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News in Brief
Life to Open Branch Campus in Italy; Northwestern Research Arm Benefits From Big Donation.
Avoiding "Just a Pop Doc" Syndrome
Yes, it's harsh. Patients don't like to admit it. They have an unspoken plan when they first visit you: to come one time, get rid of their pain and then get rid of you. They know it's unrealistic, but they'd like to pay nothing for this service.
Inspire Your Patients to Make Healthy Choices
Have you tried to get your patients to change their eating habits or their diet and couldn't get them to succeed? Were they confused and unsure of what the right thing was to eat? You are not alone!
Acupuncture Detox as Part of Drug Rehabilitation
In the U.S., more than 2,000 alcohol and drug rehabilitation programs have added ear acupuncture to their practice. The development of the protocol was determined by Lincoln Hospital as it delivered 100 acupuncture treatments daily.
Implications of Section 2706: The Non-Discrimination Provision Survey
In late April 2014, NCCAOM diplomates received an email survey with the subject line: "End discrimination against acupuncturists" polling CAM practitioners for a Request for Information from the Department of Health and Human Services, released in mid-March.
DC App – The Next Generation
According to a survey by technology firm CDW, health care professionals gain approximately 1.2 hours per day in productivity simply by using a tablet computer in practice.
Following the Thinking of the Classics
I have heard about the "best time of day" to carry out certain examinations or therapies. For example, I remember making a note years ago that early morning is the best time to take someone's pulses.
Step by Step: Long-Term Treatment of Soft-Tissue Injuries Combines Skill and Care
Treating soft-tissue injuries with long-lasting results starts the moment an individual enters the office. When it comes to pain, the only thing that matters to the patient is relief.
Chinese Medicine: The Natural Way to Children's Wellness
As a child, I did not like going to the doctor. For the most part, when I had to go I wasn't feeling good to begin with, and I was heading into a sterile environment to be awkwardly probed by a man in a white coat for a very short, impersonal period of time.
The Acupuncture Now Foundation: What Our Profession Needs
Although acupuncture is growing in popularity it continues to be underutilized due to misunderstandings about its true potential. Only a fraction of those who could be helped by acupuncture know enough to seek it out.
We Get Letters & Email
Is It Time for a Popeye Moment? The Flaw in Recommending Chiropractic as a Career.
Are You Ready for the 2016 Patient?
In October, Apple released its iOS 8 operating system for the iPhone and iPad. The new system includes Health, a new app that will interface with an ever-growing number of other apps.
Treating Chronic Depression with Acupressure
In Traditional Chinese Medicine there already exists a comprehensive theory linking the body and mind.
Capturing the Essence of Tai Chi
Over the last 12 years, I have been working on one of the few documentaries about Tai Chi. It's called The Professor: Tai Chi's Journey West and it's about Cheng Man-Ching who moved to New York in the 1960s.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
Solving the Pain Puzzle
Legendary former New York Yankees baseball player Yogi Berra once said, "You can observe a lot just by watching." He would have been a great chiropractor. We are trained to become experts with our hands: palpation, adjusting, soft-tissue release, etc.
Why Drugs and Supplements Can't Cure Disease
Chronic diseases are the outcome of disease-promoting, goal-oriented behaviors. So, the notion that diseases can be cured with drugs or supplements should be abandoned. Hypertension is the best example of this.
Make Low-Level Laser Therapy Part of Your Evidence-Based Practice
Low-level laser therapy (LLLT), also referred to as photobiomodulation, has been increasingly utilized in the clinical setting over the past decade.
The Death of the Travel Card
As long as I have been in practice, the travel card has stood as the primary style of documentation for chiropractic. It is quick, simple and direct. Unfortunately, the rules have changed.
Chronic heightened emotional states create a perfect breeding ground for illness. Through my practice I noted the increasingly obvious relationship between one's mental focus on negative thinking, emotions, resistance to experiencing feelings and disease.
Micro-Needle Dermal Roller Use in the Treatment Room
Recently micro-needle dermal rollers have been getting a lot of media attention. As a practitioner who specializes in acupuncture facial rejuvenation, I know that skin needling with a dermal roller (also known as collagen induction therapy), promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter.
Introduce Your Patients to Collagen Induction Therapy
Cutaneous (skin) aging generally occurs from either intrinsic or extrinsic processes. Intrinsic aging results from natural skin tissue damage and degeneration.
Peer Points: Promoting TCM Knowledge
When Elaine Wolf Komarow, LAc, received her first acupuncture treatment in 1989, she said it changed her life. "I felt more aware, calmer, and happier. I was so fascinated by the changes that I began to learn everything I could about the underlying philosophy of Chinese medicine," said Komarow.
Home Safety: Help Families Avoid Common Injury Hazards at Home
These days, many parents childproof their homes before a baby is even mobile. You will see an array of electrical outlet covers, bumpers on the corners of the coffee table and safety latches on the cupboards.
Treating Acute and Chronic Neck Pain With Ischemic Compression and Exercise
There are many reasons not to manipulate the neck with cavitation: the patient is too old, their neck is too tight, etc. But the most common reason is that plenty of patients are afraid of "the crack," mostly because of the bad publicity about that procedure.
Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo.
Are You Ignoring the 10,000-Hour Rule?
Having trained interns and mentored new practitioners, it has been my observation that their No. 1 clinical concern is adjusting skills. Their second clinical concern is their ability to read X-rays. Physical diagnostic skills are a distant third.
Foundation for Chiropractic Progress Announces First Group Member
The Michigan Association of Chiropractors has joined the Foundation for Chiropractic Progress as its first group member.
The Power of Mu Xiang to Treat Irritable Bowel Disease
Bloating and gas pain is something that everyone has had to deal with at one point or another; however, that's usually reserved for holiday dinners and other large gatherings.
Five Element Acupuncture Can Enhance Your Practice
For eight years I have been teaching and supervising TCM students at an acupuncture college in Colorado, in Five Element acupuncture.
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 more information about Erik Dalton, PhD.
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