resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
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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