Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
I just got finished with a ...
resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.