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Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
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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