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Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
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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