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TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
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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