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Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
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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