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DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
May, 2009, Vol. 09, Issue 05
New Perspectives on ITB Friction Syndrome
By Whitney Lowe, LMT
If you've ever been running or hiking downhill and experienced a nagging pain on the side of your knee, there is a good chance you were feeling iliotibial band (ITB) friction syndrome. It is an overuse condition resulting from repetitive flexion and extension of the knee in activities such as running, and is considered the primary cause of lateral knee pain.1 Several factors contribute to the problem, including structural deviations in the hip or knee, tightness of the hip muscles, or lack of proper conditioning. However, a new anatomical study sheds a different light on the ITB and requires us to take another view of this problem. It appears the cause of pain and mechanics of ITB function, however, may be different than we have previously thought.
Traditional anatomical illustrations of the ITB (Figure 1) show the ITB as an isolated structure running down the lateral side of the thigh. Viewing the ITB as an isolated structure has led us to perceive it as being capable of moving back and forth in an anterior to posterior direction. While you can grasp the edges of the ITB and feel it move a little back and forth, there may be much less movement occurring in the band than we originally thought.
The lateral epicondyle of the femur is located just underneath the distal fibers of the iliotibial band (Figure 2). Descriptions of ITB friction syndrome in the orthopedic literature state that when the knee is in extension, the band lies anterior to the lateral epicondyle of the femur. They go on to say that at approximately 30 degrees of flexion, the ITB begins to move across the lateral epicondyle and the posterior fibers of the ITB are the first to contact the bony prominence.2 Thickening of the posterior fibers of the ITB, has been observed in some people.3 It is suggested that the apparent thickening of the posterior aspect of the ITB is somehow related to excess friction. It is not clear whether this thickening of the posterior band of fibers is a cause of the excess friction or the result of it.
The perception of the ITB as an independent structure on the lateral thigh is not actually accurate, however. There is a fascial sleeve that encases the entire thigh called the fasciae latae (Figure 3). The ITB is actually a thickened portion of the fasciae latae. Therefore, if the ITB were moving back and forth across the lateral epicondyle of the femur, the entire fasciae latae would have to be moving significantly with it as well and that does not appear to be happening.
A recent study by Fairclough, et al., published in the Journal of Anatomy, has prompted us to take a much different look at the anatomy of the iliotibial band and what happens during ITB friction syndrome.4 This new perspective has significant ramifications for soft-tissue treatment approaches. In addition to highlighting that the ITB is an integral part of the fasciae latae, Fairclough and colleagues also found that the ITB is fibrously anchored to the femur. With the ITB fibrously anchored to the femur, significant movement back and forth across the femoral condyles is unlikely.
A Closer Look
So if the ITB is fibrously anchored to the femur and does not move back and forth across the lateral edpicondyle of the femur, what is causing the pain in this "friction syndrome"? A closer look at knee mechanics reveals what may be occurring. When the knee is flexed, there is a simultaneous internal rotation of the tibia. Conversely, as the knee is extended there is an external rotation of the tibia. The iliotibial band is attached to the proximal tibia at a location called the Gerdy's tubercle. The internal rotation of the tibia during knee flexion pulls the iliotibial band taut. As the tibial rotation pulls the ITB taut, the band presses harder against the lateral epicondyle of the femur. During portions of the flexion and extension of the knee there are different levels of tension on the anterior and posterior fibers of the band. The authors suggest these differences in the tension of the anterior to posterior fibers throughout the flexion/extension cycle are what give the illusion of the band moving over the epicondyle.
There is a layer of fatty tissue just underneath the iliotibial band where it courses over the lateral epicondyle of the femur. When the ITB is under greater stretch and tension as the knee flexes, it is pressing against this richly innervated fatty tissue. According to Fairclough, et al., it is pressure against this fatty tissue, instead of friction against the epicondyle, that causes the pain of ITB friction syndrome.
This new understanding of anatomical and biomechanical factors with the ITB has important ramifications for how we use massage to address this disorder. Previously, friction treatment was recommended directly to the distal ITB to treat this condition. The assumption was that deep transverse friction was one of the best ways to work with fibrous adhesions and tearing of ITB fibers that resulted from rubbing on the epicondyle. With this new understanding of anatomical relationships in the area, our treatment approach will be modified.
According to this new theory, the primary cause of pain in the ITB friction syndrome is the ITB being pulled taut (but not rubbing back and forth) against the lateral epicondyle of the femur and the underlying fatty tissue. Putting additional pressure on this region as we might during friction treatments is therefore not the best strategy. Our approach to treatment should emphasize techniques that help decrease overall tension on the ITB. Tension on the ITB is generated primarily from the tensor fasciae latae and gluteus maximus muscles, which insert into the band. Therefore when we are treating this condition, reducing tension in these muscles and addressing other lower extremity biomechanical compensations are the primary goals for effective resolution.
Click here for more information about Whitney Lowe, LMT.
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