Richard Macgurn—C.SMA of the Month (May 2022)
Richard Macgurn L.Ac., C.SMA
Richard Macgurn, L.Ac., C.SMA completed the SMAC program in June 2021, and is now a practicing sports acupuncturist in San Diego County, in the city of National City. Here he shares a case study of a patient with plantar fasciitis.
“For the past 8 years I have worked at a Federally Qualified Community Health Center, which is a safety net clinic serving low-income communities. All my patients are referred to me for pain, as that is the only diagnosis covered by MediCal insurance. The vast majority of my patients are not athletic. They are retired or disabled or work difficult, low-wage jobs like caregiving or cleaning.
Pain is something I needed to get good, at so I enrolled in the SMAC Program because I had a lot of severe and complicated pain cases that I didn’t feel equipped to assess and treat in a thorough way. Also, while I appreciate the metaphorically rich language of Chinese Medicine, it always bothered me that I didn’t really know what tissues my needles were engaging in and what exactly they were doing with that tissue, in concrete terms.
My practice has been completely transformed by the SMAC program. When I walk into the treatment room, I know I can get a quick overview of postural imbalances and what they mean. Then, I can zoom into the diagnosis of specific injuries and understand the pathomechanism and how it relates to acupuncture channels. I am three years out now and I’m still figuring out how to best integrate everything from the SMAC program, but my practice is thriving.
One of the workshops that inspired me to enroll in the SMAC program was a foundational course that Matt Callison taught on pes planus because I see injuries from the “flat foot” all of the time in my clinic. Here is a case study of plantar foot pain.
Plantar Fasciitis Case Study
60 Y/0 female referred to me with a diagnosis of plantar fasciitis. Patient presents with heel pain that is on the medial side of the foot near the medial tubercle of the calcaneus. The first steps out of bed in the morning are excruciating and gets better as she warms up but never goes completely goes away. She has been suffering from this condition for 5+ months and seems to be getting worse. She even went to the urgent care 3 weeks prior to here initial office visit with me because of the severe pain she was suffering from. X-ray’s showed a large heel spur and was prescribed naproxen by the ER medical doctor.
Physical Exam:
Pulse slippery, moderate strength. Ilium roughly even. Patient moderately obese. Mild knee valgus. A positive static navicular drop test. Rearfoot valgus with decreased eversion subtalar joint ROM. Palpation to the tissues of the medial arch were tense and tender. No significant hallux valgus. No hammer toes. Soleus moderately tense and tender at both medial motor points. FHL ropy and tender. Gastrocs moderate tension. Peroneus muscles ropy and tender.
1st TX
Peroneus longus and brevis MP’s, flexor digitiminimi, lateral gastroc MP, UB 58, SP8, lateral soleus MP, SP6, Lifting the Medial Arch needle technique (Callison)
2nd TX
2 weeks later. Patient reports 50% reduction in pain for several days with pain level increasing a little after that but now 14 days later pain is still 20-30% lower. pain more focused on proximal part of foot near the medial tubercle of the calcaneus. I included treating her low back and pelvis in this treatment to help align her postural imbalances.
Discussion
Because of the insurance system, I can only see patient 2x/month which makes getting results sometimes difficult. I wont see this patient again for another week, so I called her to see how she was doing. She reports 60-70% sustained reduction in pain 1 week after the second treatment. Area of pain is smaller and pain feels more intermittent. Treating the low back and hip with postural and muscle balancing helped her.
I will see the patient again soon and I am looking forward to checking ion on her process.”
To connect with Richard Macgurn, visit his C.SMA Directory Listing.
