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Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
May, 2012, Vol. 12, Issue 05
Exploring the SI Joint
By Whitney Lowe, LMT
Lumbopelvic pain is a common complaint that affects close to three quarters of this country's population. As massage therapists, we have a tendency to look for muscular causes of these pain complaints.However, a narrowed focus of attention on muscular tissues might cause one to miss key components of the client's complaint. The sacroiliac joint can be a frequent source of lumbopelvic pain. This joint is unlike many others in the body and requires a comprehensive understanding of anatomy, biomechanics and related tissues in order to best help people with the numerous disorders that may stem from dysfunctional joint mechanics.
The first place to begin in a detailed exploration of the sacroiliac joint is its anatomical structure. Most joints in the body consist of two smooth articular surfaces that are designed to glide against each other throughout a full range of motion. This is not the case at the sacroiliac joint. The articulating surfaces between the sacrum and the Ilium are more of a rough, irregular surface (Figure 1). They are designed to fit together like puzzle pieces with the irregular surface of each side matching up so it can provide greater stability. Unfortunately, when these irregular surfaces don't align correctly, which is the case with sacroiliac joint dysfunction, it can be very painful and produce serious dysfunctional mechanics.
The next prominent aspect of sacroiliac joint anatomy is the extensive webbing of ligamentous structures that surrounds the joint (Figures 2 and 3). This extensive ligamentous complex clues us in to key biomechanical aspects of the joint. Because this joint is so tightly bound by ligaments, very little motion can occur at the joint. The ligamentous mesh is primarily designed to help transfer weight from the upper torso to the pelvis, and yet allow a slight degree of mobility at that juncture. The key stabilizing ligaments in this region include: the anterior sacroiliac ligament complex, the posterior sacroiliac ligaments, and the sacrotuberous, sacrospinous and iliolumbar ligaments.
One of the more interesting facets of anatomical structure at the sacroiliac joint relates to the muscles which span the joint. In most regions of the body, motion at a joint is governed by muscles which attach to each of the bones of that joint. That is not the case in the sacroiliac joint. There are no muscles that span directly from the sacrum to the ilium. There are numerous muscles which cross the sacroiliac joint, but they cross other joints as well. Consequently, addressing sacroiliac dysfunction by treating muscles in this region requires a much greater understanding of the role muscles play immediately around this joint, as well as in distant areas. The role of related tissues and fascial connections will become increasingly apparent after looking at some aspects of this joint's biomechanics.
At first glance it would appear as if the sacrum is tightly wedged between the left and right innominate bones. The innominate is the combined ilium, ischium and pubis on each side. However, if the sacrum were tightly wedged between these two bones it would be difficult, as well as painful, for motion to occur due to the very high levels of friction. Instead, the extensive webbing of ligament structures around the joint acts more like a sling to hold the sacrum suspended in this joint and allows a very slight degree of motion while maintaining extensive stability.
The slight degree of motion capable at the sacroiliac joint is a forward and backward tipping of the sacrum in relation to the innominate bones. Forward tipping of the sacrum is called nutation, where backward tipping of the sacrum is called counternutation. Nutation and counternutation are necessary for minor movement between each innominate and the sacrum. During a walking or running stride one hip is in flexion while the other is in extension. The opposing motions of each side of the pelvis require some degree of slight movement with the sacroiliac joint articulation on each side. If these small degrees of movement are not available, significant alterations in joint mechanics occur and can produce serious pain.
Various postural distortions can cause alignment problems at the sacroiliac joint on each side. Lateral pelvic tilts, as well as anterior and posterior pelvic rotations can each produce numerous detrimental biomechanical problems at the sacroiliac joint. These composite movement problems can produce low back pain, as well as radiating pain down the lower extremity. It might be tempting to suspect that low back pain that also extends down the lower extremity is resulting from a neurological disorder at the nerve root level, when in fact it could be a sacroiliac joint disorder instead. Treatment aimed at lumbar nerve roots or intervertebral discs would likely be ineffective in this scenario.
Role of Massage in Treating SI Joint Dysfunction
Sacroiliac joint disorders routinely cause pain and disability. Massage practitioners don't always think about joint dysfunction as a primary need for massage because the emphasis in most massage treatments is so closely aligned to working on muscles. However, practitioners should remember that numerous soft tissues spanning the sacroiliac joint, both close by and in remote regions, can have significant effects on joint mechanics, giving a valuable rationale for massage therapy treatment.
A great example for understanding the crucial role of massage is simply to look at the many fascial connections that exist in this region. There are fascial connections between the hamstring muscles and the sacrotuberous ligament. Consequently, excess tension in the hamstrings could be transmitted through the sacrotuberous ligament and give adverse pulling force on the sacrum, causing joint dysfunction. There are similar fascial connections between the erector spinae muscles and the posterior sacroiliac ligament complex. Chronic tightness in the lumbar extensor muscles can then be transmitted directly to the sacrum, altering sacroiliac joint mechanics and contributing to pain. Massage treatment of these spinal extensor muscles could be a key factor in normalizing dysfunctional joint mechanics.
There are also fascial connections between the gluteus maximus and the sacrotuberous ligament. The gluteus maximus also has fascial continuity with the lower lumbodorsal fascia which blends into the latissimus dorsi. All of these fascial connections could have beneficial or detrimental effects on sacroiliac joint mechanics. With the numerous fascial connections in this region, it is clear that massage therapy treatment of these soft tissues can play a key role in maintaining optimal joint mechanics of the sacroiliac joint. Yet, without a solid grounding in the complex anatomy and biomechanics in this region it may be difficult to achieve proper interventions.
Movement specialists are still developing working models that accurately convey the complex anatomical and biomechanical relationships in this region. Yet we now understand much more about sacroiliac joint mechanics than we did just a short time ago. The massage therapist who has a better understanding of the joint structure and function along with numerous fascial connections in this region will be so much more effective in helping clients who suffer from these common complaints.
Click here for more information about Whitney Lowe, LMT.
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