resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. 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.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
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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