resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
February, 2007, Vol. 07, Issue 02
Sacroiliac Joint Syndrome
By Erik Dalton, PhD
In the early 20th century, sacroiliac joint syndrome was the most common medical diagnosis for low back pain, which resulted in that period being labeled the "Era of the SI Joint." Any pain emanating from the low back, buttock or adjacent leg usually was branded and treated as SI joint syndrome.However, this medical mindset came to a screeching halt in 1934, when Jason Mixter, MD, published an article on the intervertebral disc lesion in The New England Journal of Medicine.1 His landmark report changed the popular understanding of sciatica and helped establish surgery's prominent role in the management of sciatica at the time. Over the next few decades, discectomy surgery increased in popularity, causing many to define that period as the "Dynasty of the Disc."
SI joint syndrome continued its fall from fashion due to the lack of reliable clinical studies confirming its very existence. Although many manual therapists quietly continued treating this disorder with some success, no one was able to put forward a convincing biomechanical theory explaining how the sacrum becomes stuck "crooked" between the two innominate bones. Physicians were hesitant and reluctant to envision a joint with so little movement causing so much pain, while manual therapists countered that its limited motion is vital to proper lumbar spine functioning. So, the SI joint controversy raged until the late 1970s, when renowned manipulative osteopath Fred Mitchell Sr. introduced an innovative and practical biomechanical model that clearly demonstrated normal and aberrant SI joint movement patterns occurring in most individuals.2 Using muscles as levers to correct lumbopelvic restrictions, Mitchell's muscle energy technique spurred a renewed interest in the SI joint as a source of back pain. Figure 1 and Figure 2 demonstrate a modified muscle-energy assessment and correction routine for a painful left unilateral extended sacrum.
Since most SI joints only move about 2 to 4 millimeters during weight bearing and forward bending, they are described as a gliding-type joint. This motion is quite different from the hinge-type articulation at the knee or the ball-and-socket motion of the hip. Considered a viscoelastic joint, the SI's major movement comes from ligamentous stretching. Therefore, its primary function within the pelvic girdle is to provide shock absorption for the spine by stretching in various directions. When sacroiliac joints work in perfect harmony with the third bony articulation of the pelvis (symphysis pubis), a marvelous self-locking mechanism develops that helps us walk. Aided by power generated by the hip abductors (gluteus medius/ minimus, TFL and piriformis), the pelvic joints brace the weight-bearing side during gait. This locking system, termed force closure, allows smooth transference of body mass from one leg to the other (Fig. 3). Although no muscles directly bind down the three pelvic joints, when working synchronously with the SI ligaments they provide the pelvis − "the great adapter" − with a remarkable antigravity springing system that can absorb both ascending and descending forces (Fig. 4).
During the aging process, there is an increase in the grooves on the opposing surfaces of the sacrum and ilium, which reduces available motion of the SI joint. This is a perfect example of the body's innate wisdom attempting to sacrifice complexity of motion for stability. An interesting note is that the age with highest incidence of disabling back pain (25-45 years) is the same age at which the greatest amount of motion is available in the sacroiliac joints. It's not uncommon for an SI joint to become stiff and permanently lock as we age. This may be a good reason for massage therapists to begin incorporating specialized soft-tissue mobilization techniques on a regular basis, to maintain joint-play and prevent agonizing arthrosis and arthritis from developing. Due to the small amount of sacroiliac movement and the joint's inherent biomechanical complexity, proper assessment can be tricky.
Frequently, muscle imbalance patterns develop as tissues become strained from overuse, underuse or abuse. In the early stages of a typical SI pain episode, protective muscle spasm arises as the sacrum gets stuck side-bent and rotated between the ilia, usually from a forward-bending and twisting incident (Fig. 5). Sustained isometric contraction produces muscle toxicity and weakness causing increased SI ligament loading and overstretching. As the articulating joint surfaces become jarred loose, ligament microtearing creates an inflammatory response. Sensitive chemoreceptors bombard the spinal cord and brain with noxious stimuli, causing the brain to layer the area with protective muscle guarding. This is the beginning of a therapeutically challenging pain/spasm/pain cycle that often is hard to break. It's possible, however, to eliminate pain emanating from hypermobile joints by restoring proper pelvic alignment, frictioning the loose ligaments and addressing core strengthening exercises.
The Sacroiliac, Iliosacral and Hip Joint Connection
Although the three bones of the pelvis frequently are at the seat of a "primary" lesion, I have found that a missing key in successful correction of recurrent SI pain is motion-restricted hip joints, i.e., poor alignment of the femur in the acetabulum. For the pelvis to effectively absorb the forces imposed upon it, the hips must be aligned and functioning properly. Normally, it's not the gross motions creating dysfunction within the hip's truncated joint capsule, but restrictions of minor movements such as iliofemoral ligament adhesions (Fig. 6). Therefore, a rational treatment approach would begin with mobilization of the adhesive hip capsule, followed by step-by-step restoration of iliosacral alignment (movement of ilia on sacrum) and sacroiliac alignment (movement of sacrum between the two ilia).
Vladimir Janda, MD, reminds us that: "Any alteration in joint function caused by capsular restriction or loss of joint play affect muscles that cross the dysfunctional joint either through inhibition (weakening) or facilitation (tightening)."2,3 Following this line of thought, a fibrosed hip capsule (usually right) could reflexively spasm and shorten the neighboring iliopsoas muscle, causing reciprocal weakness in its antagonist gluteus maximus. This commonly seen muscle imbalance pattern produces a right anterior inferior rotated (AIR) ilium that refuses to stay aligned no matter how much "psoas-beating" the therapist performs (Fig. 7). Many in today's flexion-addicted society suffer from anterior hip capsule adhesions and tight psoas muscles that "glue" the femur into a flexed position, preventing adequate hip extension during gait. But we have to walk ... so what happens? As the right leg swings back into extension, the short iliopsoas and fibrosed hip capsule drag the already anteriorly rotated right ilium more forward and down, causing increased lumbosacral angle, facet joint and disc compression, greater ligament laxity, compensatory lumbar scoliosis and pain (Fig. 8).
Figures 9-11 demonstrate a nice pelvic balancing routine I've found effective for releasing adhesive hip capsules, lengthening iliopsoas and correcting iliosacral alignment. Competing athletes suffering recurring unilateral hamstring pulls always should be evaluated for hip capsule restrictions that might be causing iliopsoas facilitation and glute max inhibition. The most common cause of persistent hamstring injuries results from an altered firing order pattern, whereby a weak gluteus maximus fires late during hip extension, forcing the hamstrings to do all the work. Since motion-restricted joints can reflexively weaken associated muscles, it's a good idea to mobilize all capsular restrictions and lengthen tight postural muscles before attempting to strengthen muscle groups perceived as weak.
Once optimal hip range of motion and iliosacral alignment are restored, sacroiliac problems often spontaneously correct themselves ... but not always. If low back, buttock or leg pain persists, the therapist must be equipped with proper assessment and treatment tools to effectively deal with SI joint syndrome. Of the 10 or so ways the sacrum can become stuck crooked between the two ilia bones, usually only the flexed, extended and torsioned sacroiliac dysfunctions prove to be pain-generators. In the next "Toolbox of Touch" column, I will discuss and demonstrate six useful deep-tissue myoskeletal techniques for assessing and correcting sciatic symptoms caused by backward sacral torsions and lumbar scoliosis.
Click here for more information about Erik Dalton, PhD.
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