resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
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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