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Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
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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