resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Correcting Dysfunctional Movement Patterns – Is Local Treatment Enough?
It is widely believed that mechanical, non-traumatic back pain is largely related to dysfunctional or compensatory movement patterns the body has adopted over time.
Alcohol Consumption Strongly Linked to Risk of Colorectal Cancer
Alcohol intake is one of the primary risk factors for many human cancers, and is strongly associated with cancers of the oral cavity, pharynx, larynx, esophagus, liver, breast, and notably, the colon and rectum.
Following the Thinking of the Classics
I have heard about the "best time of day" to carry out certain examinations or therapies. For example, I remember making a note years ago that early morning is the best time to take someone's pulses.
Inspire Your Patients to Make Healthy Choices
Have you tried to get your patients to change their eating habits or their diet and couldn't get them to succeed? Were they confused and unsure of what the right thing was to eat? You are not alone!
Chronic heightened emotional states create a perfect breeding ground for illness. Through my practice I noted the increasingly obvious relationship between one's mental focus on negative thinking, emotions, resistance to experiencing feelings and disease.
Drug War Rages in Wisconsin
Based on its actions over the past 15 years (review the sidebar in the app version of this article), controversy and the Wisconsin Chiropractic Association seem to go hand in hand.
Introduce Your Patients to Collagen Induction Therapy
Cutaneous (skin) aging generally occurs from either intrinsic or extrinsic processes. Intrinsic aging results from natural skin tissue damage and degeneration.
Micro-Needle Dermal Roller Use in the Treatment Room
Recently micro-needle dermal rollers have been getting a lot of media attention. As a practitioner who specializes in acupuncture facial rejuvenation, I know that skin needling with a dermal roller (also known as collagen induction therapy), promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter.
Giving Chiropractic Some Much-Needed PR
Public relations has not always been the chiropractic profession's strong suit, a shortcoming that has subjected the profession to countless attacks on its legitimacy and seemingly perpetual confusion among the public and the health care world as to the skills and services doctors of chiropractic provide.
The Acupuncture Now Foundation: What Our Profession Needs
Although acupuncture is growing in popularity it continues to be underutilized due to misunderstandings about its true potential. Only a fraction of those who could be helped by acupuncture know enough to seek it out.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
The Bottom Line ... From a Surgeon Who Knows
Regardless of individual relationships between providers, there continues to be a type of Hatfield-McCoy feud between the philosophies of medicine and chiropractic, particularly when it comes to musculoskeletal ailments.
Five Element Acupuncture Can Enhance Your Practice
For eight years I have been teaching and supervising TCM students at an acupuncture college in Colorado, in Five Element acupuncture.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
Capturing the Essence of Tai Chi
Over the last 12 years, I have been working on one of the few documentaries about Tai Chi. It's called The Professor: Tai Chi's Journey West and it's about Cheng Man-Ching who moved to New York in the 1960s.
Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo.
Peer Points: Promoting TCM Knowledge
When Elaine Wolf Komarow, LAc, received her first acupuncture treatment in 1989, she said it changed her life. "I felt more aware, calmer, and happier. I was so fascinated by the changes that I began to learn everything I could about the underlying philosophy of Chinese medicine," said Komarow.
"Turn, Turn, Turn"
Many people are credited with saying, "If you remember the '60s, you really weren't there." Given the fact I didn't become a teenager until 1970, I actually do remember the '60s (or at least part of it). And as a child of the '60s, I was, of course, influenced by the music.
Treating Chronic Depression with Acupressure
In Traditional Chinese Medicine there already exists a comprehensive theory linking the body and mind.
News in Brief
Foundation for Chiropractic Progress Enrolls Second Group Member; Focus on Chiropractic Education at WFC-ACC Conference in Miami; Are You Ready for Another "Have-a-Heart" Campaign?
Chinese Medicine: The Natural Way to Children's Wellness
As a child, I did not like going to the doctor. For the most part, when I had to go I wasn't feeling good to begin with, and I was heading into a sterile environment to be awkwardly probed by a man in a white coat for a very short, impersonal period of time.
Implications of Section 2706: The Non-Discrimination Provision Survey
In late April 2014, NCCAOM diplomates received an email survey with the subject line: "End discrimination against acupuncturists" polling CAM practitioners for a Request for Information from the Department of Health and Human Services, released in mid-March.
It Pays to be a Foodie
If there is an inner foodie in you, just waiting to burst out—this article is for you! Do you want to know how I know? I'm that girl. My middle name might as well be "Foodie." I love food! And if my patients are any indication, many of them do as well.
Acupuncture Detox as Part of Drug Rehabilitation
In the U.S., more than 2,000 alcohol and drug rehabilitation programs have added ear acupuncture to their practice. The development of the protocol was determined by Lincoln Hospital as it delivered 100 acupuncture treatments daily.
The McGill Approach to the Lower Back (Part 1)
Stuart McGill, PhD, brings a unique combination of tools to the table. He is a scientist who also functions as a clinician. He describes himself as a medical consultant who is referred challenging patients. He is both evidence based and practical.
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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