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Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
The Aspiration to Prevent Hip, Knee and Shoulder Replacements, Part 2
The extrinsic variables that contribute to hip, knee and shoulder degeneration were outlined in my last column in the November 2014 issue. That article proposed that the hip and shoulder joints have a genetic propensity for subluxations. In the shoulder, this involves its anterior capsule, while for the hip joint this relates to its posterior capsule.
My theory suggests that this propensity comes to us from our primate evolution when our ancestors needed to develop ways to fall (as from trees) and somehow survive. For any who may have experienced a significant fall, our human tendency is to tuck and roll involving a sudden movement forward of one shoulder and a corresponding posterior movement of the opposite sided hip. Another way to appreciate this large body reflex is to reflect on the Olympian springboard and platform divers with their truly awesome ability to harness this capacity for combinations of flips, spins, tucks and rolls.
The second article of this series describes our internal anatomical structures whose cringing, shortening or twisting are proposed to be primary contributors for progressing toward hip subluxations.1,2,3 I theorize that hip subluxation and its accompanying typical soft tissue compensations are principal variables leading to many knee and hip replacement surgeries which are often attributed to the nebulous cause of aging.
To my perception, the primary factor in this all too common degenerative progression is how the femoral head interfaces with its socket, the acetabulum. Specifically, how shifts in each hip bone or, between both and the sacrum, may participate in pre-disposing hip subluxation(s) of the femoral head. Internal influences related to shoulder subluxations and further relationships influencing the knee joint will be addressed in separate articles.
My clinical experiences suggest that the cringing of the peritoneal sac, the shortening of the mesenteric root of the small intestine and the shortening of the tubes that comprise the ascending and the descending colons, are commonly associated with the local influences within the abdominopelvic cavity which can act on the lower spine and pelvis thus pre-disposing the posterior slide of the femoral head.4,5
Specifically, the ascending and descending colons have firm visceral ligamental attachments to the ilia and are incredibly powerful muscles very capable of distorting the acetabulum/femoral relationship. Additionally, the mesenteric root of the small intestine has the capacity to rotate the pelvis by virtue of its attachments to the left side of L2 and to the right sacro-iliac joint.6 Both of these structures are invested within folds of the peritoneal sac whose cringing response to stress or trauma initiates and exaggerates the responses of those previously described.1 Other organ attachments certainly co-participate as variables; yet, working with these three viscera have produced the most favorable outcomes for clients.
Consider the following: should the peritoneal sac, small intestine or large intestine structures contract significantly in response to a virulent digestive flu, food poisoning, extended constipation, infection or amebic dysentery then... "Katie bar the door, "... the relationship between the acetabulum and the proximal femur is rather likely to be affected. Little considered is the possible displacement of the acetabulum/femoral head relationship associated with these small and large bowel episodes. Sometimes everything settles back into dynamic balance yet, many times I propose, it does not.
Additionally, consider the mesenteric root of the small intestine experiencing a similar sequence of events: such a oblique/diagonal contraction between its left side lumbar attachments and its attachment to the right sacro-iliac joint may well induce a torque to the pelvis thus creating the pre-disposition of the femoral head to displace posteriorly, at least on one side.
Let's now consider the typical soft tissue compensations I have clinically experienced. When the femoral head slips posterior, I propose it begins to ride the edge of the acetabulum, thus creating a hip joint instability. The most common compensation pattern involves the gluteus medius and minimus muscles, the tensor fascia lata and its iliotibial band all contracting around the femoral head to prevent its possible dislocation. Ironically, this still allows relatively normal function and range of motion; yet, I propose that this fixes the femoral head against the lip of the acetabulum which over many years grooves a flat spot on the naturally spherical shape of the bone.
Further, I propose that any posterior glide is also accompanied by rotation of the femoral head which translates itself all the way down to its distal condyles creating rotation in the knee joint and contributing to the distortion of how the knee tracks in its normal flexion and extension movement during the walking cycle. Over time, this distortion of knee joint mechanics translates into compression, thus accelerating the wear and tear of its cartilages. It is no accident that roughly twice as many knee replacements occur than hip replacements during each calendar year.7 This is my proposed answer to how hip distortions influences knee degeneration.
Certainly, the iliopsoas is also a significant variable; yet, I suggest not in the manner you might imagine. More commonly, I believe that the psoas is often in spasm because of the posterior and inferior slide of the femoral head rather than the other way around. Its attachment to the lessor trochanter is being stretched by the posterior position of the femoral head. Also, the typical soft tissue compensations (the fixation of the gluteus medius and minimus, tensor fascial lata and the iliotibial band to prevent further displacement) create more inertia for the psoas contraction to overcome while initiating flexion of the femur in relationship to the trunk.
These protective contractions also disrupt the psoas' external rotation function that is essential to coordinating with the distal femoral condyles that participate in unlocking the knee and allowing it to functionally participate in a normal gait pattern.8 This extra effort to overcome the soft tissue protection of the hip joint over time influences the adductors to shorten in order to counterbalance the power of the femur's external rotation by the iliopsoas. This triangular protective shortening of the soft tissues involved in hip motion is part of the reason that clients with hip degeneration so often present with groin pain. With such a wide-ranging compensation pattern the femoral triangle is bound to be affected and vascular congestion will eventually ensue.
Further, it is my interpretation of anatomy that when the psoas tendon is constantly on stretch, its tension contributes to occluding the medial circumflex artery which effectively starves the femoral head. Avascular necrosis is a common diagnosis leading to hip replacements.9,10
The big picture of life is that our bodies consistently trade off "mobility for stability" during the aging process, as well in response to physical traumas of all varieties and intensities. In my view, this construct leads us back to the invisibility of flexor/extensor reflex systems that are a part of the evolutionary momentum which produced more distensibility in the anterior shoulder joint and the same in the posterior hip joint. These were all designed to prevent falling, surviving a significant accident and to prevent one's pre-mature death.
Sadly, the echo of these survival mechanisms has left us a Gordian Knot to unravel in our efforts to assist our clients in maintaining their quality of life.
In truth, my successes with undoing the progression of hip and knee degeneration is much less than I would prefer to report. However, what I have learned from my clients, I do believe can contribute to a foundation for us as a profession to build a commonly accepted model of how this progression occurs and what we might do to stabilize its downward spiral. And, if identified in its early stages, the progression may even be reversed. This understanding also points us as dedicated professionals toward building additional skill sets to address these human difficulties.