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Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
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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