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Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
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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