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Breathing Techniques To Resolve Patient Issues
When a patient of mine who has practiced yoga for nearly 30 years, told me that she was experiencing panic attacks, I was surprised. "After so many years of training, can't you turn them off?" I asked. "I do turn them off, but only temporarily," she replied.
Unlocking Secrets of the Pelvis (Pt. 3)
In part 1 of this series [Aug. 15 issue], we began to identify the many asymmetries human beings are all born with and detail how these asymmetries, when they become excessive or unchecked, can create a cascade of imbalance in every system of our body, resulting in dysfunction, pain, degeneration and eventually disease.
Patellofemoral Pain: Fascial and Exercise Treatment
I recently had a male high-school senior come in who was having some patellofemoral pain, as well as some distal iliotibial band (ITB) pain. He had just started end-of-summer training to play high-school football.
Continuing Education Showdown: Online Learning vs. In-Person Seminars
Many state TCM and acupuncture regulatory bodies and associations are interfering with the success of their members by limiting the number of continuing education credit hours they can earn online.
Acupuncture Today Continues To See Unprecedented Growth
For the past decade, the profession has seen steady growth in stature with legislators and the general public. The growing presence of the profession has been directly reflected in the growth of our publication.
The Lateral Subsystem and Lower Extremity Pain
Human locomotion is an incredible demonstration of muscle activation, timing, sequencing and patterning. The very idea that we can stand upright and put one foot in front of the other to get from point A to point B without falling down is miraculous.
Promoting Acupuncture with Acupressure Demonstrations
Dan and his wife Marla were admiring the beautiful bouquet of flowers at our booth at the Business Expo when our receptionist asked him if he knew anyone who had tried acupuncture.
Leaving a Vision of the Future Behind
Jeff Nelson, president / chief executive officer of Northwestern Health Sciences University since April, died suddenly on Oct. 22 as the result of a gunshot wound.
Acupuncture In Haiti: Aid that Works
I recently returned from Haiti. So many people ask whether Haiti has recovered since the earthquake of January, 2010. Once you've been to Haiti, you would never ask that question. It doesn't make any sense.
Sports Media Legend Joins the TIPS Team
The Foundation for Chiropractic Progress developed "Athletic TIPS" (Towards Injury Prevention in Sports) in an effort to address the growing concern of sports injuries.
Peer Points: In The Business of Herbs
When it comes to herbs, acupuncturist Cathy Margolin wants her patients and customers to know she is the expert they need. In order to do this, Margolin has studied the marketplace and incorporated key business lessons to build an herbal company that sells and markets herbs to the masses who may be skeptics.
Partnerships Leverage Power for Our Profession
While there are many recognized benefits and advantages to developing partnerships between organizations, the main reason why partnerships are established is relatively simple: There is added value in working together for a common cause or purpose.
50 Million Opportunities
Toca! Tira! Golasso! While you may not recognize these words ("Touch! Shoot! Goal!"), I hear them often.
Educating the Growing Hispanic Population About the Value of Chiropractic Care
Chiropractic was given the spotlight on the largest and highest-rated Hispanic television network in the U.S., Univision.
Acupuncture: The Key and Future of High Sports Performance
Acupuncture is commonly utilized in the intervention of pain and has also been gaining popularity in sports medicine. Athletes are treated with acupuncture for the relief of soft tissue injuries such as sprains, muscle strains, and tendonitis.
Managing a High Protein Diet
One of the most common clinical presentations in today's clinic is patients following a high protein diet. It seems that every year a new version of a high protein diet appears promising weight loss and physical transformation.
Facial Rejuvenation: The Key to Exceptional Results
Acupuncturists make the best detectives. I know this first hand because I'm an acupuncturist and a private investigator and in both professions, there is a need to dig deep to solve the mystery.
The Newest Public-Health Epidemic: Sitting Too Much, Moving Too Little
In my last column, I wrote about sitting versus standing at work. ("Sit or Stand? Strategies to Improve Workplace Health and Reduce Disease," Oct. 1 DC) I wrote the article from the perspective of an ergonomist.
Studies: Acupuncture Effective For Depression
Many people suffering from depression can find a natural and effective way to treat their symptoms with acupuncture, according to the latest study.
German Auricular Acupuncture: Effective For Your Patients
Auricular medicine as developed by Western medical doctors in Europe is a complete modality of diagnosis and treatment. Unlike body acupuncture, auricular acupuncture is treating the central nervous system rather than meridians.
21st Century Marketing: Five Ways to Use Social Networks as a Customer-Service Tool
As the popularity of social networks grows among businesses and professionals, customers' expectations about how they will be served through these networks continue to evolve.
We Get Letters & E-Mail
Change: Healthy and Inevitable; Our Scope of Practice Needs to Change; Chiropractic Physicians Deserve to Be Accurately Informed.
Electric Qigong: An Ancient Therapy Evolves
Recently in a small, dimly lit treatment room in downtown Taipei, Wesley Chen instructed his patient to lie down. A frayed wire, which he wrapped around a small piece of metal, is now plugged in.
Does Copper in Your Multivitamin Cause Dementia?
For the past year or more, I have been asked about whether it is safe to take multivitamins with copper because of a fear that is apparently spreading. The fear is that 1-2 mg of copper in multivitamins supposedly causes dementia and/or Alzheimer's disease.
A Tribute to Richard D. Yennie, DC (1928-2013)
It was with sadness that I read the obituary of Dr. Richard Yennie in the Oct. 20, 2013 Kansas City Star. However, reading it also brought reflection and warm memories, as he was a close family friend of my grandparents, Cleveland College founders Drs. Ruth and C.S. Cleveland Sr.; and my parents, Drs. Mildred and Carl Cleveland Jr.
PCOM Symposium Celebrates 25 Years
Acupuncture and Oriental medicine practitioners and students, as well as providers representing various other health care disciplines, flocked to San Diego's Catamaran Resort Hotel to attend the PCOM Annual Symposium on Oct. 24-27.
Acupuncture & Substance Abuse Rehabilitation
One of the most rapidly changing areas of healthcare is that of addiction medicine. Advances in brain imaging technology have allowed doctors and scientists to understand addiction, and recovery from addictive disorders, at the level of the individual neuron in the brain.
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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