resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
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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