resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
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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