resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
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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