resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
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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