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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.
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.
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.
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.
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.
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!
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.
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.
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.
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.
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.
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...
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.
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.
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.
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.
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."
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.
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.
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.
March, 2014, Vol. 14, Issue 03
Resolving Hip Flexor & Rotator with Rehabilitation of the Core
By Don McCann, MA, LMT, LMHC, CSETT
A common client complaint is hip pain that can be acute such as pain after a sports event, hike, car trip or sleeping wrong, or as major and chronic as a dislocation, degeneration or long term sciatic pain.The interesting key to effective long term treatment is that the above issues stem directly from an imbalance in the pelvis that all clients have with one ilium rotated anteriorly and the other ilium rotated posteriorly. This is the core distortion which is observable to some degree in everyone.
As mentioned in previous articles, the core distortion can be observed in 16-week-old fetuses and we have yet to find anyone who is not in the core distortion when evaluated. The only exceptions are clients who have been previously treated with the cranial/structural core distortion release combined with myofascial protocols. The vast majority of your clients will have the ilium rotations of the core distortion that create both structural imbalances and issues with their flexor and rotator muscles of the hips. It can be assumed that, except for the very rare exception, the clients who walk into your clinic with problems in their hips are in the core distortion and could dramatically benefit from unwinding this distortion into weight bearing support and balance. Let us look at some brief case histories that demonstrate the problems and the solutions for hip issues.
Ginny, a 19-year-old tennis player, strained her left hip flexor in a tennis match. She continued playing to finish the match and then spent a night in pain. When she presented for treatment, she was in significant pain and having difficulty walking. Her evaluation revealed an anterior rotation of her left ilium and a posterior rotation of her right ilium. She was in the core distortion. Of note, when an ilium is rotated more than 15 degrees, the flexor muscles of that ilium can only operate at a 50% or less strength and efficiency. The left hip flexors that had been strained were the anterior fibers of the gluteus medius which were weakened due to the core distortion.
The cranial/structural core distortion release was applied to release the anterior/posterior ilium rotations and provide stability for the sacrum and spine. This also equalized the functional leg lengths caused by the rotation of the iliums. There was an immediate strengthening of the quadriceps and gluteus medius on the left side which immediately increased the strength, range of motion and flexibility of the strained tissues. This was followed by a specialized myofascial/soft tissue protocol to further release ischemia, swelling and inflammation, the old myofascial holding pattern from the core distortion and scar tissue and fibers from previous strains and injuries. Since the anterior/posterior rotations of the iliums in the core distortion affected the soft tissue differently in each leg, this soft tissue protocol was designed to release the different tensions and holding patterns specific to each leg. After two sessions, Ginny was back playing tennis pain free and moving with more speed strength and flexibility than before the injury.
Charlie, a 61-year-old salesman with a large territory necessitating a lot of driving, was having severe right side sciatic pain when sitting in the seat and driving for more than 45 minutes. This had gotten so bad he had to consider retiring early. A structural evaluation showed that Charlie was in the core distortion with a left anterior ilium and a right posterior ilium. This created the functional long left leg/short right leg consistent with the core distortion. Charlie's right gluteus maximus, posterior fiber of gluteus medius and piriformis all tested weak using kinesiology which indicated more than a 15 degree posterior rotation of his right ilium. These muscles were also tightly contracted to compensate for the weakness. The cranial/structural core distortion release was applied to release the anterior/posterior rotation of the iliums and provide stability for the sacrum and spine. This also equalized the functionalleg length and allowed some unwinding of the soft tissue myofascial holding pattern of the core distortion.
Specific soft tissue myofascial protocols were applied to assist the anteriorly rotated ilium to unwind back to balance and the posteriorly rotated ilium to unwind forward into balance. These protocols released the chronic inflammation and ischemia, the myofascial holding pattern of the core distortion and lengthened individual muscles and fibers that were compressing the sciatic nerve. Charlie noticed immediate improvement with less sciatic pain. He was treated weekly for four weeks and had decreased pain with longer periods of pain free driving. At the end of the fourth treatment, Charlie was no longer having sciatic pain, was able to maintain his improvements and was able to resume his normal life activities.
Steve, a 69-year-old business owner and avid golfer, had severe hip pain. Over the years, he experienced left hip pain that had originally been diagnosed as arthritis and was now being viewed as major degeneration of the hip requiring a hip replacement. Steve had been told when the pain became bad enough that he would have the replacement. Steve's x-rays showed arthritic spurring and a significant thinning of the cartilage on the anterior superior surface of the femoral head (ball) of the femur. He had been receiving injections into the joint that had initially helped some, but now the pain had intensified and become more consistent.
Upon evaluation, Steve had an anterior rotation of the left ilium and posterior rotation of the right ilium which indicated the core distortion. With the anterior rotation of the left ilium, the anterior fibers of the gluteus medius and gluteus minimus were shortened, tightened and weakened resulting in more pressure on the femoral head (ball) where the cartilage had thinned and the spurring was occurring. This anterior rotation of the ilium also produced a functional long leg which was further jamming the femoral head into the hip socket and involving the hip flexors.
Steve's body was compensating for the longer leg by rotating the knee medially and the foot laterally to the knee which was also putting pressure in the hip. This degeneration is common with the core distortion as a person goes through life deteriorating further into this distortion due to wear and tear and life experiences. The cranial/structural core distortion release was applied to bring the anterior ilium posteriorly into balance, the posterior ilium anteriorly into balance, level the sacrum for spinal support and even the functional leg length. Soft tissue myofascial protocols were applied to the left leg and hip to further balance the pelvis, bring the medial rotation out of the upper leg and knee and the lateral rotation out of the foot. This shifted the weight bearing pressure in the hip more to the middle of the femoral head (ball) away from the area of greatest degeneration on the anterior superior part of the ball. In addition, the fibers of the gluteus medius and quadriceps were strengthened when the rotation of the iliums was reduced and they started functioning with greater support, strength, range of motion and flexibility. Additional protocols were also applied to the right ilium so both iliums could function in balance and support and would not be compensating for the imbalances in the opposite hip.
Steve's first three sessions reduced the core distortion in the leg and hips and prepared the area for deeper work into the deepest fibers of the gluteus medius and gluteus minimus. There was also significant fiber and scar tissue that built up around the femoral head that was trying to compensate for the imbalance due to the rotation from the core distortion. Sessions four through seven worked deeper on these deep fibers until they softened and lengthened and were in themselves no longer a cause for pain. Steve was then able to spread his sessions out from weekly to once every two weeks then once every three weeks as the new pattern became progressively stronger and the pressure was shifted off of the anterior portion of the femoral head. Steve resumed playing golf without pain. The release of the core distortion and balancing of the leg rehabilitated Steve's hip to the point that he no longer needed a hip replacement and was able to golf. Steve's hip flexors had played a major role in the degeneration due to their weakness and chronic shortness from the core distortion helping to hold the pressure of the hip on the anterior portion of the femoral head.
Hip flexor problems are involved in the core distortion both by being weakened and susceptible to injury and in helping to maintain dysfunction and imbalance in the hip joint. The rotators can be overstretched due to the medial rotation of the upper leg on the side of the anterior rotation of the ilium or can be over contracted as part of the myofascial holding pattern and muscle compensation of the posteriorly rotated ilium in the core distortion. These common conditions can create significant problems throughout the hip. Preventing problems in the soft tissue or hip joints, or rehabilitating already existing problems can be very effective long term when integrating cranial/structural core distortion releases with specialized myofascial soft tissue protocols.
Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.
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