resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
February, 2011, Vol. 11, Issue 02
The Bike Body
Working With Cyclists
By Erik Dalton, PhD
It's astonishing the money and time many elite and "weekend-warrior" cyclists devote to retrofitting racing bikes to conform to their bodies rather than first restoring function to the most critical piece of racing equipment: the rider's body.When muscle imbalances, faulty movement patterns and joint fixations distort the body's bony framework, the cyclist is led on a never-ending journey searching for that perfect bike fit. (Fig. 1)
My personal mantra: "Fit the body to the bike, stupid!"
Bodyworkers and functional movement trainers whose practices cater to amateur and elite cyclists are keenly aware of the clinical and performance advantages gained by restoring optimal mobility, flexibility and stability to the biker's muscle/joint complex. It makes sense to first get the kinks out before sending the client off for an expensive and sometimes useless bike retrofit. Without hands-on maintenance and functional fine-tuning, cyclists often unknowingly reinforce dysfunctional movement patterns ingrained from long-forgotten micro- or macro-traumatic injuries.
Confusion and controversy over this chicken-or-egg (bike-or-body) thing is primarily due to lack of understanding of the Law of Cause and Effect. For instance, let's say a bike shop performs a retrofit and Bob, the cyclist, smilingly pedals away on his newly reconstructed machine feeling secure and pain-free. Life is good... or is it?
Unfortunately, if Bob is one of many "flexion-addicted" Americans with a sedentary job that keeps him glued to the computer terminal day-after-day, gravitational exposure will gradually drag his body into a big "C" curve. (Fig. 2) In time, Bob's brain relearns this aberrant posture as normal and on weekend outings his "hip-flexed" desk posture morphs into a similarly distorted riding posture. (Fig. 3)
To make matters worse, stubborn pain-spasm-pain cycles often appear as the hip stiffens and the imposed stress destabilizes sacroiliac and low back structures. In the presence of lumbar spine instability, the brain may decide to lock down the low back and ribcage with protective muscle guarding. Thoracic cage rigidity not only inhibits proper diaphragmatic breathing but also sends shock waves through the thoracolumbar and pectoral fascia and into the upper extremity joints where reverberations are met with strong resistance from habitually locked hands, elbows and arms. (Fig. 4) Meantime, compensations from adhesive hip capsules also traverse down through Bob's knees, ankles and feet searching for a weak link in the lower kinetic chain.
Cyclists who opt for a bike retrofit prior to receiving manual therapy to release fibrotic hip capsules and hip flexors, soon notice a loss of endurance and may develop soft tissue or joint sprains associated with lumbopelvic imbalance. Oddly, many flexion-addicted cyclists attempt to work through the injury despite sensing a noticeable reduction of speed, power and efficiency. "No pain, no gain" is an unacceptable working model for those seeking longevity in the cycling sport.
Does decreased hip angle equal less power?
One of the most common bike positions used by "flexiholics" has the hip flexors locked short and the hams and glutes overstretched and weak. This imbalance pattern as described by Vladimir Janda in his lower crossed syndrome, forces the pelvic bowl to be drawn too far forward creating a decrease in hip angle. (Fig. 5)
Cyclists who consistently ride with an anteriorly rotated pelvis and decreased hip angle are subject to capsular and ligamentous adhesions and a subsequent loss of economy and power. To accommodate the loss of hip extension, many recreational and competitive racers compensate by posteriorly tilting their pelvic bowl and rounding their backs into a hyperkyphotic posture just to increase hip angle and power. The famed cyclist Andy Pruitt believes that changing the seat height by a mere inch alters mechanics and motor control patterns of every joint in the lower extremity. By decreasing seat height, excessive force is transferred to the patellofemoral joint, while raising the saddle too much strains the hamstrings, low back and hands.
Stand and try this: Lift one leg with the knee bent about 90 degrees as high as possible without straining or rounding the back and forcing hip flexion. Most people are able to comfortably hip-flex about 90 degrees. Try this maneuver again except this time forward-bend your trunk about 50 - 60 degrees, while raising the knee. Notice a dramatic reduction in the amount of hip flexion? Try both tests again and this time, measure available hip flexion by observing how high your foot raises off the ground. This test illustrates what can happen to hip-impaired cyclists: decreased hip flexion = greater effort = more work = poor performance.
Riding Postures and Rehab
The first order of business when treating adhesive (motion-restricted) hip flexors and capsules is to mobilize the hip in all three cardinal planes. (Fig. 6a) To restore myofascial balance, fast-paced "spindle-stim" maneuvers such as those shown in Fig. 6b help tonify weakened (neurologically inhibited) gluteal and hamstring muscles. Once the therapist manages to increase hip angle and establish proper functional balance and range of motion, the cyclist is free to decide which type of riding posture (he believes) suits him best.
Some cyclists prefer a high seat so they can posteriorly rotate the pelvis to increase hip angle. Other riders find greater mechanical advantage by putting a little curve in the low back, engaging the core, and then slightly backing off the curve to allow a neutral lumbar spine. Either way, both groups should avoid:
The Yin-Yang of Muscles and Joints
To perform well in such a challenging event, cyclists like Bob would greatly benefit from a well-constructed manual and movement therapy program that focuses on restoration and maintenance of proper intrinsic/extrinsic muscle balance and diaphragmatic breathing patterns. Fluid and dynamic body movement during cycling events is dependent on the ability of muscles and fascia to stay strong, yet flexible. A healthy lumbar spine is the driving engine in most athletic endeavors and length/strength balance between muscles, ligaments, joint capsules, and thoracolumbar fascia is essential for providing that stable platform. Any weakness or motor control issues are magnified by traumatic shocks from funky road conditions or recurring bike injuries. Eventually, excessive neurological input cannot be handled at the spinal cord level and the information is "fast-tracked" to the brain for interpretation via pain-signaling nociceptors. If the brain decides to "splint" the vulnerable area to prevent further insult, pain-spasm-pain cycles may ensue.
Ingrained muscle and motor imbalance patterns such as those discussed by Vladimir Janda, Gray Cook, Craig Liebenson and others, often require a concerted team effort to reestablish normal movement behavior. In most cases, the ideal treatment protocol is to first restore lost mobility to impaired structures and then address stability issues via functional movement training.
Like many of America's other popular, but abnormal, athletic endeavors such as golf, tennis, bowling, etc., cyclists bring with them a complex biomechanical downside that's often hard to completely fix. The "arched back" model is generally the most problematic. In an attempt to level the eyes, the rider must hyperextend occiput on atlas. The cervicothoracic junction is also forced to hyperextend (neck-on-shoulders) causing chronically locked intervertebral joints and rib jamming. This area is particularly affected by road vibrations due to the stationary position of arms, shoulders and hands. Additionally, ligamentous laxity may develop from excessive thoracolumbar and lumbosacral bowing which, in time, sets the stage for low back pain and disability.
The good news is that the human body is both adaptable and dynamic; the bad news is that our biker clients often bring along a lot of baggage including flexion-addicted sitting postures, old injuries, compensations, poor training habits, etc. Once the skilled manual and movement therapist makes necessary corrections, the bike can then be retrofitted to conform to the rider's optimally functioning body. A properly fitted bike combined with a revitalized and functionally balanced neuromuscular system allows muscles and joints to work at optimal levels of motor unit recruitment and synchronization. As endurance and performance improve, so does the natural love of cycling.
Click here for previous articles by Erik Dalton, PhD.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.