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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 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.
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.
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.)
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
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.
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.
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.
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.
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.
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.
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.
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.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
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.
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.
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 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.
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.
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.
May, 2014, Vol. 14, Issue 05
Myofascial Pain from the Gluteus Maximus
By David Kent, LMT, NCTMB
Client reports, "I have low back pain," as they rub the palm of their hand over their sacrum and ischial tuberosity. They walk with a limp to avoid standing on the painful side (antalgic gait) and are unable to find a comfortable seated position.Hip flexion is limited. Their sacrum and/or coccyx are tender to touch. While each symptom could have numerous origins, let's look at referred pain from myofascial trigger points (TrPs) in the gluteus maximus muscle.
There are numerous ways to differentiate trigger points in the gluteus maximus muscle from trigger points in the gluteus medius, minimus and deep hip rotator muscles, including the location and depth of the trigger points, the referred pain patterns identified and the specific movements that are restricted.
First, a quick anatomy review, proximally the gluteus maximus muscle attaches to the posterior surface of the ilium, posterior surface of the sacrum and coccyx and the sacrotuberous ligament. Distally, the majority of the fibers merge into the iliotibial tract, which is a thickened region of the fascia lata, which attaches on the lateral condyle of the tibia. The remaining fibers attach on the gluteal tuberosity of the femur. (Photo 1) The gluteus maximus muscle is innervated by the superior gluteal nerve (L5-S2).
The main action of the gluteus maximus is extension of the thigh at the hip. It also assists in lateral rotation of the thigh. When standing in forward flexion, the gluteus maximus works with portions of the erector spinae and hamstrings help us to stand erect. Gluteus maximus can influence posture by posteriorly rotating the innominate bone. When you are checking the client's range of motion, if the gluteus maximus is shortened, it will restrict flexion at the hip, verses the gluteus medius and minimus effecting adduction.
Just one or a combination of factors can cause trigger points to develop in the muscle including direct trauma from a fall, muscular stress from poor posture or improper workplace ergonomics. Repetitive movements that include leaning forward, ie: lifting a baby from a crib or lifting boxes off the floor, walking up an incline, hiking up a hill, jumping or running, are possible factors. Sometimes, the cause is a new exercise that requires hyperextension of the hip and low back when standing or prone (ex. swimming the crawl stroke).
Three regions in the gluteus maximus muscle have been identified for locating myofascial trigger points. Each trigger point region produces unique pain patterns. In photo 2, "X" indicates the common location of trigger points and the red color indicates the pain referral areas. Clients will describe the referred sensations from a trigger point as: pain, burning, tingling, numbness, aching, etc.
The region labeled Trigger Point 1 (TrP1) is immediately lateral to the midpoint of the sacroiliac joint. Referred pain from TrP1 can cover the sacroiliac joint, the gluteal cleft and continue over the ischial tuberosity. A small spillover pattern into the upper portion of the posterior thigh is sometimes reported. (Photo 2)
The second region, labeled (TrP 2), is just superior to the ischial tuberosity. Referred pain is often felt over the sacrum (not the coccyx or rectum), over the ischial tuberosity and buttock. The pain may feel like it originates in the deeper muscles. (Photo 2)
The third region (TrP 3) is located in the most medial and inferior fibers and can be the source for coccygodina (pain in or around the coccyx). (Photo 2)
Manual therapy techniques are one link in the healing chain. Teach client's self-care techniques like stretching. Show them how to stretch, when to inhale and exhale, where to place there hands, how to pull their knees to their chest or toward the opposite shoulder, etc.
Client education often involves explaining the negative effects of sitting all day with a wallet in their back pocket. If the client sleeps on their side, suggest they place a pillow between their knees to avoid over stretching the gluteus maximus at night.
Pain over the sacrum, coccyx and ischial tuberosity can start for many reasons. I hope it will be easier to identify and locate these three myofascial trigger points in the gluteus maximus.
Click here for more information about David Kent, LMT, NCTMB.
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