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Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
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.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
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.
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.
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.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
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!
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
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.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
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.
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.
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?
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.
December, 2011, Vol. 11, Issue 12
Back Pain: Signs and Symptoms of the Iliopsoas Muscle
By David Kent, LMT, NCTMB
Patients come to you concerned about their back pain, looking for answers and relief. The pain started when they tried to get out of bed or reached for the keys that fell onto the floor. Your ability to quickly assess your patient's symptoms and communicate your objective findings can determine if they schedule additional appointments, upgrade services or a treatment package, refer others and in some cases the amount of your tip.(Read "Practice Building: Getting Inside Your Patient's Head" MT, January 2011). The iliopsoas muscle can refer pain into the back that ranges from a mild ache to a severe debilitating level of intense pain. We will explore the signs and symptoms that indicate involvement of the iliopsoas muscle and ways to communicate your findings.
Patients will report pain and difficulty when attempting to stand erect after extended periods of hip flexion after driving or reading, seated at a desk or computer, sleeping in a hip flexed or side lying fetal position. The iliopsaos is the primary flexor of the thigh. So pain is often experienced from the iliopsoas when the patient contracts the muscle to perform hip flexion or a sit up movement when rising from a lying position.
Now, lets look at the function of this muscle from another perspective. When the thigh is in a fixed position, as when weight bearing, the iliopsoas acts as a trunk flexor. This is easily spotted during your postural and gait analysis. Postural analysis photos make it easy to document and educate patients of a shortened iliospoas muscle that is causing them to stand in a hip flexed position, bearing weight on the uninvolved side, while keeping the knee bent on the painful shorten side to shorten and reduce tension on the iliospoas (Image 1). The iliopsoas plays an import roll in maintaining upright posture when standing by preventing hyperextension of the hip joint. (Read "Getting Comfortable With Postural Analysis" MT, July 2008)
The iliopsoas is also active during gait. When the iliopsoas is shortened, patients will walk with a stooped posture, tilting their pelvis forward creating a hyperlordosis of the lumbar spine and limping when bearing weight on the involved side.
Proximally, the psoas major muscle attaches to the 12th thoracic and to all of the lumbar vertebral bodies and the corresponding intervertebral discs and the transverse processes of the lumbar vertebrae. The iliacus attaches proximally to iliac fossa, the sacrum and the anterior sacroiliac ligaments. Distally, the two tendons merge forming the iliopsoas tendon to attach onto the lesser trochanter of the femur. (Image 2)
One simple way to check the length of the iliopsoas is to have the patient sit on the edge to the therapy table, extending the hip of the iliopsoas being assessed, while flexing the opposite hip, bring the opposite knee and thight toward the chest to flatten the back, stabilize the pelvis and avoid creating a hyperlordosis of the lumbar spine. Using a photo, it is easy show the right iliopsoas length appears normal and how the shortened left hamstrings are limiting range of motion, preventing the left knee and thigh from moving closer to the chest. (Image 3)
Myofascial trigger points in the psoas muscle refer pain along the spine ipsilaterally from the lower thoracic to the sacral and upper gluteal regions. (Image 4) Patients will point moving their hand up and down or encircle one side of their back, near the spine. When trigger points are referring from both iliospoas muscles, patients will point moving their hand side to side. Iliacus produces the same back pain as psoas and referrers to the anterior thigh and groin.
While trigger points can arise in the iliopsoas from acute overload, they are usually associated with trigger points in other muscles. It will be important to assess and treat the lumbar paraspinal muscles, quadratus lumborum, tensor faciae latae, pectineus, rectus femoris, rectus abdominus (Read "Back Pain Caused by Rectus Abdominis Trigger Points" MT, June 2009), and the contralateral iliospoas muscle.
While it is easy to identify involvement of the iliopsoas, it is necessary to ruled out any precautions and or contraindications prior to performing any stretching or manual therapy. The iliopsoas is clinically important in relation to the kidneys, ureters, pancreas, appendix, sigmoid colon, lumbar lymph nodes and nerves. A clear understanding of the anatomy and proper hands-on training is necessary prior to treating this muscle. Many patients find yoga be a great way to provide self care for the iliopsoas muscle while lengthening and strengthening their entire body.
The treatment of back pain is common and hopefully easier now that you know many of the signs and symptoms of the iliopsoas muscle. Here are a few other articles I encourage you to read "Iliosacral Pain You Can't Touch" (MT, April 2011), "Back Pain: Often a Pain in the Gluteus Medius" (MT, March 2009), and "Pseudo-Sciatica and Gluteus Minimus Trigger Points" (MT, May 2011).
Click here for more information about David Kent, LMT, NCTMB.
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