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Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
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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