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Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
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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