec;17(6):309-19.

Balaji PA, Varne SR, Ali SS. Physiological effects of yogic practices and transcendental meditation in health and disease. N Am J Med Sci. 2012 Oct;4(10):442-8.

Park YJ, Park YB. Clinical utility of paced breathing as a concentration meditation practice. Complement Ther Med. 2012 Dec;20(6):393-9.

Kiran et al. Impact of meditation on autonomic nervous system—a research study. 2011Sept-Dec;1(1):144-8.

Takahashi T et al. Changes in EEG and autonomic nervous activity during meditation and their association with personality traits. Int J Psychophysiol. 2005 Feb;55(2):199-207.

Rosenkranz MA et al. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain, Behavior, and Immunity. 2013 Jan (27):174–84.

 
The History and Mystery of the Kinesio Taping® Method
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Written by Andrea Wolkenberg, PT, MA, CKTI   
Thursday, 25 July 2013 17:24
I
n 1999 I was introduced to the Kinesio Taping® Method (KTM) against my will. I was working in rehab in New York City at the time, and a co-worker who had signed up for a course in Massachusetts that included Kinesio Taping had dropped out. My boss asked me to take her place mostly because I had a car and could drive the other two therapists who had signed up. I went grudgingly and with no expectations, as I had never heard of Kinesio Taping. Flash forward to today: I am teaching more than 20 seminars a year and writing about Kinesio Taping for the benefit of my colleagues. You just never know where life is going to take you.
 
kinesio9Elastic therapeutic taping has taken off in the United States as an exciting addition to the manual therapist’s treatment toolbox. Since the 2008 Olympics, a slew of elastic tapes have made their way onto the market, touting their therapeutic benefits. As a Certified Kinesio Taping® Instructor (CKTI), I have learned that each brand of elastic therapeutic tape shares some of the properties of Kinesio Tape, but no other tape shares all of its properties. As the properties of each tape are unique—variations include thread count in the material, the degree of elasticity, the amount of recoil and the amount and quality of adhesive—one cannot generalize application methods across brands of elastic therapeutic tape. Each brand must be used in a way that is appropriate for the target population and with application methods designed for its particular properties. My goal here is to educate the reader specifically about the KTM and demystify its particular therapeutic effects.
 
Having graduated from physical therapy school in 1979, I remember well what a fertile time that was for the growth of manual medicine in the physical therapy profession. I am old enough to have taken a Cyriax course with James Cyriax, a Mennell course with John Mennell, a Strain and Counterstrain course with Laurence Jones, and so on. John Barnes was just coming into his own as the defender and promoter of myofascial release, originally an osteopathic manual treatment, which Barnes has, to his credit, elevated to high art and big business. Back then arguments raged between the stars of manual medicine as to whether it was the disc or the facet joint that was the primary perpetrator of spine-related pain; although, the treatment protocols from the warring camps were not at all dissimilar. Research on manual medicine proliferated from the 1980s on. This was also a time in medicine when specialization was taking over the profession. The specialist was in and the generalist was out: a fact of life that endures to this day. But while all this was going on in the United States and Europe, something truly remarkable happened in Japan in 1979. Dr. Kenzo Kase, an American-trained Japanese chiropractor, introduced a completely original treatment technique that was not orthopedic per se but that had vast orthopedic applications. He advanced a revolutionary concept and modality of treatment based on a non-reductionist concept of how the human body works. Dr. Kase was not interested in addressing parts and pieces of the human organism and healing the individual tissue. His idea was to use tape as a second skin to influence the sensory motor loop between the skin and the brain, creating vasomotor, neuromuscular and neurofascial changes in order to bring stressed tissues throughout the body back to homeostasis. In simple terms, by repositioning the skin over an injured tissue, sensory feedback is transmitted to the brain, which adapts and changes all the tissues in response. In other words, the body heals itself.
 
Since its introduction to the world market at the 1988 Seoul Olympics, the KTM has taken off as the go-to modality of choice for healthcare practitioners who want to offer their patients both symptomatic relief and resolution of the underlying dysfunction. Please note that I do not use the phrase "pain relief" but rather "symptomatic relief." The KTM addresses the dysfunctions that occur within the major physiological systems that can lead not only to pain, but also to edema, pathological movement patterns, gait abnormalities, postural insufficiency, muscle imbalance, changes in muscle tone, abnormal scar formation and adhesions and fascial tissue restrictions. As I tell students in my KTM workshops, if you gave me the choice of only one modality to use in addition to my manual treatment and therapeutic-exercise prescription, it would be Kinesio Tape. I can do more with one roll of tape than I can with any ultrasound or stim unit, hot or cold pack, cold laser (although, I really like the cold laser), and so on. All of these modalities have their uses, but none of them can address the myriad issues that Kinesio Tape can.
 
For those of you who are unfamiliar with Kinesio Tape and the KTM, the tape is adhesive, flexible, stretches longitudinally and was consciously designed to mimic the qualities of skin. It is roughly the same thickness as skin, stretches between 40% and 60% of its resting length, recoils to its original length and is porous. The tape itself is 100% cotton, and the adhesive, which is applied in a wavelike pattern similar to the human fingerprint, is acrylic and heat activated. It can be worn for three to five days and maintain its therapeutic benefit. As there is no latex in the product, the incidence of skin reaction is low.
 
The underlying theory that led Dr. Kase to invent the tape more than 30 years ago was based on his profound understanding of how the human body works. Each physiological system is dependent on every other system to function and remain healthy. Dr. Kase recognized that the skin and brain communicate constantly to regulate the body's responses to its internal and external environments. The skin and brain are connected not only by the nervous system, but also by the fascial system, which communicates information from tissue structure to tissue structure at much greater speeds than the nervous system. Therefore, Dr. Kase reasoned that by introducing specific and targeted proprioceptive and neural input through the skin, it was possible to affect physiological systems to change motor output, affect circulation, create or direct fascial movement and modulate pain. If one physiological system could be affected, the other systems would adjust in response. As a practicing chiropractor, Dr. Kase saw how he could affect physiological systems with his hands. He designed the tape to be an extension of his manual treatment so that the work he started with his patients in the clinic could continue at home.

By manipulating the amount and direction of stretch in the tape as it is laid down, its effect can be either compressive or decompressive to the skin and underlying tissues, facilitory or inhibitory to the muscles, optimizing or restricting to motion. Just as force generated by our hands can influence body tissue with such techniques as PNF, strain and counterstrain, and myofascial release, so too can force generated by tape influence tissue.
 

Because the tape is on a stretch when it is adhered to the skin, the recoil of the tape moves and lifts the skin...

Because the tape is on a stretch when it is adhered to the skin, the recoil of the tape moves and lifts the skin, creating visible convolutions. These convolutions create a positional change to which the body responds in several ways. First, there is a lymphatic effect and an immediate vascular change. Because the skin is lifted, filaments from the skin attached to the superficial lymphatic vessels pull on the vessel walls, opening the lumen to allow greater volume of fluid flow. Waste products that prolong the inflammatory response are removed more efficiently from the injured tissue, and oxygen-rich blood is introduced to the tissue more rapidly, speeding the healing process. At the same time, the lifting of the skin unloads nociceptors imbedded beneath it, offering immediate pain relief. With movement, the skin wrinkles and relaxes repeatedly, gating the pain on an ongoing basis, much like stroking the skin when one has hurt oneself.
 
The application of tape to the skin also introduces movement into the fascia, which is connected to skin as well as to every other tissue in the body. Fascia, which has a load-bearing function, is contractile and innervated like muscle. Imbedded within the interstitial tissue are Pacinian and Ruffini bodies sensitive to pressure and vibration, and type lll and type IV fibers, which act as nociceptors, thermoreceptors, chemoreceptors and mechanoreceptors. Tension and pressure activate the mechanoreceptors. Schleip has posited that manual therapy techniques affect these superficial and deep sensory structures, which in turn effect a change in the surrounding fascia and muscle. Plenty of current research supports the position that introducing targeted sensory input manually affects motor output. Kinesio Taping just substitutes the source of the sensory-input change from hands to tape, and, unlike hands, is able to sustain the sensory change for long periods of time.
 
In specifically addressing pain, Kinesio Taping has an advantage over most other modalities in that it affects more than just the nociceptors. In 2001 Ronald Melzak, Ph.D, proposed a more complex theory of pain than his original gate theory. According to the neuromatrix theory, Melzak suggests, “pain is produced by the output of a widely distributed neural network.” In other words, the pain message is influenced not by nociceptor activity alone, but by multiple pathways. Vision is one example. Seeing a wound or a needle being inserted into one’s skin can enhance the pain experience. We look away to lessen the impact of the pain message. Stress can also enhance the pain experience. Dr. John Sarno, a former orthopedic surgeon who felt that spine surgery was not addressing the cause of most back pain, has made an entire career of diagnosing back pain sufferers with “tension myositis” and treating them with stress reduction. He does very well with it and has saved many people from the surgeon’s knife despite MRI findings that might ordinarily lead to surgery. Psychological and cultural factors also play a role in interpreting the pain message. Some children are trained to be stoic when they are hurt, and some are rewarded by extra attention and treats. The latter group will be more apt to prolong the painful experience to glean the secondary benefits. Likewise, some cultures are generally more stoic and others more emotive, which might color the individual’s perception of pain. Tape addresses not only the nociceptors, but also the patient can see the tape and can psychologically associate it with the positive things happening in therapy. Since the tape can be worn for many days, the visual, psychological and physical effects are ongoing. Placebo is not the main effect of the tape, but it is an element and a good one.
 
One of the main criticisms I have heard about the tape is that there is no research to support the claims made about its efficacy. My answer to this is that there is overwhelming clinical evidence to prove that Kinesio Taping works to decrease pain and edema to increase proprioception, to assist in postural re-education and to restore normal motor function. The use of this modality has grown to hundreds of thousands of certified practitioners in 80 countries: We cannot all be charlatans or idiots. Research to prove what we see every day in the clinic is starting to be produced but, admittedly, is lacking overall. In the meantime, the findings that have already been published on the effects of manual therapy on the body can certainly be generalized to taping, which is just another way of manipulating soft tissue.

Andrea Wolkenberg, PT, MA, CKTI, has been a practicing physical therapist for more than 30 years. She graduated in 1979 from the University of Pennsylvania’s School of Allied Medical Professions with a Bachelor’s degree in physical therapy. She also holds a Master’s degree in Medical Anthropology in 1986 from the New School for Social Research in New York City. Andrea became a Certified Kinesio Taping® Instructor (CKTI) in 2001. She is currently the Director of Physical Therapy at Spine Options, a pain management center in White Plains, NY, specializing in the conservative treatment of back and neck pain. She is also the President of Spine Solvers Inc., which provides physical therapy services to individuals, injury prevention and workplace safety seminars to businesses, and Kinesio Taping® seminars to health care professionals.
 
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