resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
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.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
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.
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.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
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.
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.
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.
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.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
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.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
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.
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.
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.
March, 2011, Vol. 11, Issue 03
Hip Abductors: A Pain in the . . .
By Whitney Lowe, LMT
Pain in the lateral hip, thigh, and leg can cause serious, sometimes debilitating discomfort. These complaints are often diagnosed as an inflammatory joint problem such as trochanteric bursitis.Yet, the problem may revolve around dysfunction in the hip abductor muscles and not be bursitis at all. When the hip abductor muscles are the root of the problem, massage therapy is an exceptional way to bring your clients relief and get them back to full activity levels.
Anatomy & Physiology
The primary hip abductors are the gluteus medius, gluteus minimus, and the tensor fasciae latae muscles. (Figures 1, 2, 3) Each of the three muscles has a proximal attachment on the lateral aspect of the ilium. Distally, the gluteus medius and gluteus minimus muscles attach to the greater trochanter of the femur, while the tensor fasciae latae muscle inserts into the iliotibial band.
There are bursas underneath the gluteus medius and gluteus minimus muscles to prevent excess friction between their distal tendons and the femur. People with lateral hip pain are often diagnosed with trochanteric bursitis, although the bursa is often not to blame.
There are some clear differences between an inflamed bursa and other muscular problems that help the practitioner make an accurate distinction.
All three hip abductors are innervated by the superior gluteal nerve. The superior gluteal nerve has its nerve roots at the L4 through S-1 levels. These spinal segments are also the most common levels for lumbar disc herniations. If a disc or other tissue is pressing on nerve roots, there may be corresponding weakness or atrophy in the hip abductors innervated by the superior gluteal nerve. Consequently, lumbar disc pathology could produce hip muscle dysfunction and should be considered in a thorough evaluation. The superior gluteal nerve can also be compressed by the piriformis muscle as a form of piriformis syndrome. Nerve compression by the piriformis would have the similar effect of hip abductor weakness.
The three muscles mentioned above are primarily hip abductors. However, they also have other important biomechanical functions. For example, the tensor fasciae latae has a primary role in maintaining tension on the iliotibial band to help with knee stabilization. The gluteus medius and gluteus minimus are crucial for lateral pelvis stabilization. In fact, the primary function of the gluteus medius is to stabilize the pelvis during locomotion when weight is fully on the same-side lower extremity. If the gluteus medius and minimus are weak or atrophied, the pelvis will drop to the opposite side when you bear full weight on the same side during locomotion. This dysfunctional postural pattern is referred to as the Trendelenburg sign (Figure 4).
Biomechanical problems in other regions of the body can also cause problems for the hip abductors. The Morton's foot, which is indicated by a long second metatarsal and short first metatarsal, may lead to myofascial trigger points in the gluteus medius muscle.1 The trigger point development results from attempted compensations by the hip abductor muscles. Leg length discrepancies as well as other postural dysfunctions throughout the body can also cause myofascial trigger points or mechanical dysfunction with the hip abductor muscle group. Consequently, it is crucial to treat these muscles in many trunk, pelvis, or lower extremity complaints.
Hip Abductor Pathology
Chronic tightness or trigger points in the hip abductor muscles are frequently misinterpreted as other pathologies. Sacroiliac joint dysfunction produces pain in a region similar to the referred pain pattern from the gluteus medius and gluteus minimus muscles. However, careful assessment strategies can help make a distinction. If the pain is reproduced by palpation of the muscle tissue, these muscles are more likely at fault. If pain is reproduced with tests that stress the sacroiliac joint, joint pathology is more likely the culprit.
When dysfunctional, the hip abductors produce pain with walking as well as pain lying on the affected side at night. The pain may be local in the lateral hip region or it may refer into the trigger point reference zone of the muscles. Interestingly, even though the gluteus minimus muscle is smaller than the gluteus medius, pain from the gluteus minimus frequently extends down the entire length of the lower extremity. The pain referral pattern from the gluteus medius is usually limited to the gluteal or thigh region only.
The pain pattern for the gluteus minimus muscle is surprisingly similar to the pain felt from sciatic nerve dysfunction. As a result, gluteus minimus dysfunction is often misdiagnosed as sciatic nerve pathology. If the client's pain complaint is reproduced when pressing directly on the hip abductor muscles, it is more likely a hip abductor issue. Other assessment processes apply stress to the sciatic nerve and if those procedures produce more pain, it would more likely indicate the sciatic nerve as the primary source of the problem.
However, keep in mind that it would not be uncommon to have hip abductor problems along with a sciatic nerve dysfunction.
Another potential problem that may be confused with hip abductor pathology is trochanteric bursitis. This bursitis affects either of the primary two bursas underneath the gluteus medius or gluteus minimus muscles. Trochanteric bursitis may occur from pressure or impact on the lateral hip or even from metabolic disorders that cause inflammation of the bursa. In bursitis complaints there is significant point tenderness directly over the lateral hip region when pressing near the greater trochanter of the femur and not as much pain directly in the belly of the muscles. If the hip muscles are at fault, pain is more significant when pressing directly into the belly of those muscles and less near their attachment points.
Hip abductor muscle pain frequently develops from long periods of immobilization with the muscles in a shortened position. Sitting at a desk for long periods (like me writing this article) is a good example of an activity that could aggravate the hip abductors.
However, long periods of sitting could also produce lateral hip pain from other causes such as meralgia paresthetica, which is lateral thigh pain from entrapment of the lateral femoral cutaneous nerve. Clearly, it is paramount to be thorough in your assessment so you can accurately determine which tissues are primarily at fault and what type of massage treatment, if any, would be most helpful.
It is important to treat the hip abductor muscles in these different hip, pelvis, and lower leg complaints. Superficial applications will not address these muscles effectively. For example, the gluteus minimus and medius are deep to other thick muscles, so it takes specific techniques applied correctly to work effectively at those deeper levels.
Active engagement (AE) techniques are particularly helpful in situations like this where you have to work on a very deep muscle through thick muscle layers. By engaging the muscle actively in a contraction, its density increases, and the pressure you deliver is much more effective. You don't have to work as hard with your pressure and the technique is more effective in treating the muscle.
Two AE techniques that are particularly helpful in treating hip abductor dysfunction are compression with active engagement and a pin and stretch technique. There are different variations on each of these techniques, but they both use active contraction or movement of the muscle along with the massage technique in order to enhance the effectiveness and depth of pressure in the applied stroke. You can see narrated video clips of these techniques by visiting the following Web site: www.omeri.com/video.
The hip and pelvis region has crucial biomechanical and anatomical connections with many different regions of the body. The hip abductor muscles are often overlooked and should be addressed for thorough treatment of soft-tissue pain complaints in this region. Using sound assessment principles and these specific treatment techniques will greatly aid your ability to help numerous clients with these complaints.
Click here for more information about Whitney Lowe, LMT.
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