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The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. 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.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
August, 2007, Vol. 07, Issue 08
Short Leg Syndrome, Part One
By Erik Dalton, PhD
Leg length discrepancy, or as it has been alternatively termed, the short leg syndrome, is by far the most important postural asymmetry. Limb length discrepancy is simply defined as a condition where one leg is shorter than the other. If a substantial difference exists, disruptive effects on gait and posture can occur.
Leg-length discrepancy can be divided into two etiological groups:
Faulty feet and ankle structure profoundly affect leg length and pelvic positioning. The most common asymmetrical foot position is the pronated foot. Sensory receptors embedded on the bottom of the foot alert the brain to the slightest weight shift. Since the brain is always trying to maintain pelvic balance, when presented with a long left leg, it attempts to adapt to the altered weight shift by dropping the left medial arch (shortening the long leg) and supinating the right arch to lengthen the short leg.1 Left unchecked, excessive foot pronation will internally rotate the left lower extremity, causing excessive strain to the lateral meniscus and medial collateral knee ligaments.
Conversely, excessive supination tends to externally rotate the leg and thigh, creating opposite knee, hip and pelvic distortions.
Most structurally oriented bodyworkers have learned hands-on routines for separating adhesive fascial bags of the 11 lower leg muscles to lift (or lower) dysfunctional foot arches. To insure proper foot functioning, tone must be stimulated in weakened arch muscles using fast paced muscle spindle techniques. As the myofascia regains lost elasticity, blood flow and vital nutrients permeate the fatigued tissues, allowing the muscles of supination (tibialis anterior, peroneus longus, tibialis posterior, etc.) to regain strength and mobility. In addition to myofascial work, one also must focus on restoring alignment and motion to the subtalar joint commonly stuck in a valgus (pronated) position (Figure 2). The subtalar or talocalcaneal joint forms the articulation where calcaneus and talus meet and allows foot inversion and eversion. To restore normal subtalar alignment, the therapist decompresses, abducts, plantar flexes and inverts the foot using myoskeletal contract-relax-
Biomechanical Relationship of Feet to Pelvis
Ilial rotation is coupled with leg length discrepancy. In Figure 4, the femoral head on the long leg side "drives" the ilia upward and backward. Conversely, the ilium on the low femoral head side drops down (anteriorly rotates). The concurrent rotation of both ilia in opposite directions produces a left-on-left sacral torsion (Figure 5). This complex ilial rotation coexisting with sacral rotation usually is described as pelvic obliquity. Weight bearing on the right leg will produce this common compensatory pelvic pattern. Ilial rotation can be palpated by placing your fingers under each ASIS and shifting weight from one leg to another. Now place your thumbs on each sacral base and shift side to side. Right leg weight-bearing should cause the right sacral base to go deep (anteriorly rotate).
For efficient locomotion, a symmetrical and well-aligned body is essential. When the three bones of the pelvis are distorted by limb length discrepancies, gravitational forces wreak havoc on weakened SI joint and accessory pelvic ligaments (sacrotuberous and iliolumbar). These structures find themselves desperately struggling to maintain structural balance. Left untreated, a diverse array of symptoms appears as the short leg destabilizes the pelvis by unleveling the sacral base. Painful lumbar compensations often travel all the way up through the atlantooccipital (A-O) joint, as the spinal column is forced to rotate and side-bend to accommodate the uneven sacral base.
In the lower limbs, short leg compensations can be summarized as follows:
Compensatory (functional) scoliosis commonly is reflected as a low shoulder on the high ilium side, as seen in Figure 7. A short "C" curve is common in the cervical spine, due to a "stuck" occipitoatlantal joint unable to tilt the head on the neck to level the eyes with the horizon. Elbow and hand positions can appear shorter on the short leg side, with the opposing arm swinging more on that side. Some authors suggest that there is a rotation of the pelvis toward the long leg side, possibly due to hyperpronation and medial leg rotation.2 These authors describe a typical gait when the short leg steps down and the long leg compensates by "vaulting."
Walking on the toes on the short side and flexing the knee of the long side seems to be a fairly consistent compensatory movement pattern. As the center of gravity unevenly shifts, the smooth sinusoidal motion of gait is disrupted. Thus, the cosmetic effect of walking also can contribute to the compensatory mechanism and eventual injury. For example, walking on the toes can lead to contracture of the Achilles and calf muscles, creating conditions such as Achilles tendinitis and plantar fascitis.
Other functional scoliotic compensations include shortening of the quadratus lumborum on the long side, and a shortening of scalene, levator scapulae, sternocleidomastoid, and upper trapezius muscles on the contralateral side. This typical adaptive muscle imbalance pattern helps maintain erect head position with eyes level. Regrettably, prolonged muscle shortening "crams" vertebral and rib articulations, compounding the problem. The spine's neuronal pool overflows as subthreshold stimuli progress to full-blown efferent nerve discharge, triggering increased muscle guarding. Thus, a vicious pain/spasm/pain cycle sinks its neurological tentacles deep into old intrinsic spinal groove muscles (rotatores, multifidus, intertransversarii and levator costalis), resulting in central nervous system overload, limbic system hyperactivity ... and dis-STRESS.
The presence of a limb length discrepancy usually is easily recognizable during gait by observing the following:
Note: During running, it has been suggested that limb length discrepancy makes no real difference, due to the fact that only one foot strikes the ground at any given time. However, Blustein and D'Amico's extensive research finds that leg length discrepancy is the third most common cause of running injuries.3
The importance of limb length discrepancy cannot be ignored and often is the key feature in lower limb and back pathologies. Thus, the use of proper visual and anatomic landmark evaluations is paramount in distinguishing between a functional and a structural limb length discrepancy. If in doubt about your ability to adequately and consistently distinguish leg length differences, have a three-dimensional radiographic postural study performed by a qualified manual medicine physician.
Proper limb measurement is essential. Unfortunately, there is no single hands-on method proven completely reliable in its own right. It is for this reason that therapists should develop a holistic approach that includes systematically eliminating aberrant lower limb myofascial strain patterns while restoring joint play to all feet and ankle bones. Although presentations do differ from client to client, most of the previously discussed patterning theories will prove accurate. During the assessment phase, the most important feature for the beginning therapist to recognize is that asymmetry exists. From there, more specific details emerge with experience.
Integral parts of treating the condition are identification, comprehension of each individual's compensatory adaptations and their relationship to resultant symptomatology. Today's touch therapist must be aware of the fundamental importance of limb inequalities, particularly the "short right leg" controversy featured in my next column.
Click here for previous articles by Erik Dalton, PhD.
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