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How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
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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