resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Alcohol Consumption Strongly Linked to Risk of Colorectal Cancer
Alcohol intake is one of the primary risk factors for many human cancers, and is strongly associated with cancers of the oral cavity, pharynx, larynx, esophagus, liver, breast, and notably, the colon and rectum.
Treating Our Veterans with PTSD
As July 4th, Memorial Day and Veterans Day continue to pass year in and year out, we honor our veterans from past wars with parades, BBQs and a day off from work, but our veterans live daily with the spiritual scars of war.
The Bottom Line ... From a Surgeon Who Knows
Regardless of individual relationships between providers, there continues to be a type of Hatfield-McCoy feud between the philosophies of medicine and chiropractic, particularly when it comes to musculoskeletal ailments.
The Art of Observation
How many of us spend time just watching our clients walk, climb in and out of cars, rise from a chair or navigate a flight of stairs? Spontaneity is the key. Along with a subtle ability to observe without the client knowing or being made to feel like a lab rat.
What TCM Never Had to Deal With
You probably started getting a sense of it when you were in school. The professors would talk about diabetes as "wasting-and-thirsting disease" and you had a thought that you didn't know anyone who was wasting away in any way, shape or form.
"Turn, Turn, Turn"
Many people are credited with saying, "If you remember the '60s, you really weren't there." Given the fact I didn't become a teenager until 1970, I actually do remember the '60s (or at least part of it). And as a child of the '60s, I was, of course, influenced by the music.
The Power of Vitamin K
You may have heard rumblings in recent years that vitamin K helps reduce the risk of osteoporosis and cardiovascular disease, and is administered intravenously by some integrative medical doctors who combine it with high-dose vitamin C in cancer treatment.
Drug War Rages in Wisconsin
Based on its actions over the past 15 years (review the sidebar in the app version of this article), controversy and the Wisconsin Chiropractic Association seem to go hand in hand.
News in Brief
Foundation for Chiropractic Progress Enrolls Second Group Member; Focus on Chiropractic Education at WFC-ACC Conference in Miami; Are You Ready for Another "Have-a-Heart" Campaign?
Correcting Dysfunctional Movement Patterns – Is Local Treatment Enough?
It is widely believed that mechanical, non-traumatic back pain is largely related to dysfunctional or compensatory movement patterns the body has adopted over time.
The McGill Approach to the Lower Back (Part 1)
Stuart McGill, PhD, brings a unique combination of tools to the table. He is a scientist who also functions as a clinician. He describes himself as a medical consultant who is referred challenging patients. He is both evidence based and practical.
Body and Skin Rejuvenation Through Inner Balance, Equals Outer Beauty
First of all, I will draw a line in the sand. You know how there is often a big divide between the methods of Western medicine and holistic or energy medicine?
Cultivating Our National Strength
The time has come to seriously look at the state of this profession and its influence in the U.S. Where are we? What has happened? Where do we go from here?
The Power of Positioning
During the evening, I like to relax while either reading a book or watching television. One of my shows, NCIS, has the main character always drinking coffee. Everyone knows it is a Venti from Starbucks because of its distinctive color and style.
Hon Lee: Scholar, Warrior, Spy, Teacher and Healer
It was fun. Growing up in New York's Chinatown was like living in a Chinese village that had been transplanted to a five square block area in southern Manhattan. The thing I liked most about the city, and still do, is it's rich cultural diversity.
Behavior as Symptoms of Energetic Imbalance
Karen and Josh said they wanted me to help them fix their marriage. That is why they were sitting on the couch in front of me, complaining about each other. She was too domineering, he said, overly controlling and bossy.
Eight Ways to Help Manage Your Content
You have just completed your last session for the day, checked your voice mail and emailed a new patient about their appointment, but something it gnawing at you, something you just can't quite put your finger it on.
MUIH Launches Doctoral Degree Programs
Maryland University of Integrative Health recently announce it will now offer doctoral degrees.
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!
Giving Chiropractic Some Much-Needed PR
Public relations has not always been the chiropractic profession's strong suit, a shortcoming that has subjected the profession to countless attacks on its legitimacy and seemingly perpetual confusion among the public and the health care world as to the skills and services doctors of chiropractic provide.
Ancient Chinese Medicine Meets Modern Anatomy Dissection
Have you ever thought it would be beneficial to explore under the skin and examine qi deficiencies in every system of the body? Would you like to see traditional Chinese medicine diagnosis patterns as they relate to western biomedical symptoms and conditions?
Yo San University Celebrates, Supports Community Clinic
Yo San University of Traditional Chinese Medicine recently celebrated 25 years of teaching excellence and serving its community by awarding actor Pierce Brosnan the Robert Graham Visionary Award and raising money for its popular community clinic.
The Aspiration to Prevent Hip, Knee and Shoulder Replacements
In 1983, my right hip was fractured in a head on automobile accident with a drunk driver. The hip joint was so severely shattered that the acetabulum appeared as potato chips in the x-ray. The tibial plateau and ankle were fractured as well. The very good news was that I was only 30 years old and, after a month in traction and through the assistance of skilled soft tissue practitioners, chiropractic care and exceptional yoga teachers, I was able to rehabilitate to functional capacity over the next year.1 The other good news is I was very lucky. The car burned completely within 3 minutes. An unidentified motorist saved both my step-son and myself.
Soon thereafter, clients with varying degrees of hip degeneration started showing up at my office. I have been able to assist many, yet the first theme of this article is the most important: we all need to become part of our clients' early detection team. This article will also propose some innovative relationships between the hip, knee and shoulder joints. I pray they will intrigue and pique your interest and motivate you to further explore them. These are anatomical interpretations that can positively influence your clients' range of function and their quality of life. Satisfied customers are how you grow your practice and prosper.
As massage therapists and frontline health care providers, we have an opportunity to incite curiosity and realistic hope into our nation's aging population. The progressions of hip, knee and shoulder degeneration are encroaching upon the quality of life of so many that the general public is beginning to reach out to our profession to assist them. No one wants the painful and life-disrupting experience of intrusive surgery and recovery; yet, many will still endure them in large measure because early detection and competent preventative care has been missing.
Certainly, many clients come to us with pain and reduced range of motion associated with these joints. According to the physician who reviewed this article, his clinical experience suggests that his patients present with the early signs of these degenerations as young as their early 40‘s.2 The important question is whether each of us has the skill sets to screen for early indicators that these joints may be progressing toward degeneration. The following are my time tested screenings for the shoulder, hip and knee. Other tests certainly do exist.
For the shoulder, with the client seated, passively move the arm and shoulder into abduction guiding their arm over their head, feeling for ease, or lack thereof, for the humeral head gliding under the acromial shelf. If the range feels restricted, tremors or locks out (abruptly stops), this may be an indication that a degenerative process has begun. Yes, we may do much to mobilize the shoulder, yet planting a seed that more formal orthopedic evaluation and a MRI review may be useful to your client is a really good idea with all significant joint problems.
For the hip, have the client lie on their side with their bottom leg and thigh extended. Place your foot on the table with your knee bent to 90 degrees and lift their top thigh and leg, balancing it on your thigh. Grasping just above the ankle, passively lift the leg into abduction, while palpating at the femoral trochanter and feeling for the range and quality of the movement through both of your hands as you guide the hip joint into internal rotation. Most commonly within my experience, if someone's hip joint has started down the path of degeneration, you will feel not just a restriction to motion, but rather an abrupt stop to the motion. This lack of internal rotation has been my most reliable indicator that degeneration is progressing, especially if my best efforts to mobilize the joint are minimally effective.
Evaluating knees is trickier because degeneration can create either an advancing immobility to flexing and extending normally or the joint can become destabilized to the point where a client suggests that it feels as if their knee is going to give out on them with increasing regularity. Again, our refrain needs to be encouragement to seek further medical evaluation.
Functioning as part of your clients' early detection team is a golden key to preserving their quality of life even if you typically see most of your clients only once. You touched them, you cared enough to express concern, trust that the seed was planted. This will serve us as a profession to do so.
Let's now explore the relationships between the hip, knee and shoulder. Based on my clinical experience and research, the foundation to understanding the hip joint is that "roll and spin" is what characterizes its ongoing capacity for proper function. This relates to the ability of the femoral head within the hip socket to spin during internal and external rotation as well as to roll forward and backward during the flexion and extension phases of the walking cycle.3
What I have deduced over many years is that when clients present with chronic somatic hip pain and restriction, the femoral head has slipped posterior and has begun to ride the edge of of the hip socket. Of course, over time, the related soft tissues, especially the gluteus medius and minimus, the iliopsoas, the tensor fascia lata and its iliotibial band all shorten to protect and stabilize the femoral head as do other pelvic soft tissue structures.
The net effect is that hip range of motion is reduced and altered from its normal tracking. I hypothesize that the hip's blood supply is reduced both due to the shift of the femoral head and as a result of protective spasm of the relevant soft tissues. To fully comprehend the essential anatomical nature of the femur, it is important to recognize that there is a tri-angular relationship between the proximal femoral head, its lateral projection - the trochanter - and its distal femoral condyles. These distal condyles interface with the depressions of the tibial plateau to form the knee joint.
A factor that I believe has been overlooked is that even a small chronic rotation and posterior shift of the femoral head and trochanter may be communicated down the shaft of the femur in such a way that the "tracking" of the knee between the femoral condyles and the depressions of the tibia are influenced. You may observe this twist by noticing the relative position of the patella usually lateral to center, or with your client prone, noticing the angle of the posterior knee crease as more diagonal than horizontal. Sometimes, the twist into the knee is so obvious that the lower leg, ankle and foot are externally rotated relative to the knee joint by 25 degrees or more.
So to be clear, I am proposing that often in the progression of hip degeneration a posterior shift of the femoral head occurs and that the femur as a whole becomes fixed in a slightly rotated position, thereby communicating this torque into the functional articulations of the femoral condyles, altering proper knee tracking and support function.
The progression of degeneration is proposed to loop between both ends of the femur. Which joint degenerates more quickly is influenced by many variables, yet the number of knee replacement surgeries is approximately double that of the number of hip replacements.4 Might these relationships be a factor in chronic low back dysfunction and pain? In my clinical experience, the answer is a resounding "Yes."5
Very early in my career, one of my instructors stated that knee problems usually begin as hip troubles, yet did not describe "how."6 From experiences with tens of thousands of clients, I now believe a posterior shift of the femoral head coupled with this angular relationship between the two ends of the femur is at least part of the answer. Further, with the associated tracking relationship of the knee being strained, I theorize that the increased friction between the opposing joint surfaces contributes to knee degeneration over years of misaligned compression.
I further propose that the degeneration of the hip, knee and shoulder may have an evolutionary linkage. My conjecture is that their inherent weaknesses come to us as an evolutionary pre-disposition from our time as primates living in trees. A fall from a height all too often led to an immediate or eventually related death. Those dead primates' genes were not passed on. As a result, I propose that nature selected for a more flexible anterior shoulder capsule and a more distensible posterior hip capsule to assist the capacity to "tuck and roll" during a sudden fall.
Take a moment to consider: Aren't all falls sudden? Remember for yourself a time when you had a sudden, unexpected fall. Did you not endeavor to twist while going down? One may not have been successful, but the automatic response to do so was there. It is a good thing we have these reflexes to assist us.
Typically, after a fall or significant impact, these reflexes lock into the nervous system shortening one entire side of the body. Thomas Hanna referred to this as a Lateral Trauma Reflex. Might such an ipsilateral shortening be a variable that could contribute to the degeneration of the joints being discussed? Over 25 years of my clinical experience with clients supports this assertion.7
Additionally, it is an osteopathic construct that the fascial elements from the latissimus dorsi's attachment to the humerus relate downward throughout the torso via the sacroiliac joints, blending into the lateral hamstrings, then descending further along the peroneal muscle group to the lateral ankle and foot.8 This one construct gives us a fascial linkage between the joints that need to be most commonly replaced. I don't think that is a coincidence, do you?
Most importantly, as massage therapists, it suggests that we may be able to provide preventative assistance if clients come to us earlier in the progression of their joint degenerations. For those of us in our profession who feel the call to learn more of how to assist clients with these progressions of degeneration, this is the time. Those who are aging and desire to be active throughout the span of their lives need you. This is a call to action, our nation needs you.
My next article will explore the more intrinsic relationships of anatomy and physiology that I have clinically correlated to be contributing variables to the progression of degeneration within these joints. Reflect for a moment, our quality of life really does depend upon the normal functioning of our hips, knees and shoulders.