Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
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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