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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.
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.
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 Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
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.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
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.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
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.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
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.
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."
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
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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