resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
November, 2011, Vol. 11, Issue 11
Joint Capsular Patterns
By Whitney Lowe, LMT
Passive and active range-of-motion tests are routinely used to identify soft-tissue pathologies. Unfortunately, practitioners often do not derive the full benefits of the information they can acquire through these tests.An expanded understanding of joint biomechanics will help you gain much more valuable information in your range of motion evaluations that will greatly improve your treatment strategies. When certain soft-tissue pathologies are present, many joints have a characteristic pattern of limited movement. Each pattern of movement limitation is unique to a particular joint. This movement restriction is caused by dysfunction in the joint capsule. Consequently, it's called the joint's capsular pattern.
Diarthrodial (freely moveable) joints have a space between the two articulating bones. The joint capsule is a fibrous connective tissue that holds the two bones together. It is composed of two different tissues. The outermost layer is a tough connective tissue called the fibrous capsule and is mostly made of ligamentous fibers. Inside the fibrous capsule is another layer of tissue called the synovial membrane (Figure 1). This membrane is responsible for secreting synovial fluid, which helps to lubricate the joint, supply nutrients and remove metabolic wastes from the area.
The fibrous capsule is richly innervated so it can produce a great deal of pain if there is any damage to it. The synovial membrane, however, has very little, if any, innervation and so it is rarely a source of pain. However, any irritation or restriction of the synovial membrane may also affect the fibrous capsule and therefore cause pain. In fact, stretching a fibrously adhered or restricted joint capsule is thought to be the chief cause of pain in osteoarthritis. Damage or dysfunction to the fibrous capsule or synovial membrane is then likely to produce a capsular pattern of motion restriction.
Not all joints have capsular patterns. The pattern appears to be more characteristic of joints with significant range of motion. For example, the sacroiliac joint, which is more of a tight and fibrous articulation with very little movement, does not have a capsular pattern. It makes sense that joints with very limited movement would not have a capsular pattern because it is very difficult to measure range of motion in them anyway. If the pattern of motion restriction in a joint is not the characteristic capsular pattern for that joint, the restriction is referred to as a non-capsular pattern. A non-capsular pattern would exist in a situation where there was joint or soft-tissue pathology but the joint capsule was not the primary tissue at fault.
The shoulder (glenohumeral joint) has the greatest range of motion of any joint in the body. Consequently this is also the joint where the capsular pattern is most important to evaluate, and where capsular pattern evaluations are used most frequently. Capsular patterns are also very important in the shoulder because unlike most other joints where motion is first limited by muscles becoming taut, it is actually the joint capsule that can limit shoulder motion in certain directions before the muscles become fully stretched.
In the shoulder, the capsular pattern dictates that motion restrictions occur first in lateral rotation, then in abduction, and third in medial rotation. In the early stages of a capsular restriction you may only see limitations to external rotation. As the condition progresses, there would be further limitations including abduction and eventually medial rotation. If an individual has a significant limitation to abduction, but no problem with lateral rotation, this would be considered a non-capsular pattern. As a result, this pathology is probably not primarily a joint capsule pathology. A much more likely cause would be some type of external structure causing the movement restriction such as an impingement problem under the acromion process.
Putting The Information To Use
In many cases, massage practitioners are not likely to be treating internal joint pathologies that involve joint capsule damage. However, certain conditions such as adhesive capsulitis (frozen shoulder), directly involve the joint capsule. There are effective massage treatment strategies for adhesive capsulitis, so it will be very helpful to identify if the joint capsule is involved. One of the big advantages of understanding the capsular pattern in this condition is you can continually monitor range of motion in the capsular pattern to measure how successful your treatment is at improving range of motion and reducing the capsular restriction.
Muscles are also a common limiting factor in joint range of motion. Consequently, muscular restrictions could mimic or magnify the capsular pattern of restriction. When performing range of motion evaluations, be sure to consider the musculotendinous unit, as well as ligamentous/capsular restrictions. There are a number of resources that have lists of capsular patterns for specific joints. The resources indicated here have charts or lists of capsular patterns that are very informative.
Click here for more information about Whitney Lowe, LMT.
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