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The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
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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