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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.
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.
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.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
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.
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.
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.
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.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
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.
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.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
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.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
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.
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.
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?
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
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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