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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.
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."
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
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.
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?
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
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.
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.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
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.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
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.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
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.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
January, 2008, Vol. 08, Issue 01
Leg Length Discrepancy and Low Back Pain
By Whitney Lowe, LMT
Low back pain is one of the most common reasons for people to seek care from a massage therapist. Unfortunately, despite all our advances in knowledge, most health care researchers admit that we still don't know what causes many cases of back pain. There are numerous suspected causes and biomechanical dysfunction in the lumbopelvic region is a frequent culprit. One biomechanical factor that causes low back pain is a leg length discrepancy (LLD).
Several months ago, a discussion of bodywork began on Yahoo! Groups about the role of pelvic rotation and LLD. This discussion eventually carried me into debates and conversations with a number of experts across multiple disciplines about the role of LLD and lumbopelvic pain. Thus, my perspective was significantly changed about how to assess LLD and the role it plays in various soft-tissue disorders.
There are two types of LLD, structural and functional. It is important to distinguish between the two as they are treated differently. A structural LLD also is called a true leg length discrepancy and is considered a true or structural discrepancy because the cause is an actual length difference in the lower extremity bones (femur or tibia). Also, structural LLD usually is congenital. Small discrepancies between the length of bones on each side of the body are common, but the problem occurs when the difference in length is more pronounced (usually .5 to 1 inch difference is considered within normal limits).1 Surgeries, accidents or previous fractures are other causes that produce a structural LLD.
Structural LLDs are treated with a heel lift if they are not severe; severe cases can require surgery. Before getting a heel lift, it is important to determine that there is a true structural discrepancy and not a functional one. The most accurate way to identify a structural LLD is with a lower extremity X-ray that allows a comparison of bone measurement with the other side. If X-ray evaluation is not an option, a comparison of the measurement between bony landmarks on each side with a tape measure is another option, although it is somewhat less accurate. Visual evaluation, such as that pictured in Figure 2, is commonly used to evaluate LLDs, but is the least accurate.
A functional LLD is more common than the structural-discrepancy type, however its cause can be hard to determine. Functional LLDs occur when it appears that one leg may be longer than the other, but there is no significant difference in the length of the lower extremity bones. Instead, a postural distortion has caused one lower extremity to appear longer or shorter than the other.
Figure 1 shows an example of how a functional LLD occurs from tight lumbar muscles. This is a posterior view of our client. The client has a tight left quadratus lumborum muscle that has pulled the left iliac crest in a superior direction. When you evaluate the height of each iliac crest in a standing position it appears that the left side is higher. If this client were supine, it would appear that the left leg is shorter because the pelvis and lower extremity on the left side are being pulled in a superior direction by the tight quadratus lumborum.
Some functional LLDs are harder to evaluate than others. A number of clinicians suggest that an anterior innominate rotation can produce an LLD. The innominate is one half of the pelvis and includes the ilium, ischium and pubis on one side. Each innominate can rotate independently of the other. Therefore, you can have one innominate that is anteriorly rotated and one that is more posteriorly rotated. If the client is supine, the anteriorly rotated innominate may appear to push the femur in a distal direction. When you evaluate the two legs using a method such as a visual leg length comparison (Figure 2), the leg on the side of the anteriorly rotated innominate could appear longer.
The problem with this evaluation method occurs when the person stands up. When the individual places weight on the lower extremity it affects innominate rotation. The innominate rotation can't push the femur inferiorly when the person is standing because the lower extremity is bearing weight (you would have to push the lower extremity into the ground). So what happens to the innominate rotation? Some people say it stays as an anterior rotation and others say weight bearing causes a reverse (posterior) rotation of the innominate. However, there is very little biomechanical research on this issue to clarify what actually occurs.
Bearing weight does not change a functional LLD that is caused by a tight quadratus lumborum (Figure 1). When the individual stands upright, the pelvis still will appear high on the side of the apparent short leg. This apparent LLD remains because it is caused by the innominate on that side being pulled superiorly and not because a lower extremity is being pushed down in an inferior direction.
After consulting numerous resources and conversing with experts on this issue, it is clear that there is no consensus on what happens with functional LLDs caused by innominate rotation when the individual is weight bearing. Yet there is agreement that most functional LLDs that cause back pain are created by soft-tissue dysfunction and can be corrected by manual methods such as massage. Several good recommendations are provided in Erik Dalton's article on the "Short Leg Syndrome" in the November 2007 issue of
LLD, whether structural or functional, is an important contributor to lumbopelvic pain. What is still not clear is exactly how the mechanics of the sacroiliac joint, lumbar spine and hip directly cause specific pathological problems with an LLD. If there is a simple mechanical cause of pain there should be a strong correlation between the assessment of LLD and specific symptoms of lumbopelvic pain. Unfortunately, there is a poor relationship between evaluation methods for pelvic position and specific pain complaints.2,3 Additional research is highly needed to help us understand the complex biomechanics of this region and exactly what role innominate position or leg length play in lumbopelvic pain.
Click here for more information about Whitney Lowe, LMT.
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