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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.
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.
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.
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.
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.
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.
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).
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.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
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.
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.
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.
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."
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?."
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.
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.
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.
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.
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.
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.
September, 2012, Vol. 12, Issue 09
Locomotive Power and Femoroacetabular Impingement
By Debbie Roberts, LMT
To think about locomotive power you first need to think about the chain of muscles, tendons, ligaments and joint structures that allow us to walk, run, jump, climb and play. This action of moving forward from the foot all the way to the trunk is what defines kinetic chain energy or locomotive power.
Static and Functional Assessments
As a therapist, it's crucial to take static AND function postural assessments with new clients. The standard static assessment will show you if some part of the body is forward or rotated, indicating weakness or tightness. But it won't tell you where the problem is occurring.
For that, you'll need to conduct a functional assessment. This allows you to see how the body responds to loads. Then you're able to better understand where the muscular weakness and dysfunction are happening.
Femoroacetabular Impingement of the Hip Joint
One place these assessments can be useful is in recognizing Femoroacetabular Impingement (FAI) of the hip joint. Remember that old song from your childhood, "The foot bone's connected to the ankle bone, the ankle bone's connected to the knee bone," and so on? This old ditty gives us an important hint about understanding FAI. The key is in order to properly assess what's going on at the hip, you have to begin all the way down at the foot. The first step is to look at the way the foot strikes the ground and the way the body absorbs the load through the femur.
When seeing a patient who is at risk for FAI, it's helpful to know the six primary signs and symptoms:
If FAI appears to be a factor for your patient you can begin by performing a static test. In a static observation, an S-posture indicates Lower Cross Syndrome. This can be the result of a misaligned ankle that affects the knee, which in turn leads to a change in the pelvic position.
Since the hip joint is located between the knee and the pelvis, it's naturally affected as well. If this occurs, you're looking at a muscular imbalance and insufficiency of the lower kinetic chain energy, which leads to a dysfunction at the ball and socket joint of the hip and possible FAI.
The FABER test is another assessment you can use to determine if FAI is a factor. If you're not familiar with the FABER test, the name tells the whole story: F-lexion, AB-duction, E-xternal R-otation of the hip. When conducting a FABER test, start with the patient supine and then flex, abduct and externally rotate the hip by placing their left foot over their right thigh or knee. Then slowly lower the knee down toward the table as you look for restrictions or signs of pain. Repeat to the other side. (FABER) (Ganz R. Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Ortop. 2003; 417:112-8.)
Causes of FAI
There are many theories as to how and why individuals develop FAI. One theory is that during development structural abnormalities of the hip, such as hip dysplasia (femur dislocation), can occur (Pollare 2011). Another cause is physical stress or trauma, like that suffered from a femoral neck fracture (Byrd & Jones 2011). Genetics is another potential factor in FAI (Leunig, Beaule' & Ganz 2009).
Whether the cause is developmental, trauma induced or genetic, in all cases one thing is consistent: FAI occurs when there is an abnormality of the femoral head and its congruency to the acetabulum. This is the culprit in early "primary" osteoarthritis of the hip, especially in young, active patients (Tannast, Siebenrock & Anderson 2007).
How Does FAI Develop?
FAI can develop over time through repeated and excessive hip flexion and internal rotation. This results in maximal contact between the anterosuperior femoral head-neck junction and the acetabular labrum, especially when there is not enough clearance to avoid friction. The repetitive movements and compressive load create a torsion effect on the internal structures inside the hip socket (Emara et al. 2011).
A patient whose FAI has progressed will develop an abnormal, asymmetrical and accommodative movement pattern. Taking a kinetic chain assessment will help you see the full dysfunctional pattern, allowing you to create a more complete treatment plan. This allows you to stop chasing the pain by helping the patient to correct the muscular imbalances that have contributed to the impingement.
To truly understand the development of this condition, let's look at the function of the hip joint and the moving parts that contribute to its healthy movement. The main job of the hip joint is to bear weight (Banerjee & Mclean 2011). The femoral ball slides against the acetabular socket and allows the body to perform movements of flexion, extension, abduction, adduction and internal and external rotation (American Medical Association 2011). The joint is supported by bones, cartilage, muscles, ligaments and tendons and has two main components: the acetabulum and the femur. The femoral head fits into and moves against the acetabular surface.
Anatomically, the iliopsoas, gluteus medius, gluteus minimus and gluteus maximus all provide anterolateral stability. So it's easy to see how an S-posture, with tight hip flexors and quadriceps and a weak extensor chain (gluteus maximus, medius, minimus and hamstrings), can alter the load. This puts excessive forces onto the hip joint and alters the patient's movement or gait pattern.
How FAI Presents
In the last year, I have seen more than half a dozen women in their 50s suffering from FAI resulting in osteoarthritis of the hip. After doing static and functional assessments, I discovered that every one of these patients had the typical muscular imbalances of Lower Cross Syndrome.
During their assessments, I noticed that all of these women began their static posture in an S-curve. After a functional assessment, including a FABER test, Thomas test, squat test and toe touch, it was clear that each one also suffered from a muscle imbalance of a hypertonic psoas muscle and tightness in the quadriceps and IT band. This was accompanied by loss of strength in the extensor chain.
All of these patients were referred to me by a their orthopedist or chiropractor and each came with a report of findings and diagnosis in her file. This allowed me to focus on helping them with their muscular imbalances by creating a treatment plan based on their doctor's recommendations and their individual needs.
A few of the women I saw were on very conservative treatment that blended modalities such as massage, cupping, muscle energy, traction of the femur, treatment in side posturing and corrective exercises. Some have undergone debridement for labral tears. Still others have received injections of the trochanteric bursa combined with physical therapy.
Unfortunately, four of these women did have to undergo hip replacement surgery, with two of them needing bilateral hip replacements to correct congenital disorders.
What We Can Do As Therapists
With the rise in hip replacement surgeries among younger women, it's time for us to take an active role in helping our patients with muscular imbalances to protect their hips from FAI. Without proper assessment, you may be only chasing the pain and symptoms of FAI and not helping with the correction of postural imbalances.
With the right assessment tools, however, you may be able to help your patient properly position the hip simply by lengthening the appropriate muscles and correcting the S-posture. By learning to take both functional and static assessments you can play a positive role in helping your patients identify and correct FAI and prevent future osteoarthritis.
Click here for more information about Debbie Roberts, LMT.
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