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Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
Reader Beware: Consider the Source
The aftermath of last year's presidential elections brought a running conversation on the role played by "fake news" that was largely presented via social media.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
March, 2008, Vol. 08, Issue 03
Treating Piriformis Syndrome
By Whitney Lowe, LMT
Sciatica is a term that describes radiating neurological pain that courses down the back side of the lower extremity. When the term is used, most people think of intervertebral disc pathology as the source of the problem. Lumbar disc pathology certainly can produce lower-extremity neurological pain, but other conditions can produce identical symptoms.
The sciatic nerve, formed by nerve roots from the lumbar and sacral plexuses, is the largest nerve in the body. It passes through a number of small spaces as it makes its way from the lumbopelvic region down the lower extremity. Along the way there are several sites at which sciatic nerve compression can occur. Nerve compression in any of these locations can produce symptoms identical to those of a herniated lumbar disc.
In the gluteal region, the piriformis muscle can compress the sciatic nerve, creating a condition known as piriformis syndrome. The sciatic nerve derives from the L4-S2 nerve roots and courses anterior to the sacrum, before passing inferior to the piriformis muscle (Figure 1). Tendinous bands at the edge of the muscle can compress the nerve. It also can be compressed between the piriformis and the sacrospinous ligament. Even a low level of pressure applied to the nerve for a long period of time can create symptoms.1
Other nerves in this region also are susceptible to compression and are variations of piriformis syndrome. The superior gluteal nerve can be squeezed between the piriformis and the greater sciatic notch (Figure 1). The superior gluteal nerve is primarily a motor nerve that supplies the gluteus medius, gluteus minimus and tensor fasciae latae. Nerve compression produces weakness in the abductors of the hip, but radiating pain down the posterior leg does not occur, as the nerve is confined to the gluteal region. If neurological symptoms are confined to the posterior thigh and do not extend below the knee, compression of the posterior femoral cutaneous nerve could be the reason. The posterior femoral cutaneous nerve lies adjacent to the sciatic nerve and also can be compressed by the piriformis muscle.2
Certain anatomical variations play a role in piriformis syndrome. The sciatic nerve is composed of two divisions: the peroneal and tibial. Usually, they are bound together along the length of the nerve, but in some cases they divide as they pass the piriformis muscle (Figure 2). Sometimes one division goes through the muscle while the other goes below it. In other cases, one division goes above the piriformis while the other goes below. In a small percentage of the population, both divisions go directly through the piriformis muscle.3 It is easy to see how some of these anatomical variations cause increased neurological symptoms.
Piriformis syndrome routinely occurs from external pressure such as sitting on a wallet. In rare cases it results from a direct blow to the buttock area.4 As a result of trauma, adhesions can develop between the piriformis muscle, the sciatic nerve and the roof of the greater sciatic notch.
Myofascial trigger points in the piriformis or other gluteal muscles can create hypertonicity and lead directly to nerve compression. Trigger points in the gluteus minimus are known to reproduce symptoms identical to sciatica and could be confused with piriformis syndrome.3 Sacroiliac joint dysfunction also can perpetuate trigger points in the piriformis muscle and increase the likelihood of nerve compression.5
The most important factor in designing a treatment strategy for any soft-tissue disorder is to understand the nature of the problem and make sure the physiological effects of the treatment approach fit appropriately. The primary problem in this condition is nerve entrapment by a soft-tissue structure. Therefore, the goal of treatment is to reduce compressive force on the affected nerve(s). The piriformis muscle is the cause of the nerve entrapment, so treatment strategies emphasize reducing piriformis tightness.
After applying superficial effleurage and other general warming techniques to reduce tension in the gluteal muscles, treatment of the piriformis can begin. Keep in mind that this region can be very tender, so approach treatment with presence and compassionate pressure. Myofascial trigger points in the piriformis muscle are treated with static compression techniques. Apply pressure to the region and hold it for 8-10 seconds until you feel some degree of tissue relaxation under your treatment hand. Static pressure can begin with a broad contact surface such as the back of the fist to gain initial muscle relaxation. After warming up and relaxing the muscles with broad applications of pressure, use a small contact surface such as the thumb, elbow or pressure tool for specific trigger-point treatment.
Use caution when applying pressure to this region because you don't want to further compress the region of nerve entrapment. The muscles may be tender, but pressure on the piriformis region should not reproduce or aggravate the neurological symptoms. If pressure on the piriformis region aggravates neurological symptoms in the gluteal region or down the lower extremity, you need to reduce pressure and/or move to a different location.
Longitudinal stripping methods along the length of the piriformis muscle also help reduce tension. Stripping techniques are performed with the fingertips, knuckle, thumb, elbow, or pressure tool. The stripping motion can be performed from the sacrum toward the trochanter or from the trochanter toward the sacrum.
In some cases, you want to avoid putting direct pressure on the region of nerve entrapment. Muscle energy technique (MET) stretching is a great option in this case. To perform an MET treatment for the piriformis, begin with the client in a prone position. Bring the lower extremity into lateral rotation to shorten the piriformis. Instruct the client to hold the leg in that position as you attempt to pull the foot in a lateral direction (medially rotating the hip). Tell the client to slowly release the contraction. As the contraction is released, pull the foot farther laterally, which stretches (Figure 3).
Piriformis compression of nerves in the gluteal region is likely a cause of lower-extremity sciatic nerve symptoms. If piriformis syndrome is accurately identified as the cause of the symptoms, massage is a valuable treatment strategy as long as it is performed correctly.
Click here for more information about Whitney Lowe, LMT.
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