resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
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 previous articles by Erik Dalton, PhD.
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