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Yo San University Receives $1 Million Gift
Long-time Yo San University supporter Thomas S. Blount recently gave a $1 million dollar gift to the University, it's largest charitable gift to date. Mr. Blount was a retired naval officer, aerospace consultant and philanthropist.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Building Community: A New Way to Socialize Your Practice
Social Media can seem like a slippery slope when, in fact, it is fairly easy to understand. With social media platforms, you can connect with current and potential new clients, build strong customer loyalty and increase brand awareness.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Breech Baby: A Scientific Approach
You learned a classic cookbook style treatment strategy in college for treating breech baby presentation. I'm sure you've used it. The main ingredient: moxa at Urinary Bladder 67.
Create Community and Grow Your Practice
Many healthcare providers are fortunate to enjoy the freedom and independence of owning their own businesses. However, the constant demands can lead to a lonely and isolating experience unless you make an effort to get out of your office.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Cold and Flu Season: Expanding the Repertoire
As we move into the winter months, it is important for clinicians to have a solid working knowledge of effective herbal protocols for treating and managing clinical cold and flu presentations.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
When I started to think about what I wanted to do, I toured different schools to choose where to pursue my original chiropractic education.
How to Market to the Medical Profession
The world of health care is changing dramatically. When situations occur that cause expenses to increase, it is time for you to develop strategies that maintain and grow revenue.
Detoxification Demystified and the Crucifers that Help
"Let food be your medicine and medicine be your food," is a quote often attributed to Hippocrates, a philosopher of the 5th century BC.
The 2015 Nobel Prize Shines a Spotlight on TCM Research
Traditional Chinese Medicine continues to make it's presence felt on the world stage as the 2015 Nobel Prize in Physiology or Medicine was jointly awarded to William C. Campbell and Satoshi Omura for their work on combating parasites and YouYou Tu for her discoveries in combating Malaria.
Suffering Makes Us Human
It is possible that suffering, instead of being something negative, can be one of the greatest gifts to bring out one's humanity — if we allow it to be.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
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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