resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Climbing the Ladder of Opportunity (Part 1)
President Obama spoke of building "ladders of opportunity" in his State of the Union and Inauguration addresses.
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
Betraying Patients and the Profession
Imagine flying from New York to Paris on a jumbo 747. Your thoughts are on your vacation and experiencing the City of Lights. Midway over the Atlantic Ocean, you overhear the flight attendants talking in muffled voices.
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
New Knee, New Pain (Part 2)
The patient presented to the chiropractic clinic with symptoms of genu varum and pain on the medial aspect of the tibiofemoral joint.
Look, Listen and Learn to Code
Study of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) coding system can leave a doctor of chiropractic a bit confused. The description of the five new-patient and five established-patient examination codes takes up several pages in most coding books. The degree of detail and charts used to describe the codes can be overwhelming.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
News in Brief
Parker Announces Executive Director of Parker Professional; Athletic TIPS Program Getting Financial Support; ANJC Award Recipients Named.
Ask and You May Receive
A friend of my mother has had a problem with her ears for almost 20 years. Whenever the wind blows, it sends shooting pain through her jaw. She has seen any number of medical specialists over that time, but with no relief.
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Increased Breast Cancer Risk: Another Implication of High Cholesterol
In addition to being a known risk factor for heart and cardiovascular disease, recent studies have highlighted the link between high cholesterol and increased risk of breast cancer. Breast cancer is the second most common malignancy in women after skin cancer.
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
We Get Letters & E-Mail
Let's Restore Integrity to Health Care – Starting With Us; MDs Offer More – So Can We.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
Why Stretching Doesn't Work
Like most chiropractors, a good part of my day is spent working with sedentary office workers who spend eight to 12 hours a day glued to a desk chair in front of a computer.
Putting Public Health Into Action: Thinking Globally, Acting Locally
The Chiropractic Health Care section of the American Public Health Association (APHA) met at the 141st APHA Annual Meeting and Exposition in Boston late last year, and it was another triumph for chiropractic and its public health advocates.
An Introduction to Evidence-Based Clinical Practice - Again
One of your patients is in for treatment and catches you off guard by asking you a question about a news article she recently read. It seems that a new intervention for back pain was found to reduce the rate of serious side effects by 50 percent.
The Many Faces of Cervical Compression
When evaluating the neck, there are any number of orthopedic tests to be considered.
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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