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Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
By the Numbers: 3 Common Financial Mistakes With Major Consequences
Warren Buffett is on record for sharing the hidden art of becoming wealthy and making it simple enough for anyone to grasp.
Immunizations by Colorado DCs: Really?
You probably didn't hear about it, but back on Nov. 21, 2013, the Board of Directors of the Colorado Chiropractic Association (CCA) adopted "immunization authority" for Colorado DCs as its No. 2 legislative goal.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
The Science of Stretching
In 1986, Rob DeCastella set a course record by running the Boston Marathon in 2:07:51, just 39 seconds off the world record.
Coding for the Subluxation: ICD-9 vs. ICD-10
When I attended chiropractic school, I was taught that chiropractors approach health care differently than the traditional medical establishment.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Remembering Clarence Gonstead and 50 Years of the Gonstead Clinic
Dr. Clarence Selmer Gonstead (1898-1978) took chiropractic practice from back-alley bone setting to an understandable biomechanical science. His life was dedicated to clinical competency.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Are You a Bad Chiropractic Patient?
My father was a great DC. In fact, as you might expect, he was the doctor of chiropractic I measured all other doctors against. Sadly, he died at age 61 when I was in my early 30s.
Why You Should Include the Single-Leg Stance Test in Every Patient Assessment
The single-leg stance (SLS) test, also known as the single-limb stance test, unipedal stance test or one-legged stance / balance test, is often used in the geriatric population to assess static postural and balance control.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Curbing Label Overwhelm
For the average consumer, reading a food package can be overwhelming: natural, organic, non-GMO, gluten free, free range ... you get the picture.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
Fibromyalgia: Put the Pain in Its Place
While some fibromyalgia patients respond favorably to regular chiropractic care, others experience minimal relief. Unfortunately, many of these patients must rely on pharmacological management to relieve their constant pain.
Physical Exam 101: The Hands
I am sure you are familiar with the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
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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