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The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Suffering Makes Us Human
It is possible that suffering, instead of being something negative, can be one of the greatest gifts to bring out one's humanity — if we allow it to be.
Building Community: A New Way to Socialize Your Practice
Social Media can seem like a slippery slope when, in fact, it is fairly easy to understand. With social media platforms, you can connect with current and potential new clients, build strong customer loyalty and increase brand awareness.
Create Community and Grow Your Practice
Many healthcare providers are fortunate to enjoy the freedom and independence of owning their own businesses. However, the constant demands can lead to a lonely and isolating experience unless you make an effort to get out of your office.
The 2015 Nobel Prize Shines a Spotlight on TCM Research
Traditional Chinese Medicine continues to make it's presence felt on the world stage as the 2015 Nobel Prize in Physiology or Medicine was jointly awarded to William C. Campbell and Satoshi Omura for their work on combating parasites and YouYou Tu for her discoveries in combating Malaria.
Yo San University Receives $1 Million Gift
Long-time Yo San University supporter Thomas S. Blount recently gave a $1 million dollar gift to the University, it's largest charitable gift to date. Mr. Blount was a retired naval officer, aerospace consultant and philanthropist.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
How to Market to the Medical Profession
The world of health care is changing dramatically. When situations occur that cause expenses to increase, it is time for you to develop strategies that maintain and grow revenue.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Detoxification Demystified and the Crucifers that Help
"Let food be your medicine and medicine be your food," is a quote often attributed to Hippocrates, a philosopher of the 5th century BC.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
When I started to think about what I wanted to do, I toured different schools to choose where to pursue my original chiropractic education.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Are You a Stakeholder?
In today's world many new things are occurring, especially in the world of information technology. With these changes, comes an entire new set of vocabulary words and definitions.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Cold and Flu Season: Expanding the Repertoire
As we move into the winter months, it is important for clinicians to have a solid working knowledge of effective herbal protocols for treating and managing clinical cold and flu presentations.
February, 2012, Vol. 12, Issue 02
Hip and Thigh Pain: The Tensor Fascia Latae Connection
By David Kent, LMT, NCTMB
Have you ever had a patient with hip and lateral thigh pain that did not respond to your traditional treatment? Would it be helpful to know which muscles to double check that refer pain into the hip and lateral thigh? Are you looking for cost-effective ways to educate patients and set your practice apart from the competition? Keep reading to get some answers to your questions.
Patients will describe referral patterns from myofascial trigger points in the tensor fascia latae muscle, as pain in the hip and down the front side of their thigh (Images 1A and 2).
Other symptoms include tenderness and pain, from the pressure of the patient's own body weight, which prevents them from laying on the effected side. Patients can lay on their opposite side by placing a pillow between their knees. The pillow prevents the tensor fascia latae, and the other hip abductors on the painful side from being lengthened, which can activate trigger points. If both sides are too painful, the patient will sleep on their back with a pillow under their legs or in a reclining chair.
Patients will also report experiencing pain when standing up straight after being in a hip flexed position from activities such as driving, sitting, sleeping in a fetal position or on their back with support under their legs. Movements of the hip, including walking, will also produce pain in the hip and or lateral thigh. They may have received a diagnosis of trochanteric bursitis or iliotibial band friction syndrome.
While you may know the location of trigger points and their specific pain referral patterns, your patients do not. They are in pain and looking to you for answers and relief. It only takes a minute to educate your patients about trigger points and it's a great way to build your practice. Explain to patients that if you press on a trigger point, it will produce a referred phenomena that is typically described as pain, burning, tingling or pressure in a region away from the location of the trigger point.
Charts are great visual educational tools (Images 1 and 3). Show patients how your charts work and what they may expect if you palpate a trigger point. For example, in image 4, "X" indicates the common location of trigger points within the muscle. Solid red areas indicate an essential pain zone or area of pain experienced by every patient that had that trigger point activated during research studies. The red dots indicate spillover pain zones. These are areas of pain experienced by some, but not all, patients outside of the essential pain zones.
Besides the tensor fascia latae, there are numerous other muscles that commonly have trigger points that also refer pain into the hip and lateral thigh. Laminated charts allow you to use a wet-erase marker to circle trigger points that may be involved. This process lets you educate the patient while creating a visual checklist of the muscles you will isolate during the treatment. After the therapy session, you can wipe the chart clean with a little water on a towel (Image 3).
Deep to the tensor fascia latae, the anterior fibers of gluteus minimus can have trigger points (Image 4a). (See "Pseudo-Sciatica and Gluteus Minimus Trigger Points," MT, May 2011). Trigger point 2 (TrP2) in the gluteus medius is positioned just belong the iliac crest, mid way along the crest (Image 5b). (See "Back Pain: Often a Pain in the Gluteus Medius," MT, March 2009). All five of the trigger points in the vastis lateralis can refer pain into the hip, the lateral thigh and lateral knee (Images 6 and 7). Trigger points in the more lateral fibers of quadratus lumborum also refer pain into the hip (Image 8)
The shape of the tensor fascia latae is wide in the middle and tapered on each end (fusiform). It is approximately 15cm (5.9 inches) long. The tensor fascia latae attaches proximally to the anterior superior iliac spine (ASIS) and the anterior part of the external lip of iliac crest. Distally it attaches into the iliotibial tract which continues to attach into the lateral condyle of the tibia (Image 1). These attachment points allow the muscle to abduct, medially rotate and flex the thigh. It also helps to keep the knee extended and to stabilize the trunk on the thigh.
Trigger points and the pain they refer are symptoms, our goal is to treat the causes. Trigger points form for many reasons, from direct trauma during an accident, to poor posture habits and more. Information from the patient history forms, subjective complaints, postural analysis, orthopedic assessments and tests (Ober's), joints range of motion (ROM), length and strength of muscles and palpation exam will guide us to design the most effective treatment plan.
A picture is worth a thousand words and a great way to document posture while educating the patients. Posture photos are simple, cost-effective tools that set your practice apart from your competition and should be included as part the initial treatment or package of treatments.
Just like doctors use x-rays and MRIs to give a report of findings, you can use pictures to show and tell patients how their posture is causing the pain. Simply take postural analysis photos using the camera in your iPhone, smart phone, tablet or iPad and show the obvious distortions to your patients on the screen. Visual aids help patients see how their posture is perpetuating the formation of trigger points and how your treatments can help. No special software is needed, you just take the pictures and look at them. A postural analysis grid chart make it easier for the patient's untrained eyes to see the distortions in the photos (Image 3). (See "Practice Building with Postural Analysis," MT, January 2012 and "Practice Building: Getting Inside Your Patient's Head," MT, January 2011).
Click here for more information about David Kent, LMT, NCTMB.
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