resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
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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