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AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
June, 2012, Vol. 12, Issue 06
Achilles Tendon and Foot Pain Caused by Tibialis Posterior
By David Kent, LMT, NCTMB
When patients report subjective complaints of posterior leg (calf) and sole (bottom) of foot pain when walking or running, especially on uneven surfaces, the symptoms are typically not isolated to one muscle.The tibialis posterior muscle is often involved and is the deepest muscle in the posterior compartment of the leg. Let's review the anatomy, myofascial trigger point location, pain referral patterns and a treatment technique for the tibialis posterior muscle.
The region between the knee and ankle is called the leg, it is divided into three compartments: anterior (front), lateral (side) and posterior (back). The posterior (flexor) compartment is the largest and contains seven muscles, which can be divided into a superficial and deep group. (Photo 1)
The superficial group includes gastrocnemius, soleus and plantaris. The deep group includes tibialis posterior, flexor digitorum longus, flexor hallucis longus, and popliteus. (Photo 1)
The tibialis posterior muscle is positioned between the tibia and fibula. (Photo 2) Medially, it is covered by the flexor digitorum longus muscle and laterally by the flexor hallucis longus muscle. (Photo 3) These muscles influence the ankle and foot joints. The popliteus is also in the deep compartment, however, it affects the knee joint.
The tibialis posterior muscle attaches proximally to the tibia, fibula, adjoining interosseous membrane and the intermuscular septum. (Photo 2)
Distally, the tendon runs behind the medial malleolus to attach on the navicular, the calcaneus, the cuboid, three cuniform and the second through fourth metatarsals. (Photo 2)
When the tibialis posterior contracts, it produces inversion of the foot, with plantar flexion of the ankle joint. If the muscle is weak it contributes to pronation of the foot and a loss of support of the longitudinal arch. (Read Practice Building with Postural Analysis MT, January 2012.)
The fibularis (peronial) longus and bervis are main antagonists to the inversion action of the tibialis posterior.
Patients with myofascial trigger points in the tibialis posterior muscle report calf and foot pain when walking or running. The pain is more intense when walking of running on uneven brick or cobblestone surfaces, as the muscle contracts while producing inversion of the foot and plantar flexion of the ankle joint.
Active myofascial trigger points can typically be located in the proximal third of the tibialis posterior muscle. The referred pain is most intense in the achilles tendon and the sole of the foot. A spillover pain, felt to a lesser degree, is experience in the calf. (Photo 4)
Visual aids such as anatomical models and charts are great patient education tools to demonstrate the muscle layers, trigger point location and pain referral patterns prior to treatment. Show patients how your charts work and what they may expect if you palpate a trigger point. For example, in Photo 5, "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. (Read Getting In Our Patients Head MT, January 2011)
The patient's subjective complaints and your objective findings will determine the appropriate treatment techniques to integrate. Care for yourself while providing quality care for your patients by using proper body mechanics and adjusting the treatment table height accordingly. One goal during treatment is to reduce pain, not create it. Patient comfort should always be considered. Pillows and bolstering systems allow for a wide range of positioning options, with sections that adjust to various angles. Continually confirm with the patient during treatment that treatment pressure is comfortable. (Read Learning to Engage All The Senses MT, March 2012)
Whenever deep muscles require therapy the superficial tissues must first be properly released prior to treating deep structures. There are numerous techniques for treating the tibialis posterior muscle, this article will touch on only one.
Outline of the treatment technique:
Step 1 – First, shorten the superficial gastrocnemius and soleus muscles by positioning the patient prone with support like a bolster under the ankle to create knee flexion and plantar flexion of the foot. Apply oil or cream to posterior leg. (Photo 6)
Step 2 – Superficial Gliding. Start on the medial side of the calf. Using distal to proximal movements, from the ankle to the knee, treat in thumb width strips starting on the medial side and moving to the lateral side gliding over the gastrocnemius and soleus muscles. (Photo 6)
Step 3 – Pincer Compression. Isolate and examine the bellies of the gastrocnemius and soleus utilizing pincer compression. Note, if your hands are slipping on the skin during this step, due to oil of cream on the skin, treat through a tissue or linen. (Photo 7)
Step 4 – Tibia and Fibula attachments. Glide distal to proximal on the posterior aspect of the fibula, then repeat the same on the posterior aspect of the fibula. Caution to avoid the common fibular nerve located between the skin and the fibular head. (Photo 8)
Step 6 – Release distal attachments in the foot. (Photo 10)
Symptoms of pain when walking or running in the calf and foot are typically not isolated to one muscle. The tibialis posterior is the deepest leg muscle and often involved. I hope this article provides you with empowering knowledge that can be applied immediately to your patients.
Click here for more information about David Kent, LMT, NCTMB.
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