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All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
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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