resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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!
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."
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.
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.
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.
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.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
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.
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.
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.
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."
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.
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.
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.
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.
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.
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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