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Building the DC-MD Bridge
From MDs practicing integrative holistic medicine to the family internist, many DCs are enjoying unprecedented attention from their allopathic colleagues.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Don't Forget About the Performers
Donald Petersen Jr.'s recent article, "Your Chance to Go Back to High School" [May 1, 2014 DC], focused on the injuries incurred by high-school athletes and the subsequent opportunities for the chiropractic profession.
Watch Out for Red Herrings
In clinical practice, when one condition mimics another, it makes it difficult to obtain an accurate and timely diagnosis.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
News in Brief
Oregon Gov. John Kitzhaber (a medical doctor, no less) proclaimed October 2014 "Oregon Chiropractic Health and Wellness Month" in an official proclamation signed Aug. 25, 2014.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Detoxification for Athletes: The Key to Winning Performance
One of the most dangerous culprits that affects an athlete's ability to perform at an optimum level also happens to be one of the most elusive.
Take Care of Your Skin: Tips to Pass on to Your Patients
Many of our patients are not aware that the largest organ in the human body is actually the skin. Accounting for 16 percent of total body weight and covering up to 22 square feet of surface area, the skin is more than just a "covering," as originally thought.
From the Other Side of the Table
People come to us to gain freedom from pain, to feel better, to live better. As D.D. Palmer stated, "We Chiropractors work with the subtle substance of the soul." Therein also lies the rub.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
The Life & Legacy of James Sigafoose, DC (1933-2014)
Surrounded by his family and closest friends, Dr. James M. Sigafoose passed away quietly on Thursday, July 3, 2014. With his wife of 60 years, Patsy, along with his children, Tina, Daun, Kieth, Selina and Carey – all chiropractors – at his side.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Ringing in a Fiscal New Year With a Recommitment to Cost-Effectiveness
Back when the Foundation for Chiropractic Education and Research was in its heyday, I used to send out New Year's greetings and virtual noisemakers to some close friends on July 1 – the beginning of our new fiscal year – wishing for prosperity in the year ahead.
How to Find Your Ideal Patient – and Help Your Ideal Patient Find You
Just imagine: You're at the front desk looking at the scheduler and a smile creeps across your face. Row after row, name after name, hour after hour; you're blessed with an entire day of ideal patients. Every day should be like this, you whisper. Exactly!
Decompression-Traction: A Core Treatment Method in Chiropractic's Future
We're all competing for new patients. We're competing for new patients with physical therapists, massage therapists, medical specialists and hospital fitness centers. We're even competing with side-effect-ridden medications that quit working every four hours.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
May, 2013, Vol. 13, Issue 05
The Journey to Find the Cause of a Pain in the Butt
By Debbie Roberts, LMT
I hope that title caught your attention because I like to get you questioning and thinking before we begin. I'm going to be talking about a possibly new term I may have just coined: sports butt.The definition is a non-specific condition that might be known as a royal pain in the Assumption. This is what I encountered recently when working with a gentleman that had pin point pain located at the ischial tuberosity, with some radiation of pain from time to time down the back of the leg and occasional groin pain.
The client is an avid walker of 4-5 miles per day, post runner and 73 years old. He presented with pain on sitting, pain on walking when his heel struck the ground, pain on straight leg raise, and pain that was chronic located in one circular area at the hamstring origin and lower hip rotator region. In addition, he had a medical diagnosis of spinal stenosis by x-ray results. He cannot have an MRI because of his pace maker. The unresolved pain sent me on this journey to find out everything there is to know about what causes a pain in the butt. So, I invite you on this journey with me to learn the many reasons behind a pain in the bum.
The Many Names Of Sports Butt
The names and definitions vary, but here are some of my favorites. In the Myofascial Pain and Dysfunction The Trigger Point Manual, you get the term "Chair-seat Victims." Think of the activity of cycling.
Another of my favorites is "Yoga Butt," a term for a range of symptoms frequently experienced in Ashtanga and other forms of Vinyasa or Power yoga. This is typically blamed on the over stretching of the hamstring.
"Weavers Bottom" is inflammation of the bursa that separates the gluteus maximus muscle of the buttocks from the underlying bony prominence of the bone that a person sits on (ischial tuberosity). Weaver's bottom is a form of bursitis that is usually caused by prolonged sitting on hard surfaces. Also known as ischial bursitis.
"Ischial tuberosity pain" is the point of origin of the adductor and hamstring muscles, as well as the sacrotuberous ligaments. The forceful pull of these muscles can happen during a variety of sports, as a result of a trauma, such as a fall or other type of injury, or through the overuse of the hamstrings, as in the case of my client an avid walker/post runner.
"Piriformis Syndrome" is another common term. The piriformis muscle is responsible for the symptoms of the piriformis syndrome and is a "double devil" because it causes as much distress by nerve entrapment as it does by projection pain from trigger points.
"Ischiofemoral Impingement" is when the lesser trochanter of the upper femur is impinging on the ischial tuberosity. The quadratus femoris muscle, which is near the piriformis deep under the gluteus maximus, is often irritated in this syndrome. An MRI is the best study of this condition which will show the measurements of the left/right distances from the lesser trochanter to the ischial tuberosity.
"Sciatica" is perhaps the most well known and its symptoms include pain that begins in your back or buttock and moves down your leg and may move into your foot. Weakness, tingling or numbness in the leg may also occur. The most common cause of sciatica is a bulging or ruptured disc in the spine pressing against the nerve roots that lead to the sciatic nerve. Sacroiliac joint dysfunction happens when patients usually experience pain in the low back or hips. So, which one do you think he had? Tough decision, right? There are a lot of things that can cause hip and buttocks pain. Where would you begin?
Patient History And Evaluation
Orthopedic tests and my clients test results:
I do want to remind you that the reason you still do the orthopedic tests are not to find another diagnosis (which is outside our scope of practice) but to rule-out should they be in your care and/or is there another medical referral that should be made.
Let's rule out some other things together. Since he was an avid walker, maybe it's sports related and an ischial tendonitis? He has a very small pelvis with a posterior tilt, so maybe it's ischiofemoral impingement of the quadratus femoris muscle? He also has lack of internal hip rotation and groin pain, so maybe it's DJD or a torn labrum? He had loss of strength in the gluteus maximus, so maybe it has to do with the trigger point or sciatic nerve? He had removed his orthotic that was placed in his shoe to help with his foot pronation, so maybe it's piriformis syndrome?
All of these things ran through my mind, including his diagnosis already from the orthopedist that said his pain was probably due to spinal stenosis. He was given an injection that didn't help. That is also why he asked for my help because the injection and anti-inflammatories really hadn't helped change his pin-point buttock pain. He is a winter resident and had received deep tissue massage therapy up north which, for awhile, gave him temporary relief of symptoms. He sought out an orthopedist there with no resolve. He visited a chiropractor who told him 30 visits of spinal decompression would relieve the pain. He did not go forward with this option yet.
Here is some of the therapy I used during his visit: myofascial release to the hip complex with cupping (hoping if it was impingement we could relieve some compression), PNF stretching to the psoas (thinking of helping his postural distortion), isometrics around the hip complex (helping reset the muscle spindle fibers for length), direct tissue work to quadratus femoris (possible relief of ischial impingement), hamstrings,adductors, IT band, quadriceps and muscle energy techniques for the SI dysfunction.
He was happy and thrilled for about a day. Then his symptoms returned, but were different in that the direct pin-point pain wasn't there. I was still hopeful. I re-evaluated and treated again, and got a phone call saying, "it's gone, no pain." Two days later, with one episode of prolonged sitting, it returned. I re-evaluated and treated again, for the third time and with one day of absolutely no pain. Then, you guessed it, he went for a walk and within a quarter of a mile the pain was right back to square one.
I know what you are thinking. Why doesn't he avoid things that would aggravate it? Well, he did that, too, for more than four weeks. The pain in the butt was just never relieved more than temporary. This is my personal rule if it returns after three or four visits: the patient requires another medical evaluation and opinion. What causes pain? Our choices are nerve, bone or muscle-fascia. Because we work with muscles, the therapist can sometimes get fooled into thinking that it just has to be a muscle impinging on a nerve. This is limited thinking and can be the mistake of any professional who specializes.
Well, are you ready for what it was? Finally, a CT scan revealed a ruptured disc. The doctor is confident that specific pain relieving injections will do the trick. However, the physician said he is open to further investigation to rule out ischiofemoral impingement in the event the injections don't work. Why write an article in a massage publication about something that wasn't helped by massage. Well, as therapists it is always good to look at all the possible causes of pain and postural dysfunction.
"Every master knows that the material teaches the artist," IIya Ehrenburg (1891-1967). Even with all the orthopedic assessments we have available to us today this still is not enough. We can often times be fooled by thinking it is a muscle because we are in the business of treating dysfunctional muscles and getting temporary relief of symptoms. By not over treating and encouraging the patient to seek further tests, we play a vital role in our clients' health and well-being.
Editor's Note: For more information from Debbie Roberts, visit http://youtu.be/hmgBLjx5tvc.
Click here for more information about Debbie Roberts, LMT.
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