resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
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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