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Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Acupuncture and the Pulse
In 1991, I attended a martial arts workshop hosted coincidentally by Sung Baek, a martial artist and the head of his lineage as a Korean trained acupuncturist. I was enamored by the details Sung could attain from the pulse, as told to me by some of his apprentices.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
What Does Success Mean to You?
Recently, I was asked to speak to young, budding businesswomen about running a successful business — and at first I thought, "Me? You want me to speak to others about success?!"
Breath: The Movement of Oxygen and Energy
I remember with surprising clarity the first time a patient started crying during an acupuncture treatment I was giving. This is now quite a long time ago, back in 1999, when I was a student.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients, in May 2014, researchers showed that drinking the equivalent of 2 to 4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
The Source-Luo Point Combination
The luo collaterals are part of the acupuncture channel system presented in the Su Wen and the Ling Shu (The Nei Jing). The function and clinical application of the luo mai are primarily presented in chapter 10 of the Ling Shu, however, they are also found in others chapters in the Su Wen and the Ling Shu.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
TMF 2015 Scholarships
The Trudy McAlister Foundation (TMF), a nonprofit organization established to support students who are on track to make contributions either to clinical practice and/or to the understanding of the role of Traditional Oriental Medicine, has announced the 2015 scholarship recipients.
Acupuncture in the U.K. Today: A Personal View
When asked to write a short piece on the current state of the U.K. acupuncture profession, my first response was to say it has all been relatively quiet.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
The Nectar of Plants: Essential Oils and Chinese Medicine
Essential oils are a very hot topic these days, especially with the likes of the Ebola virus and the resurgence of measles lurking in our awareness, but when I first became interested in Chinese medicine, essential oils weren't on the radar screen for acupuncturists.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Use Technology to Gain New Patients and Improve Efficiency
From the smartphone in your pocket to your microwave oven, advancements in technology have made almost every aspect of our lives easier.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Calculating Billable Units
I recently learned of an office that was audited based on the number of acupuncture sessions performed in one day. Is there a maximum number of sessions that can be performed in one day?
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
The Year to Make Things Happen
It is hard to believe that the Year of the Ram – 2015 is half over. Time seems to be moving especially fast. This is the year for things to happen for the acupuncture profession.
The Modern Acupuncturist
You studied ancient Chinese medicine, but I'll bet you don't practice it! Contrary to popular belief, our medicine has evolved A LOT over the years. Let's take a brief walk through history and discover the differences between ancient and modern acupuncturists.
November, 2009, Vol. 9, Issue 11
Fixing Achy Hips
By Erik Dalton, PhD
Structurally oriented therapists are keenly aware of the crucial role proper iliosacral alignment plays in preventing compensatory low back and SI joint pain. During the 10-step screening evaluation, therapists usually compare anatomical landmarks such as anterior and posterior superior iliac spines and iliac crests.A commonly observed pattern reveals an anterior/inferior right rotated ilium accompanied by a high left posterior rotated ilium. Scientists have developed fascinating theories (motor dominance, cerebral lateralization and genetic potential) to shed light on the possible origins of these frequently seen patterns.1-6 Although most manual therapy clinicians agree that the foot's architecture plays a major role in iliosacral rotation, many remain unsure of the link between foot posture, pelvic obliquity and hip/back pain (aside from lengthening or shortening of a limb).
For demo purposes, let's "mock-up" a postural foot assessment with the client standing. Using the finger pads of your right hand, palpate the medial arch of the left foot. Contact the navicular bone and with two fingers, attempt to lift the arch, checking for joint play. (Fig. 1) If the navicular and cuneiforms resist this spring test and the mid-foot appears flat, the arch is pronated. As we recall, the most common lower-extremity asymmetry is foot pronation. Weakness of tibialis anterior, peroneus longus and the plantar aponeurosis (Stirrup Spring System) results in a valgus subtalar joint (STJ) accompanied by a dropped navicular bone. (Fig. 2)
When palpating the navicular on the opposite foot, one discovers a high rigid arch that feels stuck in a supinated position. By viewing the Achilles tendon and calcaneus bone from behind, one observes the subtalar saddle joint cocked in a varus position with body weight shifting laterally and compressing the cuboid. This is the precursor for such conditions as plantar fasciitis and fibular stress fractures. Ideally, at heel strike, the foot and ankle ligaments give to the pressure allowing the arch to flatten and the tibia to internally rotate. During toe-off, the arch springs open and the tibia externally rotates. Stored potential energy is released in a powerful pulse driving kinetic energy back up through the system to help counter-rotate the torso and pelvis to propel the legs forward.
Recall that the term "kinetic chain" describes how we move our bodies. We move in either an open kinetic chain or closed kinetic chain. The difference lies in whether the moving part is loose in space or fixed against a hard, unrelenting surface such as the ground. Pronated and supinated feet are an unstable platform and soon encounter resistance further up the kinetic chain. Loss of antigravity spring leads to compensations that torsion and compact the knees, hips, low back and trunk. (Fig. 3)
Femoral Positioning & Pelvic Rotation
In my experience, the most overlooked and least appreciated area of compensation arises as the femoral heads become asymmetrically positioned in the acetabula. For example, when the pronated left foot internally rotates the thigh and the supinated right foot externally rotates the thigh, one would be walking sideways with each step. (Fig. 4) Of course, the body's sensitive proprioceptors immediately begin left-rotating the trunk with the axis of rotation primarily focused at the hips. As the femoral heads reposition in the acetabula, a great amount of stress is placed on the joint capsules, articular cartilages and supporting ligaments.
Use a plastic skeleton and pronate the left foot noticing how it internally rotates the left lower extremity, causing the femoral neck to follow. This closed-chain movement crams the femoral head posteriorly against the back of the acetabulum. (Fig. 5) Conversely, supination of the right foot externally (right) rotates the femoral neck allowing the head to migrate into the anterior part of the acetabulum. With the right femoral head pushing anteriorly and the left pushing posteriorly, the bony pelvis is forced to left rotate. In this scenario, the high (left) femoral head becomes the axis of rotation as it drives the anterior portion of the pelvis upward and backward, causing the pelvis to rotate to that side. Thus, the right ilium reacts by dropping on the low femoral head side, resulting in an unleveling of the sacral base and a buckling of the lumbar segments.
During a screening evaluation, therapists often stop their assessment and begin treating the right anterior/inferior rotated ilium via hip flexor work followed by QL-lengthening techniques designed to drop the elevated left ilium. The "fix it as you find it" approach defies sound structural integrative methodology and is doomed if the torsioned pelvis has roots in foot dysfunction. Notice in Figure 6 how combined pronation and supination not only torsion the pelvic bowl, but initiate a functional lumbar scoliosis that spreads its tentacles through the thoracic and cervical spines.
Experiment by doing the following: place fingers under each ASIS, pronate your left foot, supinate the right, and feel the right ASIS drop anteriorly/inferiorly as body weight side-shifts over the left posterior/superior rotated innominate. In the absence of hip or lumbar pathology, you should feel the pelvic bowl left rotate.
This mechanism of anteroposterior femoral head positioning also helps explain other clinical findings. For example, we often have clients presenting with bilateral foot pronation (pes planus) complain of back pain. Bilateral pronation increases lumbar lordosis and lumbosacral angle, causing excessive compressive force through the L4-5 and L5-S1 facets and intervertebral discs. With these individuals, both femoral heads are positioned posteriorly allowing the pelvic contents to "dump" forward and sway the back. Conversely, bilateral supinated feet position the femoral heads anteriorly in the acetabula resulting in decreased lumbar lordosis, flat back, flat butt and loss of kinetic energy into the ground during gait. Although various aberrant combinations of femoral positioning exist, some are considerably more detrimental than others.
Femoral Positioning & Hip Impingement
The "godfather" of femoral acetabular impingement (FAI), Reinhold Ganz, MD, has stated, "Surgical management of hip impingement syndromes is one of the most exciting developments in the entire field of hip pathology and hip disease in the last decade. The key to recognition of FAI is that even minor abnormalities in positioning of the proximal end of the femur can lead to difficult motion and possibly to impingement within the well-constrained hip joint."8 During the physical examination, Ganz recommended checking the hip's internal rotation in flexion using the anterior impingement test. If limited or highly painful when range of motion is executed, this could indicate femoral acetabular hip impingement.
Orthopedists theorize FAI could serve as a major cause of damaged hip joints in adults and the primary reason behind the escalation of hip replacements. Treating FAI impingement should involve techniques for balancing femoral head/neck positioning relative to the acetabulum. Since FAI arises from bony or mechanical abnormalities of femoral head placement in the acetabulum, manual therapists often have the best shot in preventing or correcting this anomaly and would benefit greatly by attending workshops designed to assess and treat this pervasive condition.
A prerequisite need for all pain management, sports, and structural integration therapists should involve a basic understanding of the relationship of iliosacral unleveling and foot posture. Since most therapists are not privy to radiographic measurements, we must develop keen palpatory and visual skills to properly evaluate bony and soft tissue landmarks. As Sir William Osler eloquently stated, "In order to treat something, we must first be able to recognize it."
Any attempt to tackle iliosacral rotational patterns armed with inadequate assessment and treatment tools will undoubtedly end in failure and frustration. From a functional standpoint, there is strong evidence of an associated increase in the incidence of low back pain and hip joint osteoarthritis if foot posture and femoral rotational patterns are not addressed in a timely manner.
In my next column, I'll present theories on why we encounter common compensatory patterns; discuss cerebral lateralization and motor dominance, and share myoskeletal techniques to address the strain patterns falling within the FAI realm.
Click here for more information about Erik Dalton, PhD.
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