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Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
July, 2012, Vol. 12, Issue 07
Pelvic Pain from The Adductor Magnus
By David Kent, LMT, NCTMB
Living with pelvic pain is a daily occurrence for many people. It is very unsettling for a patient to have undergone countless medical tests and procedures with no clear source of the pain identified.Myofascial trigger points (TrPs) are one possible cause of pelvic pain. Trigger points 1 and 2 in the adductor magnus refer pain into the pelvic region (Image 2b and c). Let's talk about= the anatomy, trigger point locations, referral patterns and provide a link to an online video clip showing a treatment routine for the adductor magnus with the patient in a side lying position.
The adductor magnus is the largest muscle of the adductor group. It is tripartite, composed of three parts, an adductor minimus part, a middle part and an ischiocondylar or "hamstring" part (Image 1).The fibers of the adductor minimus part run almost horizontal. The fibers of the middle part run at an angle and the fibers of the isciocondylar or third part, run vertical (Image 1). Besides having three parts, the adductor magnus contains an opening.
The word hiatus originates from the latin term, hiare, to stand open. A hiatus is a normal opening in a membrane or other body structure. The adductor hiatus is an opening in the distal attachment of the adductor magnus muscle and is located just superior to the adductor tubercle of the femur (Image 1). As the femoral artery and vein pass through the adductor hiatus, their names change to become the popliteal artery and vein.
Two nerves innervate the adductor magnus muscle. The tibial part of the sciatic nerve supplies the ischiocondylar or "hamstring" part of the adductor magnus. This same nerve also innervates the hamstring muscles. The obturator nerve supplies the adductor minimus and middle parts of the adductor magnus.
Proximally, the adductor magnus attaches on the inferior ramus of the pubis, as well as, the ramus of the ischium and the ischial tuberosity. Distally, it attaches on the back of the femur, from the gluteal tuberousity to the adductor tubercle.
Since the adductor magnus has three parts, each with fibers pulling in differ directions and is innervated by two different nerves, the effects on posture and biomechanics are significant. For example, the middle part can rotate and tilt the pelvis, adduct and flex the thigh. While the ischiocondylar or "hamstring" part extends the pelvis. We will visit these dynamics in a future article. For now we will look at trigger points.
Trigger points can form in the adductor magnus for numerous reasons from physical trauma, activities like hiking, slipping on a wet or icy surface that causes the persons legs to extremely abduct, or from many hours of sitting in a hip flexed position on a plane, in a car or while working at a desk, to name a few.
Trigger point 1 (TrP 1) in the adductor magnus muscle is located at the level of the mid thigh. It refers an essential pain zone into the medial thigh, starting below the inguinal ligament, into the pelvic region, running distally to the medial knee (Image 2a - b), "X" indicating the common location of trigger points within the adductor magnus muscle. Solid red areas indicate an essential pain zone. Red dots indicate spillover pain zones. (Image 2 A-C) Trigger point 2 (TrP2) in the adductor magnus muscle is located proximally. It refers internal pelvic pain. Patients may describe the pain as referring into organs such as the vagina, rectum or bladder.
In addition to adductor magnus, other muscles with documented trigger points that refer into the pelvic region include the obturator internus, piriformis and obliquus internus abdominis, coccygeus and levator ani. Be sure you are properly trained, licensed and operating within your scope of practice prior to performing therapy.
I wish you the best helping patients with pelvic pain. If the cause includes trigger points in the adductor magnus, you now have information to provide a soft tissue solution. Here is a link to an online video clip showing a treatment routine for the adductor magnus with the patient in a side lying position: www.youtube.com/KentHealth.
Click here for previous articles by David Kent, LMT, NCTMB.
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