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How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
November, 2013, Vol. 13, Issue 11
Examining the Anterior Pelvic Tilt
By Whitney Lowe, LMT
We are all aware that posture or body position plays an important, if not crucial, role in the healthy function of our musculoskeletal system. Some types of compromised or dysfunctional posture are easy to evaluate.Elevated shoulders or forward head posture, for example, are frequently cited as key components of upper back, neck and headache pain.
Pelvic alignment is frequently noted as a key factor in many soft-tissue disorders as well. Yet determining ideal pelvic alignment is challenging and there is often misinformation about what actually produces pelvic misalignment. Let's take a closer look at specific biomechanical characteristics of pelvic alignment and their importance in constructing an appropriate treatment plan.
Pelvic Tilts Defined
The most common pelvic misalignments are referred to as pelvic tilts. There are three types of pelvic tilt: anterior, posterior and lateral. This article takes a detailed look at the anterior pelvic tilt, and explores key principles of how they develop, common misunderstandings and treatment considerations.
Let's clarify some anatomical and biomechanical principles first. The pelvis is composed of two halves which join anteriorly at the pubic symphysis and posteriorly at the sacroiliac joint on each side. Each half of the pelvis is also referred to as an innominate bone (consisting of ilium, ischium and pubis). Each innominate moves independently of the other, although most frequently we see pelvic misalignments involving the two innominates moving together. For our purposes in this article, assume that both innominates are moving together.
Each of the pelvic tilts involve rotary motion whereby one bone is rotating around an axis point of another. A simple analogy is a pinwheel which rotates around a point at the center of the pinwheel. The point at the center of the pinwheel is called the axis of rotation (Figure 1). It is crucial to understand the anatomical axis of rotation for pelvic tilts, because this is one of the key factors that leads to common misunderstandings about how a pelvic tilt functions biomechanically.
In an anterior tilt, the pelvis tips downward in an anterior direction so the pubic symphysis moves inferiorly (Figure 2). A common misconception about the anterior pelvic tilt is that the axis of rotation is at the sacroiliac joint. There is only a minor degree of movement capable at the sacroiliac joint and not enough to provide significant rotary motion. The actual axis of rotation for anterior pelvic tilt is at the iliofemoral (hip) joint.
An anterior pelvic tilt is most commonly caused by the combined actions of muscles on opposite sides of the body which act together to create the dysfunction. Tightness in the iliopsoas and rectus femoris (hip flexor) muscles combined with tightness in the erector spinae, multifidus and quadratus lumborum (back extensor) muscles produce the anterior tilt. These muscles act like a force couple to produce the anterior rotation (Figure 3).
The anterior pelvic tilt simultaneously creates an exaggerated lumbar lordosis. Many individuals with this postural distortion are told they have weak abdominal muscles and need to focus on strengthening exercises to offset the postural distortion. However, if the underlying muscular dysfunction of the hip flexors and low back extensors is not addressed, strengthening exercises of the abdominal muscles will have little benefit.
There are other detrimental effects that result from the anterior pelvic tilt. When the lumbar lordosis is increased, there are greater compressive loads on the posterior vertebral arch structures. The increasing compressive loads on these posterior vertebral structures can lead to facet joint irritation, stress fractures in the vertebrae, increased disc pressure and early disc degeneration.
Unfortunately, there is no highly reliable method for determining the presence of an anterior pelvic tilt and, if present, how severe it is. The lack of a reliable method for identifying this postural dysfunction has led to a number of erroneous theories and misconceptions about causes and treatment. Let's take a look at one of the more common erroneous theories.
It is a common misconception that an apparent leg-length discrepancy is caused by one innominate being excessively anteriorly rotated and "pushing" the lower extremity of that side in an inferior direction. If you envision a person supine on the treatment table, it's easy to see how one might come to that theory. If the innominate on the right side is anteriorly rotated, it seems that it might push the right lower extremity in an inferior direction and produce an apparent leg-length discrepancy.
The problem with this theory is that it discounts two key issues: the axis of rotation at the hip joint and the difference between pelvic movement in weight-bearing and non-weight-bearing positions.
Because the axis of rotation for an anterior pelvic tilt is at the hip joint, the pelvis rotates around the hip and therefore does not push the lower extremity in an inferior direction. Just as we would not expect the pinwheel to push its stem farther from the center, rotary movement around an axis does not cause the stem (lower extremity in our case) to be pushed inferiorly (Figure 4).
The assumption that an anterior pelvic tilt would push the lower extremity inferiorly also discounts the fact that when you are standing on the lower extremity, the pelvis physically cannot push the leg down. Instead, the pelvis rotates around the hip joint. A leg length discrepancy which is caused by muscle imbalance is far more likely to result from tightness in the quadratus lumborum muscle which pulls one side of the pelvis (right or left) higher. We will explore the ramifications of lateral pelvic tilt in another article.
The reason it is important to accurately understand the causes for these postural distortions is that our perception of their cause directs our treatment. A focus on the iliopsoas muscle as the primary cause for an apparent leg-length discrepancy would be unsuccessful when the true source of the problem is the quadratus lumborum.
In most cases, the anterior pelvic tilt is produced by dysfunctional muscular mechanics. Treatment should focus on reducing hypertonicity in the lumbar extensors and hip flexors. However, any treatment that reduces tightness in these muscles is unlikely to be successful by itself. Postural retraining is almost always an essential component to ensure that the same dysfunctional patterns are not repeated and re-engaged immediately after treatment.
Pelvic biomechanics can be challenging to accurately identify, but a fundamental awareness of these anatomical and biomechanical principles will help direct treatment in the right direction so the most beneficial results may be achieved.
Click here for more information about Whitney Lowe, LMT.
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