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Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
March, 2014, Vol. 14, Issue 03
Learning How to Track Anterior Knee Pain
By Whitney Lowe, LMT
How many times have you heard someone say "Oh my aching knees?" It happens with frequency among athletic populations, but just as frequently plagues individuals who are not highly active. Unfortunately, people may have their condition dismissed and told it is just arthritis and they can live with it or perhaps take anti-inflammatory medications.Yet, in many cases, anterior knee pain is a soft-tissue problem that involves complex biomechanics of the knee that are not thoroughly evaluated and could be effectively treated with soft-tissue approaches like massage. A deeper look at these structural and mechanical issues helps in developing a better plan for using massage in addressing anterior knee pain.
There are several key anatomical structures that play a role in anterior knee pain. The quadriceps muscle group has the primary role of producing the power of knee extension for locomotion. Knee pain doesn't usually derive directly from the quadriceps muscle. More often, dysfunction lies in the distal tendon of the quadriceps muscles or the other connective tissues that connect the muscle group to the tibia.
The majority of quadriceps fibers attach to the tibia by way of the patellar tendon. However, the connection of the quadriceps with the tibia is not limited to the patellar tendon alone. The quadriceps retinaculum, also called the extensor retinaculum, has a key role in helping transmit the contraction force of the muscles to the distal tibia (Figure 1). The retinaculum is often overlooked as a pain producing tissue, but it is frequently the cause of anterior knee pain when patellar tracking disorders are present, which are discussed below.
The patella is another structure that is crucial to knee function, but often misunderstood. It is commonly thought that the primary function of the patella is to protect the knee. But that's not really its role. Its primary function is to improve the power of the quadriceps. Because the patella is embedded within the patellar tendon, it acts like a fulcrum to pull the tendon farther away from the joint's axis of rotation making the quadriceps group more powerful (Figure 2).
Biomechanics and Tracking Disorders
The patella has a ridge on the underside of it and this ridge fits in the groove between the two femoral condyles (Figure 3). As the knee moves in flexion and extension the patella tracks in a superior and inferior direction. The ridge of the patella must stay centered between the femoral condyles for proper knee mechanics.
Unfortunately, in many cases the patella does not track straight up and down in the groove. Muscle imbalance and other alignment factors such as a large Q angle can lead to problems in correct patellar tracking. When the patella is tracking incorrectly it is most commonly pulled in a lateral direction. This is called a lateral tracking disorder.
If not corrected, tracking disorders in the patella can cause long-term degeneration of the knee. If the patella is being pulled to one side it causes excess friction between the underside of the patella and the femoral condyles. The excess friction produces a softening and degeneration of the articular cartilage on the underside of the patella, which is a condition called chondromalacia patellae.
Tracking disorders of the patella cause anterior knee pain, but there is still some controversy as to which tissues are the source of the primary pain. For example, it was once thought that tracking disorder pain was caused by the cartilage degeneration of chondromalacia. However, the articular cartilage has very little innervation, so it is unlikely that cartilage degeneration is a primary source of knee pain. The layer of bone just underneath the articular cartilage is called subchondral bone. It is richly innervated and it is likely that tracking disorder pain may result from damage that has extended all the way to the subchondral bone.
There is another likely explanation for anterior knee pain resulting from tracking disorders that does not appear as frequently in much of the orthopedic literature. The patellar retinaculum and other connective tissues that help attach the quadriceps to the tibia are also richly innervated. An imbalance of tensile forces on these retinacular tissues can cause anterior knee pain in the soft tissues.
An effective way to identify if the retinaculum and other extensor mechanism connective tissues are a key factor in the anterior knee pain is to stress these tissues while palpating them. The most effective way to do this is to perform a resisted knee extension and palpate with moderate to deep pressure all of the connective tissue structures around the knee while the contraction is held. This same procedure could be done by engaging an eccentric contraction of the quadriceps muscles while these structures are being palpated. The eccentric contraction has the tissue being lengthened at the same time it is being deeply palpated, which exaggerates the stress on the tissue and makes it easier to identify problem areas.
Many tracking disorders originate from imbalance in the pulling forces between the different quadriceps muscles. Massage can be a highly effective means of helping to restore normal biomechanical balance in the knee. Unfortunately, it is greatly underutilized in the traditional rehabilitation community for addressing this problem. Invasive techniques such as cutting the lateral retinaculum surgically so it doesn't pull the patella so far laterally are often used before all conservative measures been attempted.
Massage treatment can be very helpful in balancing the excess pull from the lateral side of the patella. Once the key areas of tightness and sensitivity have been identified they can be addressed with very specific stripping techniques and those involving active engagement as well. By applying deep specific elongation techniques with a small contact surface like a thumb, fingertip, or pressure tool, the practitioner is able to provide a highly specific treatment strategy that is more focused than many of the other general approaches such as relying only on strengthening techniques to restore balance in the region.
Many practitioners have shown and demonstrated excellent clinical results with soft-tissue treatments for tracking disorders. Now we need to compare those treatments with more traditional methods and see if they are clinically effective across the board. If they are found to be more successful, and it is likely that they would be, there would be a greater body of supporting evidence to encourage a different treatment approach that includes massage.
Click here for more information about Whitney Lowe, LMT.
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