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9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
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!
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
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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