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Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
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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