resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
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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