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Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
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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