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The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
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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