resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Medication Primer for Alternative Health Care Practitioners (Part 2)
Morphine is arguably the greatest drug of all time, at least in the sense that it is so powerful in relieving pain.
Pre-Conception Wellness: What Do Your Patients Need to Know?
Deciding to have a baby is one of the most important decisions a woman will ever make. But how many women are really prepared for a healthy pregnancy?
News in Brief
In Remembrance: A Moment of Silence for Robin McKenzie (1931-2013); DC Re-Elected to Co-Chair AMA Code Review Board; WFC Celebrates 25 Years.
10 Life Lessons That Will Change the Way You Practice
"What would you do if you knew you couldn't fail?" I have posed this question for years to groups I've spoken to across the country and around the world.
Treating Rib Joints to Protect Thoracic Stability
It is an exciting world that awaits us when we go to work every day. We deal with all types of people who present with varying health conditions we can (hopefully) help alleviate.
The Monkey on Your Back
Many practitioners run their clinic without any extra help—at least initially. I've always been pretty good at multi-tasking. Having nine kids taught me how to wear multiple hats and juggle a lot of responsibilities. Running a clinic is similar.
Study: Acupuncture for Acute Low Back Pain More Effective Than Drugs
New research by Korean doctors of Oriental Medicine suggested that an acupuncture method could reduce acute lower back pain faster and more effectively than conventional drug injections.
It's About the Word
The new patient was already a fan of chiropractic. "I liked the guy a lot," he said of the previous DC he had consulted. "But he is on the other side of town, and I just can't get there after work. So he sent me to you, since you're his buddy."
If you visit the website of the JAMA and search on the word chiropractic, more than 200 results appear. If you sort that list chronologically and look at the oldest entry, you will find "Medical News" that includes the following.
Maintaining Professional Boundaries in a Facebook World: Social Media Guidelines for DCs
A few months ago, I received an unexpected message on my Facebook account: "Hi Doc, do you remember me? I'm so happy to find you here on Facebook. It's been years since I have seen you and I'm glad to reconnect with you.
Weight Training: Are Cheat Reps Worth It?
While resting between exercises at the gym recently, a young lifter asked me for a spot on a set of barbell bench presses. The bar was loaded with a moderately heavy amount of weight that at first glance appeared to be too heavy for his frame.
We Get Letters & E-Mail
The "Great Opportunity" for Chiropractic: Expanded Scope of Practice; The SOAP Note: An Effective Tool for Documentation; Treating Patients Goes Beyond Following Established Protocol.
Beauty is Averageness
After seeing Kim Kardashian's face all over the Internet -and my inbox- following her posting on getting facial acupuncture, I recalled the work of Michael Cunningham who was at the University of Louisville when I was doing my doctoral work.
Keeping Up With Western Medicine Advancements: The Amazing World of Imaging Studies
When patients with neuromuscular problems come to you for treatment there is usually a lot you can do for them to improve their mobility or reduce their pain, whether it is a middle age woman with a frozen shoulder.
Obesity is a Shen Problem
The expressions "obese" and "obesity" are not pejorative terms. They are scientific terms, determined solely by the Body Mass Index scale, which combines a person's height and weight in a mathematical formula. A number of 30 and above denotes "obesity."
Three Essential Herbal Products For Your First-Aid Kit
There are three Chinese patent medicines that belong in everyone's first aid kit. All three are for topical application, and all three provide extraordinary benefits unavailable from any domestic over-the-counter.
Healing the Qi: The Boston Marathon Bombing
On Monday, April 15 2013, locals and visitors from around the globe gathered for the world's largest marathon in the city of Boston. With 23,000 participating in the race and many more on the sidelines, the marathon represents a Boston institution.
Extraordinary Vessels and Emotional Healing
In addition to the 12 primary Organ-related meridians in the body, there are other energy circulation channels that have been mapped out by Traditional Chinese Medicine. Probably the most significant of these are called the Eight Extraordinary (or Extra) Vessels.
Protein and Weight Loss
Recently I was asked by the staff at Dynamic Chiropractic to referee some of their water-cooler discussions regarding nutrition. Topping their list was this one about protein and weight loss: "Why is protein important for weight loss and how much should I eat?"
Dry Needling is Acupuncture: But What of Education? What of Public Safety?
One of my patients told me recently, that their physical therapist used a "dry needle" and that it wasn't acupuncture. Apparently, physical therapists (PT) are taught to tell their patients that "only acupuncturists practice acupuncture."
The Physiology of Anger
Most of us recognize and have felt anger at some point in our lives. Anger can be seen as a natural response to some kind of pain, whether emotional or physical.
Lateral Femoral Cutaneous Nerve Entrapments
The lateral femoral cutaneous nerve arises from the 2nd and 3rd lumbar nerves. It is formed in the psoas muscle and emerges from its lateral border to cross the iliacus muscle and exit the pelvis.
Weaving Eastern & Western Medicine Together: Q&A with Beijing's Dr. Kezhen Zhang
Dr. Kezhen Zhang M.D., is currently the founder and president of Beijing Taijitang Traditional Chinese Medicine Hospital.
Becoming a Concussion Expert in Your Community: What You Need to Know (Part 2)
What makes an individual an expert in concussions? Obtaining education about concussions and treating concussed patients are two factors that lead to expertise.
Chiropractic Care for Veterans: Serving Those Who Served (Pt. 2)
To what extent do you think the role of chiropractors in the VA can serve as a model for greater chiropractic integration elsewhere in the American health care system? That's a very important question.
A Solution for the Primary Care Crisis?
A white paper generated by the ACCAHC Primary Care Project and UCLA Center for Health Policy Research Senior Research Scientist, Michael Goldstein, PhD, addresses a clear oversight noted in recent workforce analyses designed to assess the nation's primary care needs.
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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