resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
February, 2001, Vol. 01, Issue 02
Pelvic Pain in Pregnancy
By Kate Jordan, NCTMB
The most common reason women seek the services of massage therapists during pregnancy is for back pain. In order to treat such discomfort effectively, it is helpful to differentiate between pain originating in the lumbar spine and pain arising from dysfunction in the posterior pelvis.
Pregnancy places unique stresses on weightbearing joints in the torso.As a woman's pregnancy progresses, her uterus enlarges, moving her center of gravity forward of her feet. This causes her to rotate her rib cage posteriorly, shifting her weight to the lumbosacral joint and the sacroiliac joints in the pelvis.
Numerous studies of back pain in pregnancy have found that as many as 50% of pregnant women experience some back pain, and 10% experience severe pain. About 30% of these women had no history of previous back pain.
When women make pain drawings of their back pain, only 25% show pain in the lumbar area. More than 50% draw their pain below the crest of the ilium and lateral to the sacrum. They describe this pain as deep in their gluteal area, traveling down the back of the thigh. Even though this appears to be "sciatic" pain, only about one of every 10,000 pregnant women have actual disc disease in pregnancy, and usually those who do had disc problems before they got pregnant.
The number of women complaining of back pain in pregnancy has increased in the past 20 years perhaps because more women are working, often in ergonomically stressful jobs. In one study in Sweden, 70% of all working pregnant women took sick leave, mostly for back pain.
It's important to differentiate between lower back pain and pelvic pain. They should be approached in different ways, and the treatment for back pain may make pelvic pain worse. A woman whose back pain comes from her pelvis will locate it in her gluteal region on one or both sides; she will have a free range of motion in her back and hips; and her pain will not be constant, but related to the movements she makes.
There is a simple test that will confirm that a womens pain originates in the pelvis, rather than being referred from another area. This is called the posterior pelvic pain provocation test. With your client well-supported in a side-lying position, with her painful side facing up, position her upper leg in 90 degrees of hip flexion, with flexed knee on a pillow support. With one hand stabilizing her sacrum, compress the knee and femur into the acetabulum. If this pressure reproduces her pain, either in the symphysis pubis or the sacroiliac area, her pain is likely to be coming from one of the ligaments around those joints.
Pelvic changes in pregnancy were noticed as far back as the days of Hippocrates. The pregnancy hormones relaxin, estrogen and progesterone cause a measurable widening of the pubic symphysis anteriorly, and a shifting of the SI joint posteriorly. Widening of the pubic symphysis begins as early as the eighth week of pregnancy. Any pain felt in the pubic symphysis is a direct result of dysfunction in the sacral area.
Pelvic pain may be noticed around the 18th week of pregnancy. Women experience higher pain intensity with pelvic pain than back pain, and the higher a woman's relaxation levels, the more pain she will experience. This pain is caused by stretching of the pelvic ligaments, causing the pelvic muscles to attempt to establish stability by increasing muscle tension, leading to chronic pain in the area. Because the discomfort is primarily caused by hormonal changes, it cannot be prevented during pregnancy.
On the other hand, secondary muscle pain can be prevented. If your client receives supportive bodywork during her pregnancy, she is likely to have no further pain after her baby is born. Some studies have shown that more than 35% of women who had no treatment during pregnancy suffered persistent pelvic pain afterward.
In particular, if a woman has pelvic pain, she should not be encouraged to do back exercises, or any kind of vigorous exercise. Exercise will only increase her pain, especially the following day. She should avoid stairs, standing on one leg, extensive walking, extreme ranges of motion of her back and pelvis, standing, heavy lifting and prolonged sitting. She should also avoid bed rest, since this will weaken supportive muscles. One of the most helpful support measures for pelvic pain is the use of a pelvic belt. These should be worn throughout the pregnancy whenever your client is upright. Bodywork techniques should focus on the pelvic musculature, particularly the gluteus maximus,gluteus medius, lateral hip rotators, the hamstrings, hip adductors, the rectus femoris, and the quadratus lumbuorum. Techniques that will be particularly effective for pelvic pain include neuromuscular therapy, muscle energy techniques, and positional release techniques. Clients should also be taught side-lying positioning that supports a neutral pelvis (no rotation) for sleeping and resting.
After giving birth, posterior pelvic pain disappears in most women within three months. When a woman begins to exercise again, she should start with strengthening exercise for her pelvic muscles, before she begins any back exercise.
Click here for previous articles by Kate Jordan, NCTMB.
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