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Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
May, 2011, Vol. 11, Issue 05
Pseudo-Sciatica and Gluteus Minimus Trigger Points
By David Kent, LMT, NCTMB
Knowing the specific pain patterns of each muscle gives you many advantages over your competition and allows you to most effectively apply your specialized skills. This knowledge allows you to efficiently assess, educate and design treatment plans tailored to your patient's complaints.
The gluteus minimus can be easily overlooked since the referred pain from this muscle is felt so deep and remotely from the location of the trigger points. Let's examine the gluteus minimus muscle, its anatomy and trigger point pain referral patterns and ways to help build your practice.
The gluteus minimus is the deepest of the three gluteal muscles, is also the smallest in length and lightest in weight. It attaches proximally to the external surface of the ilium and distally to the anterior surface of the greater trochanter of the femur. (Image 1A). The muscle fibers of gluteus minimus and gluteus medius run in the same direction and produce the same action.
When the lower extremity is free to move and all fibers of the gluteus medius contract they produce abduction of the thigh. When just the anterior fibers of gluteus minimus contract, and the lower extremity is free to move, they produce medial rotation of the thigh. When the lower extremity is in a fixed position, as during the weight bearing phase of gait or when balancing on one leg, the gluteus minimus, along with the gluteus medius, and tensor fascia lata, keep the pelvis level when the opposite limb is raised off the ground.
The superior gluteal nerve arises from L4 through S1 and innervates the gluteus minimus, gluteus medius and tensor fascia lata. When the nerve is compromised due to trauma, disc involvement or other factors, the supporting action of these muscles are diminished. When the patient tries to balance on one limb, the pelvis falls on the side of the raised limb indicating a positive Trendelenburg sign. The referred pain from trigger points in the gluteus minimus may be constant in duration, severe in intensity and may cause the patient to limp when they walk. The discomfort may also interrupt their sleep if they roll onto the effected side.
When active trigger points are present in the anterior fibers of gluteus minimus, patients will have pain and difficulty getting up out of a chair or standing up straight, following periods of hip flexion, as when seating in a car, watching TV, working at a computer or sleeping in a fetal position. Intake forms will help you ask the right questions to uncover all of the patient's symptoms.
Zones and Trigger Points
In images 1 - 3, "X" indicates the common location of trigger points. Solid red indicate Essential Pain Zones or the regions of referred pain that is present in nearly every person with active trigger points. The dotted red regions indicate Spillover Pain Zones or the regions of referred pain on some, but not all, patients with active trigger points.
Trigger Points (TrPs) in the anterior fibers of gluteus minimus refer into the lower buttock and down the lateral aspect of the thigh into the fibular region of the leg. Rarely do the referrals cross the ankle, but on occasion will refer into the dorsum of the foot. (Image 1B). Trigger points in the posterior fibers tend to refer more medial into the lower buttock (then the anterior trigger points) and into the posterior thigh and proximal calf (Image 1C).
These trigger points form for numerous reasons from direct trauma, inter muscular injections, postural distortions, running, swimming, walking too far and/or too fast over uneven terrain, and sporting activities such as tennis, handball or cycling.
Resolve & Distinguish
First identify, then eliminate or modify the factors that perpetuate the existence of trigger points. These may include periods of prolonged immobility such as seating in a car, watching a movie, working at a desk, sleeping in a fetal position or sitting on a wallet.
It will be easy to distinguish gluteus minimus trigger points from others, like the piriformis or the overlying gluteus medius, based on their referral patterns and the location of the trigger points.
Piriformis trigger points refer into the posterior thigh distally to the knee (Image 2), whereas the gluteus minimus trigger points also include the lateral thigh and calf (Images 1B,C).
Gluteus medius trigger points are less likely to involve the thigh (Image 3).
Range of motion is another way to determine which muscles are involved. Trigger points in the gluteus maximus restrict hip flexion, while trigger points in the piriformis restrict medial rotation of the thigh.
Trigger points in the gluteus minimus and gluteus medius will restrict adduction of the thigh.
The success of your practice is influenced by your ability to educate your patients. Set your self apart and reinforce a professional image by using visual aids like trigger point wall and flip charts to show patients their pain referral patterns. Postural analysis photos make it easy for you to assess, show patients imbalances in their musculoskeletal system and document postural improvement over a series of treatments. Read "Getting Inside Your Patient's Head" (MT, January, 2011).
Knowing the specific pain patterns of each muscle gives you the knowledge to efficiently assess, educate and design treatment plans tailored to your patient's complaints.
I wish great success in the treatment room.
Click here for more information about David Kent, LMT, NCTMB.
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