resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
July, 2014, Vol. 14, Issue 07
Exploring the Anterior Pelvic Tilt
By Whitney Lowe, LMT
Lumbopelvic pain is a common complaint that is not always remedied with many standard low back pain treatments. For many people, some treatments have been helpful, but the condition still persists.Frequently, the pain problem exists because an underlying postural or structural deviation has not been properly addressed. One such postural problem that might be considered is an anterior pelvic tilt, which can contribute to lumbopelvic pain in a number of ways.
The upright posture and locomotion of humans poses biomechanical balance challenges for the pelvis. The weight and force loads of the upper body are transmitted and distributed to the two lower extremities through the pelvis. When the pelvis is not aligned properly numerous biomechanical problems result, which can be painful and debilitating. Let's take a look at what constitutes an anterior pelvic tilt, some of its detrimental effects, and what role massage can play in helping to resolve it.
For the sake of this discussion, the pelvis will be addressed as a whole, even though it is composed of two separate halves, called innominates. The left and right innominate can move independent of each other, but most postural distortions occur when the left and right halves are both out of alignment in the same direction.
An anterior pelvic tilt occurs when the pelvis rotates anteriorly in the sagittal plane. The sacrum is tightly wedged between the two innominates so when the pelvis tilts anteriorly, the sacrum moves with it. The sacrum is tightly bound to the L5 vertebra, which is bound to adjoining vertebra. When the sacrum tips forward, the lower lumbar vertebrae are subsequently tilted forward, creating an increase in the lumbar lordosis at the same time.
There is a natural degree of anterior tilt in the pelvis that is necessary for proper movement and shock absorption. When the degree of tilt is too much, it is considered a dysfunctional anterior tilt. However, it is difficult to get an accurate determination of the exact degree of anterior tilt without a goniometer. Consequently, many clinicians use approximate alignment references to determine if the tilt is excessive.
However, just because it is challenging to define the anterior tilt, doesn't mean we should ignore it. Although massage therapists may not have the training to make accurate goniometer measurements, there are some simple tips for determining if a pelvic tilt could be a contributing factor to a clients pain. One way to evaluate the tilt with visual examination is to look at your client from the side. Place one finger on the posterior superior iliac spine (PSIS) and the other finger on the anterior superior iliac spine (ASIS). If the ASIS is more than a half inch lower (and slightly more in females), this would be considered a dysfunctional anterior tilt (Figure 1).
A degree of lordotic curvature in the lumbar region is necessary for proper shock absorption in the spine. However, too much lordosis causes multiple problems. As the lordosis is increased, there is increased pressure on the facet joints of the spine (Figure 2). The increased facet joint compression can lead to pain, irritation and even early arthritic changes in the spine.
An increased lordosis is frequently caused by excessive hypertonicity in the lumbar extensor muscles. Tightness in this muscle group is both a cause and an effect of the exaggerated anterior tilt. The lumbar extensor muscles are often tight in conjunction with the iliopsoas in a postural pattern known as the Lower Crossed Syndrome (Chaitow, Delany vol 1, 2000). A vicious cycle of muscle tightness and postural distortion ensues because muscle tightness contributes to the anterior tilt and is perpetually reinforced as a postural pattern. Myofascial trigger points in the lumbar extensors are also likely to develop as a result of the chronic tightness.
The increased lordosis may also decrease the opening of the intervertebral foramen which could lead to nerve root compression in the area. The risk of nerve root compression is increased if there are bone spurs or other obstructions along the edge of the foramen which encroach on the nerve with the exaggerated lordosis.
Another detrimental effect of the anterior tilt occurs at the Sacroiliac (SI) joint. There is only a slight degree of movement at the SI joint. For the most part, this joint is tightly bound so that the sacrum and ilia on both sides are almost locked into position with each other. The anterior pelvic tilt alters the force loads at the SI joint and is a frequent cause of SI joint pain and dysfunction.
Most of these potential effects are somewhat obvious, but another one that is not quite as clear is the increased risk of hamstring strains. When the pelvis tilts anteriorly, the ischial tuberosity rises in a superior direction, putting greater tensile stress on the hamstring muscle group. The elevated tensile load can lead to an increased incidence of hamstring strains, especially in active individuals.
So, is there a role for massage therapy in addressing this problem? There is a role for soft-tissue treatment, but there is also controversy and misunderstanding in constructing the most helpful treatment plan.
One of the biggest mistakes that clinicians make in attempting to treat the anterior pelvic tilt is to over-simplify the treatment strategy. For example, if you look at a person with an exaggerated anterior tilt from the side, it would appear that the lumbar extensors are tight and the abdominal muscles are weak and elongated, which is true. The mistake comes in attempting to address this distortion by strengthening the abdominal muscles with standard abdominal muscle exercises like sit-ups or crunches performed with the feet rigidly held in position.
When the feet are held rigidly in place for a sit-up exercise, it is called a closed-kinetic chain exercise. Unfortunately, performing a sit-up in a closed kinetic chain position strongly recruits the iliopsoas muscle. Since tightness in the iliopsoas is a contributing factor with this condition, further strengthening is counter to the intended treatment goal.
The key goal in a treatment strategy for the anterior pelvic tilt is to reduce tightness in the lumbar extensor muscles and iliopsoas. In many cases, the abdominal muscles, which appear weak and overstretched, are not weak because they lack sufficient exercise, but are instead weak because they are being neurologically inhibited by the tight lumbar extensors (their antagonists). Reducing tightness in the lumbar extensors will often allow the abdominal muscles to resume a normal level of tonus. A variety of massage techniques can be directly aimed at the lumbar extensors to reduce their hypertonicity.
One of the biggest mistakes that massage therapists make when attempting to address an anterior pelvic tilt is to focus just on the soft-tissue treatment with the idea being that reducing the muscle tightness will restore the proper pelvic position. Unfortunately, that rarely occurs. Postural distortions like the anterior pelvic tilt have developed from chronic habitual reinforcement. Even if you perform excellent massage work on these muscles, the person is likely to quickly slip back into the postural distortion if certain habitual patterns are not addressed.
Dysfunctional postural patterns need to be changed by constant reinforcement of new and more correct postural adaptations. Certain treatment systems like Alexander Technique, yoga or Feldenkrais are aimed at improving awareness of posture and position in order to make changes and reduce dysfunctional positions. However, it isn't always imperative that the client adopt one of these practices.
Sometimes, it can be as simple as teaching new postural positions and encouraging the client to be aware of his or her own postural positions and to reinforce that change as much as possible. Having the client explore the ergonomics of his or her home and work activities is also important. Does their work set up inspire a slumped position at a desk? Do they stand a lot, could they put one foot up on a small block? Can they take more breaks for stretching and be shown good stretching solutions?
As clinicians, our goal is to understand each individual's biomechanical stresses as best we can so we can craft a reliable treatment strategy most likely to achieve beneficial results. At the same time, keep in mind that the presence of an anterior pelvic tilt is not a guarantee of any of the above adverse outcomes. There are people who have an anterior tilt that do not develop any issues. That is why it takes a thinking practitioner to determine when the pelvic tilt might be a contributing factor to a client's pain.
Click here for more information about Whitney Lowe, LMT.
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