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Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
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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