Low back pain is a common symptom reported among the majority of the population. Generally caused by direct trauma from an injury or as a result of an aggravated condition, low back pain can greatly restrict an individual’s daily activities, affecting their overall physical as well as mental performance. Although there’s a variety of factors which can lead to back pain along the lumbar area of the spine, an incorrect sitting posture over an extended period of time has been known to be one of the leading causes for this well-known symptom.
Sitting is one of the most difficult positions for the body to maintain. Improper sitting postures�for prolonged periods of time while hunched over in a chair can build excessive pressure on the spine and affect the blood circulation in the legs. For an individual that spends their workdays sitting down, the long term result of an improper posture can greatly alter the individual�s overall health.
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Proper Posture While Sitting
Sitting for extended periods of time while hunching over a desk can cause discomfort, numbness and spine misalignment over time if the improper sitting posture is not corrected. Holding the body upright can also further increase pressure and tension in muscles, ligaments, joints, and other tissues surrounding the spine. A sedentary lifestyle where the individual doesn�t take frequent breaks throughout their workday to stand and stretch can gradually lead to cardiovascular disease due to the decreased blood flow, tightened hip flexors, shortened hamstrings, pinched nerves and many other physical injuries and/or conditions in the long run.
How Chiropractic Differs from Traditional Care
Aches and pains on the body, particularly around the spine, herniated discs, nerve complications and painful joints are direct results of working while in improper sitting postures for prolonged hours of the day. When you’re in a seated position, a lot of pressure is being placed directly on the spine and its surrounding structures. Our bodies were designed to stand upright and maintaining a seated position can be physically stressful.
“The weight is distributed while in a standing position,” explained Kelly McGonigal, Ph.D., a health psychologist at Stanford University and a leading expert in neck and back pain, �That’s not the case with sitting. McGonigal added, “When you sit, you distort the natural curve of the spine, which means your back muscles have to do something to hold your back in shape because you’re no longer using the natural curves of the spine to lift yourself up against gravity.”
Approximately 80 percent of individuals in the United States alone may experience some form of chronic pain in their lifetime. Ultimately, working on a sitting position for extended periods of time per day is putting a tremendous mental and physical stress on our bodies.
Correcting Posture
Maintaining good posture when sitting helps preserve the three natural curves of a healthy spine; the cervical curvature, the thoracic curvature, and the lumbar curvature. The normal curvatures of the spine should form a slight S-shape. An excessive curve in the spine could suggest a possible underlying condition and may present symptoms of pain and discomfort, among other uncomfortable symptoms.
The key to maintaining a proper posture is to avoid slouching by sitting up straight as well as sitting all the way back in your chair. Additionally, the chair should be tucked in close to the desk. Placing a pillow or cushion directly behind your lower back area, or the lumbar spine, can help sustain good posture by providing enough support and allowing the spine to naturally curve inward. Furthermore, it�s also recommended to stand and stretch about every 20 minutes to give your body a break from long held positions, release pressure that is being built up on the spine and restore the body�s regular circulation by pushing the blood out of your legs. Doing this consistently throughout your day can prevent the muscles, ligaments and other tissues of the body from getting strained. Simple stretches at your desk, such as twisting, turning the head from side-to-side and chin tucks upward towards the ceiling can also help. These movements will ultimately help to relieve an individual�s chronic pain as well as restore an individual�s health progressively over time and improve their overall well-being.
Sitting is one of the most difficult positions for the body to maintain. Sitting for prolonged periods of time while hunched over in a chair can build excessive pressure on the spine and affect the blood circulation in the legs. For an individual that spends their workdays sitting down, the long term result of an improper posture can greatly alter the individual�s overall health.
While for many individuals sitting behind a desk for a prolonged period of time each day is an inevitable and often necessary part of their lifestyle, practicing a proper posture as well as seeking the proper care once the symptoms of low back pain manifest can change the effect of the issue. Chiropractic care as well as physical therapy and other forms of treatment, are available to the public to help reduce their painful symptoms and restore their original functionality. The spine is one of the body’s most important structures and it’s essential to maintain its health to achieve overall wellness.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Chiropractic care is a natural treatment utilized to provide regular health maintenance to the spine, intervertebral discs, nerves and other tissues surrounding these structures, without the use of drugs or surgery. It focuses on the proper alignment of the joints in the body, particularly the spine, to reduce spinal nerve stress, promoting overall wellness.
Chiropractic is a well-known, alternative treatment option used to treat a variety of injuries and conditions, most commonly to improve symptoms of neck and back pain. From athletes to the general population, chiropractic treatment has been regarded as a safe and effective form of care, most recently, it�s even been utilized for women throughout pregnancy.
While it�s not commonly considered, chiropractic care can offer tremendous benefits for patients during their pregnancy and there have been no known contraindications to chiropractic treatment throughout this stage of a woman�s life.
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Is Chiropractic Care Safe During Pregnancy?
All doctors of chiropractic, or chiropractors, are trained to work with women who are pregnant. Investing in the fertility and overall health and wellness of women throughout their pregnancy or those whom are trying to conceive is a routine care for a majority of chiropractors.
Many chiropractors take a specific interest in prenatal and postnatal care and they may pursue additional training to specialize in the treatment of pregnant women. The following represents designations of chiropractors who�ve taken advanced steps in working with infertility and pregnancy health and wellness.
DACCP � Diplomate with ICPA reflecting highest level of advanced training
CACCP � Certified with the ICPA reflecting advanced training
Member of ICPA reflecting special interest
Webster Certified � trained to work specifically with pelvic balance in pregnancy
Chiropractors which have acquired professional training to work with pregnant women commonly utilize special chiropractic tables that adjust to a woman�s pregnant body. They are also trained to utilize treatment methods and techniques which avoid the use of unnecessary pressure on the abdomen. In addition, a doctor of chiropractic will provide the patient with the most appropriate set of stretches and exercises that are safe to perform during pregnancy.
The Importance of Chiropractic During Pregnancy
Throughout the pregnancy process, a woman�s body will undergo a variety of physiological and endocrinological changes in preparation for creating the best environment for the development of the baby. Furthermore, the body will have to adjust to its new body mechanics, especially the normal structure and function of the spine. Several pregnancy body changes include: a protruding abdomen; increased back curve; pelvic alterations; and postural adaptations.
These new adjustments can challenge the structure and function of the body, to the point that a misalignment of the spine of other joints as well as the irritation and inflammation of the tissues can occur. Ultimately, restoring the original alignment of the spine and the balance of the pelvis in relation to the rest of the body is one of the main reasons why chiropractic care is essential throughout a woman�s pregnancy.
A misalignment of the spine or pelvis, also known as a subluxation, can reduce the amount of room available for the proper development of the baby. This restriction is medically referred to as an intrauterine constraint. Also, the misalignment of these specific structures can make it difficult for the baby to get into the best possible position for delivery, affecting the mother�s ability to have a natural, non-invasive birth. Breech and posterior positions can interfere with the ease of labor, leading to the use of other medical interventions, such as c-sections.
Maintaining the spine�s natural alignment helps the entire body function effectively. Because the nervous system is the master communication system between the brain and the rest of the body, including the reproductive system, ensuring the connection between these is not interfered by a subluxation is fundamental to guarantee the well-being of the individual.
Benefits of Chiropractic Treatment Throughout Pregnancy
Chiropractic during pregnancy can provide a substantial amount of benefits for pregnant women. These benefits include: maintaining overall health and wellness throughout pregnancy; helps control symptoms of nausea; reduces labor and delivery time, relieved neck, back and joint pain; and it can help prevent a potential cesarean delivery.
Talking to a Health Care Provider
As the amount of women who seek to take advantage of the benefits chiropractic care can offer throughout their pregnancy increases, more healthcare providers have begun to seek the services of doctors of chiropractic who specialize in the treatment of pregnant women. When considering chiropractic to maintain overall health and wellness during pregnancy, or when searching for an alternative treatment option for an injury or condition while pregnant, make sure to discuss these options with your healthcare provider. Chiropractic care should not be utilized as a sole source of treatment and maintenance during pregnancy, however, chiropractic can be used in collaboration with other medical services to ensure the patient receives the best care throughout their pregnancy.
Kinesio Taping Can Benefit Pregnancy
Aside from chiropractic care, there are other treatment methods and techniques which can also benefit women throughout their pregnancy. Many individuals use kinesio tape, also known as elastic therapeutic tape, an elastic cotton strip with an acrylic adhesive that comes in a variety of colors. Kinesio tape is generally utilized in athletes to treat a variety of injuries or conditions, however, applying the elastic therapeutic tape on pregnant women can help relieve many pregnancy discomforts, providing other great benefits.
The elastic therapeutic tape, or kinesio tape, functions by treating as well as helping to recover from and prevent injuries. With its acrylic adhesive, it serves to lift the skin and promote better blood circulation. Used universally today by the growing population, kinesio tape has even been utilized by the elderly to treat normal home injuries. Apart from treating injuries, elastic therapeutic tape can help stabilize and correct posture.
When it�s applied properly by a professional, the natural elasticity of the tape will gently lift the skin to help relieve pressure from pain receptors. Once it�s applied, the individual�s circulation will improve, working immediately and continuing to provide relief 24/7 for approximately 3 to 5 days per application. In addition, kinesio taping helps ease the body�s natural healing process, allowing for the individual�s original range of motion to improve by also providing stability and support to the surrounding muscles, joints and other tissues, as well as reducing pain and discomfort, swelling and controlling inflammation as a result of the improved blood flow.
A variety of benefits kinesio tape can offer include: prevention of injury; treatment and rehabilitation; promotes blood circulation; posture correction; optimized performance; near immediate treatment; stays on up to 3 to 5 days throughout treatment; able to shower and sleep with it for continuous relief; no heavy bracing; and it offers no restrictions due to its elasticity.
How Kinesio Tape Helps Pregnant Women
During pregnancy, the use of elastic therapeutic tape can be a safe and effective treatment option for pregnancy discomfort as well as for other types of injuries and conditions. Low back pain and pelvic pain can be common issues that affect pregnant women.
Kinesio tape is a drug-free alternative, similar to chiropractic care, that can offer pregnant women additional relief from the well-known symptoms which develop during pregnancy, including back pain, swollen feet, sciatica, and carpal tunnel, among others. Because of this, elastic therapeutic taping can be one of the most ideal options for expecting mothers who seek natural relief from the common symptoms associated with pregnancy.
Kinesio tape can also function similarly to a support belt or belly band, with the proper placement of the colorful tape to either the back or abdomen. The most frequent postural pain and discomfort pregnant women experience can be relieved using the kinesio tape in this manner as it will help distribute the weight of the additional pounds. It can also greatly reduce fatigue as well. In comparison to purchasing support belts and belly bands, elastic therapeutic tape can be considerably more economic in the long run. For most pregnant women, symptoms of pain and discomfort while pregnant can make sleeping difficult. Nonetheless, because these tapes can be worn while sleeping, they can provide continuous relief and a much needed rest.
Many healthcare professionals are trained to apply elastic therapeutic tape, however, one can learn to apply them themselves. Using kinesio tape can be challenging and difficult to apply at first. It�s important to allow a primary care physician, chiropractor or other healthcare specialist to demonstrate the proper way to apply kinesio tape before attempting to apply it yourself. Some elastic therapeutic tape may need to be altered before being applied to achieve a specific function. Always make sure the skin is dry and clean before applying the tape to ensure it lasts longer. To remove the tape, use baby oil on the strips to gently loosen the adhesions.
Technique #1: Belly Belt
This first technique functions by lifting the lower belly to help relieve painful symptoms as a result of the increased amount of pressure being placed onto the pelvic flooring. Begin by attaching one strip of tape firmly at the middle of the lower belly. Then, follow by pulling both sides of the tape upward to lift the belly, attaching the ends securely. If you need to apply more strips, repeat the process using a second strip and check how it feels for you.
Technique #2: Front Sling
This technique is excellent for providing frontal support for pregnant women. Using two strips of kinesio tape, attach the ends firmly at the bottom, pulling each strip upwards and securing them under the breasts. Women with smaller and/or shorter torsos can cut the elastic therapeutic tapes in half and follow the same application process.
Technique #3: Baby Belt
This technique can be significantly helpful for pregnant women whose bellies are protruding outwards quite a bit. Using two strips of kinesio tape, you are going to form an �X� at your belly button, beginning from the bottom, just above the hip bones. While pulling the tape across the belly, make sure to pull firmly in order for the tape to hold your belly in place securely.
Technique #4: Maximum Support
This fourth technique is for pregnant women who experience full belly pain. If you have lower back pain as well as belly pain, you can combine this technique with the following technique (see next technique). Using 4 strips of elastic therapeutic tape, beginning at one hip, apply the tape and pull it diagonally across your belly button up to the opposite ribcage. With a second strip, follow the same procedure as before on the opposite side. Next, take a strip of kinesio tape and apply it from the bottom, up on each side of the navel. Make sure to firmly attach the elastic therapeutic tape at the bottom and then pull upwards to anchor it at the top above the diaphragm.
Technique #5: Lower Back & Belly Support
If you need both lower belly and back support, this one is good for you. You will need two strips.. Using one strip you will have someone attach one end to one side of your lower back and firmly stretch it across, anchoring on the other side. With your second strip, you will stretch only the middle by pulling at both ends, attaching the middle part of the tape first to your lower abdomen. Then, you will firmly pull each side upward to secure. It should feel as if you are �lifting� up your belly. The discomfort should go away immediately.
Technique #6: Frontal Belly Support
The next technique is perfect for pregnant women who�ve only experienced discomfort in the front and lower abdominal regions. Utilizing two strips of elastic therapeutic tape, with the first strip, begin by applying it at the pubic line then pull upward, attaching the end of the tape right under the diaphragm. With the second strip, begin by applying it at one end of the lower belly, above the pubic line, and stretch it across. With smaller women, it might be necessary to cut the strips in half and follow the same procedure.
Technique #7: Diaphragm Support
This final technique is considered fundamental for when the baby gets so big that they begin to push into the diaphragm and can make normal breathing difficult. For this procedure, only one strip of elastic therapeutic tape is necessary. Smaller pregnant women may have to cut the strip in half and follow the same procedure. Foremost, you will need to firmly attach and hold the strip at one end while pulling it across to the other side, focusing on pulling it downward. The point is to bring the top of the belly down to ease the diaphragm.
It�s important to consult your healthcare provider or chiropractor before attempting any of the following kinesio tape techniques by yourself to discuss whether kinesiology taping is appropriate for you. Furthermore, be sure to notify your healthcare practitioner if you have sensitive skin to ensure you do not react negatively from the tape adhesive. Once the kinesio tape is applied, a healthcare professional can provide careful instructions on how you can preserve the usefulness of the tape while showering, bathing and dressing.
The above information is by no means a replacement to a consultation with a licensed healthcare provider. Consultation with a chiropractor or other healthcare provider is recommended for any individual suffering from symptoms due to an injury or condition. If you are not experienced with using elastic therapeutic tape, allow a medical doctor, chiropractor, physical therapist or other experienced healthcare provider to demonstrate how to properly apply the tape for use at home.
Massage for Pregnant Women
Just as chiropractic treatment and various techniques using elastic therapeutic tape can benefit women throughout their pregnancy, massage can also be a helpful alternative to provide further relief to pregnant women. The goal of every pregnancy massage is to provide unique and special needs to expecting mothers.
Certified pregnancy massage therapists are qualified and experienced to perform the specially designed massage techniques on women to help relieve the most common pregnancy symptoms, making sure to protect both mother and child during the massage.
Pregnancy massage can differ greatly from others and it is often unique in its application. During the massage, the pregnant women is carefully supported using cushions and pillows to provide the expectant mother with superior comfort. This type of massage is above all very gentle and deep tissue techniques are never utilized as a safety precaution. In addition, many areas of the body are avoided to protect both mother and child, providing extra attention only to specific areas of the body which are particularly affected by pregnancy, such as the back and/or the feet. Regardless of these safety precautions, pregnancy massage is generally not advised during the first trimester.
The gentle pregnancy massage can tremendously help both physical and emotional pain and discomfort in pregnant women and the psychological benefit of itself can be greatly therapeutic. In addition to stress and anxiety reduction, a pregnancy massage can help reduce common symptoms associated with pregnancy, such as swollen ankles and lower back pain.
In conclusion, a woman�s overall health and wellness is fundamental throughout their pregnancy and alleviating painful symptoms along with those common discomforts associated with the stages of pregnancy can help provide comfort to expecting mothers. From chiropractic care and the application and use of elastic therapeutic tape to pregnancy massages, there are a variety of safe, efficient and beneficial alternative treatments and techniques that can help pregnant women throughout their pregnancy without the need of drugs. The above mentioned treatment options are natural alternative which have been considered by many women. If you are in need of relief or simply wish to enjoy the benefits of these procedures, make sure to discuss them with your healthcare provider before following through with these treatments.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Your body is designed to work well and take care of itself, as long as you take care of it. In part, this means eating a balanced diet, exercising regularly, and getting the right amount of sleep. But sometimes you do need outside help to keep your body working at peak efficiency. Chiropractic care serves as an excellent example. Your chiropractic visits�do more than crack your back. Your treatment sessions can help improve your overall body structure and health.
1. Better Posture
If you work in an office or over a machine during the day, you likely develop a slump in your workplace. Your back starts to curve, your shoulders droop forward, and soon you start feeling a bit of an ache to your torso at the end of every day. If you let it go for long, you soon discover you don�t stand or sit as tall as you used to. You can almost feel your body deteriorate around you, from your spine out to your arms and legs.
Chiropractic care helps head this off at the pass. You stretch your body out and stretch and straighten your�back. The small curves that start to set in on you unfurl, and you soon feel your whole body relaxing as a result. The treatment soon has you standing taller, working more comfortably and moving into your evening feeling stronger than ever.
2. Better Body Movement
As you stand straighter and move through your day with your back set more correctly, you begin to see the benefits extend into other areas. One is your overall range of motion. A straighter, better aligned back gives your arms and legs a better base from which to move. You can move more comfortably and freely through your day and your whole body responds, adjusting to your centered, realigned core.�Your body is meant to be flexible;�designed to bounce back and recover quickly and freely from exertion.
Stiffness in the center stifles this natural state throughout the body and chiropractic care brings you back to where you should remain. Instead of movements beginning out of place, you can move your arms and legs with a fuller range of motion. Your body no longer fights itself for you to move. Everything flows in concert, and you feel better with every step and arm swing.
Football & Chiropractic
3. Greater Strength
Beyond flexibility, you also generate strength from your core. Personal trainers and fitness gurus explain this theory from their perspective of toning stomach and back muscles- and they are correct. However,�strength runs deeper than even the muscle groups, extending to your skeletal structure underneath it all. Your spinal column and hips underlie and support the movements you make at a basic, foundational level. When your spine is misaligned, the system of bones and muscles cannot create and work in the harmony with which they were designed to act.
A chiropractic alignment returns the natural order and base of your strength. It allows your vertebrae to work together, each bone supporting and adding to the strength of the next. The result? A body working as one powerful unit, creating and building strength from the center, rather than relying on a less complete support system. You work less to do more, and have more power to use when you need to use it.
�A Healthier You
4. More Effective Nervous System
The body needs a straight, free spine for more than just physical support. Your spine protects the spinal cord, the center (with your brain) from which all communication through your nervous system emanates. If the bones contract or move out of place, that communication system works less efficiently. You cannot react as quickly or respond as well to the world around you.
A chiropractic realignment helps return your body to peak functional capacity. The nerves no longer get pinched off or otherwise interrupted in the process of moving impulses and stimuli though the body. Your senses sharpen and work better, resulting in an improved reaction time. Your internal safety systems and mechanisms work better, and your whole body functions more smoothly. You start to heal yourself more quickly, from physical aches and pains to infections because your signaling mechanisms and pathways are more clear. You can respond to issues inside your body more quickly, and fight off issues more readily.
Whole Body Wellness
5. Pain Relief
In the midst of all of this, some of the symptoms that may initially drive you to a chiropractor can start to diminish. Pain does not come directly when you are not aligned properly. The body has a remarkable tolerance to small changes, and at times,�big changes. This generally works to your advantage, but it has the downside of masking smaller problems and concerns until they become bigger ones. Your body starts to cover up alignment issues with shifts in posture and resilience. By the time you feel the discomfort, you have likely shifted dramatically out of place.
Because of this, expecting immediate relief from chiropractic treatment may be setting yourself up for disappointment. You sometimes do feel instantaneous improvement, but the more likely scenario is to feel your physical symptoms gradually improve. With the help from your body, time heals. Maintaining your body to help�it do its job more effectively goes a long way toward making your life more comfortable.
Your body can do amazing things for you if you let it. Unfortunately, the stress and the wear and tear we put it through over time can diminish its effectiveness in handling everyday experiences and events. When you take the time and effort to maintain your physical condition, you free your body up to do the things it was meant to do: support, protect, and take care of itself. We are remarkable beings, designed to achieve incredible things both mentally and physically.�Chiropractic care�helps you maintain your body, as a support system and a base for everything else that you do.
Sometimes you need outside help to keep your body working at peak efficiency. Chiropractic care serves as an excellent example. Chiropractic �does more than crack your back and treatment can help improve your overall body structure and health.
Proven�research is now indicating that receiving Chiropractic adjustments to the pelvis can�increase vertical jump height. �This new research further solidifies the stance of many professional and collegiate teams with providing Chiropractic care for their athletes. In addition to injury prevention this research proves that chiropractic care results in an increase in sports performance.
[Purpose] This study aimed to investigate the effect of pelvic adjustment on vertical jump height (VJH) in female university students with functional leg length inequality (FLLI). [Subjects] Thirty female university students with FLLI were divided into a pelvic adjustment group (n = 15) and a stretching (control) group (n = 15). [Methods] VJH was measured using an OptoGait. [Results] After the intervention, jump height improved significantly compared with the pre-intervention height only in the pelvic adjustment group, while FLLI showed statistically significant improvement in both groups. [Conclusion] Pelvic adjustment as per the Gonstead method can be applied as a method of reducing FLLI and increasing VJH.
Key words:�Pelvic adjustment, Functional leg length inequality, Vertical jump height
INTRODUCTION
The pelvis, a structure located between the hip joint and the lumbosacral spine and attached to several muscles, regulates the movement of the hip joint and lumbosacral spine. The position of the pelvis is the most critical factor determining the sagittal alignment and posture of the human body). Only when the pelvis is in the neutral position can be in the right posture, move the upper and lower body in the dynamic posture, and improve daily movements and ambulatory ability).
Functional leg length inequality (FLLI) worsens due to pelvic tilt in the medial plane and pelvic rotation in the sagittal plane). Therefore, FLLI might be improved by pelvic adjustment. High-velocity and low-amplitude (HVLA) adjustment has been widely utilized as a general chiropractic adjustment method). Many studies have indicated that leg length inequality (LLI) causes posture alteration), limiting exercise and causing tension of the muscles and other soft tissues5). LLI is accompanied by several clinical symptoms6)�such as lumbar pain)�and hip pain). Correcting leg length inequality reportedly reduces pain, increases mobility, and improves posture).
Vertical jumping is practiced to enhance the muscular strength and endurance of the leg and serves as a barometer of muscular strength). There have been studies in which plyometric training was undertaken to improve leg muscle strength), dynamic stretching was applied after jogging for 5 minutes to improve vertical jump height (VJH), or HVLA manipulation was performed for talocrural joint dysfunction). However, there has been no study in which FLLI was corrected and VJH was measured as a barometer for leg muscle strength. Many studies have assessed the effect of pelvic adjustment on FLLI), posture), pressure on the foot, and balance). However, no study has investigated the changes in FLLI and VJH resulting from just a single adjustment. Therefore, this study aimed to assess the immediate effects of a single pelvic adjustment on FLLI and VJH in female university students with FLLI.
SUBJECTS AND METHODS
A total of 30 female university students with an FLLI of more than 10?mm between the left and right legs were selected and randomly assigned to one of two groups: the pelvic adjustment group (adjustment group, n = 15) and control group (stretching group, n = 15). The exclusion criteria were as follows: anatomical LLI; degenerative osteoarthritis; muscle, bone, or nervous system problems; ankle joint, knee joint, hip joint, or lumbar pain; limited range of motion due to burn or postsurgical scarring; and regular leg exercise. This study was approved by Korea Nazarene University�s Institutional Review Board, and the safety of all subjects was protected during all parts of the experiment. All subjects understood the purpose of this study and provided written informed consent prior to participation in accordance with the ethical standards of the Declaration of Helsinki.
The age, height, and weight of the subjects in the adjustment group were 23.5�4.7?years, 163.0�5?cm, and 54.1�5?kg, while those in the stretching group were 22.2�6.3?years, 162.7�6?cm, and 53.1�6?kg, respectively. Gender was analyzed using the ?2�test, while age, height, and weight were analyzed using the independent t-test. As these analyses detected no statistically significant differences (p>0.05), the two groups were deemed identical.
The pelvic adjustment performed in the adjustment group consisted of an HVLA technique administered in the prone posture in accordance with Gonstead�s theory. Subjects were instructed to lie prone, their pelvic height was checked, and the posterior-inferior innominate bone was given an anterior-superior impact while the anterior-superior pelvis was given a posterior-inferior impact. When making these impacts, the therapist put one of his hands on top of the other, placed them on the posterior-superior iliac spine or the ischial spine, and then gave the impact using his own weight, gravity, and acceleration). This adjustment was performed 3�5 times by one skilled physical therapist with more than 10?years of clinical experience. The control group stretched the backbone erector, rectus abdominis, iliac muscle, psoas major, quadriceps muscle, leg adductor, and quadratus lumborum adjacent to the pelvis in order to resolve muscular imbalance that could further the pelvic imbalance. In the process, the therapist assisted the subjects in performing additional height training for each muscle and maintaining each posture at the maximum height for 10�15 seconds. The subjects then resumed the initial posture, rested for 5 seconds, and repeated the stretching one more time. Stretching was done three times per posture for a total of 15 minutes).
For leg length measurement, subjects lay straight on a bed, and the tape measure method (TMM) was used to measure the leg from the anterior superior iliac spine (ASIS) to the medial malleolus. Beattie et al. reported that LLI as measured by the TMM did not show a significant difference from radiological findings. We were therefore confident in the reliability of using the TMM for measuring leg length). The measurement started from the ASIS so that pelvic bone-related problems such as pelvic tilt and pelvic asymmetry could be included.
We used an OptoGait (Microgate Srl, Bolzano, Italy), a system for optical detection, to analyze ambulation and measure VJH. On its signal-sending bar, there are 96 LEDs that communicate via an infrared frequency. The signal-receiving bar has an identical number of LEDs. We installed the signal-sending and signal-receiving bars of the OptoGait one meter apart on a flat surface. When a subject performs a vertical jump between the bars, the bars calculate the time at which the subject touches the floor or stays in the air and communicates this information by sending and receiving 1,000 signals per second, generating accurate data. Based on this basic data, the OptoGait software calculates the precise VJH.
Leg length and VJH were measured before and after the intervention. The measured data were analyzed using the statistics program SPSS 12.0 KO (SPSS, Chicago, IL, USA), and the collected data are presented as averages and standard deviations. The significance of pre- and post-intervention differences was tested using the paired t-test, and the significance of between-group differences was tested using the independent t-test. The p-value ? was set at 0.05.
RESULTS
In the pre- and post-intervention comparison, VJH improved significantly only in the adjustment group, while FLLI improved significantly in both the adjustment group and the stretching group (p<0.05) (Table 1). When comparing the pre-intervention data, post-intervention data, and changes between the pre- and post-intervention data, VJH showed statistical significance only for the changes between the pre-and post-intervention data, while FLLI showed statistical significance for post-intervention data and changes between the pre- and post-intervention data (p<0.05) (Table 2).
Table 1.
Comparison of the Pre- and post-intervention data for VJH and FLLI in each group (mean�SD) (Unit: VJH-cm, FLLI-mm)
Table 2.
Comparison of VJH and FLLI between the adjustment group and stretching group (mean�SD) (Unit: VJH-cm, FLLI-mm)
DISCUSSION
The pelvis supports the abdomen, connects the spine and legs, and is involved in transferring weight from the spine to the legs when a person stands up, maintaining a straight posture and enabling smooth arm movements). Due to their erect ambulation, human beings are exposed to gravity and can thus be subject to a malalignment of the pelvis and legs affecting posture, ambulatory pattern, and balance. LLI is easily observed clinically and causes functional disturbance of normal biomechanics).
Winter and Pinto reported that pelvic obliquity is caused by LLI), and Mccaw and Bates explained the relation between biomechanics and spinal deformity due to LLI). Defrin et al. reported that when a shoe insert was used in 22 chronic back pain patients with LLI of 10?mm and less, pain intensity and muscular weakening were reduced), which appears to be due to reduced pain and muscular weakening attributed to decreased pelvic tilt resulting from LLI adjustment. On the basis of previous studies on pelvic adjustment, Alcantara et al. reported that following adjustments using fast and slow speed amplitudes in patients with sacroiliac joint obliquity, pain was reduced, and patients could resume daily life and work). Park et al. reported that balance in 20 elderly men was improved through pelvic adjustment according to the Gonstead method). In this study, FLLI was reduced after pelvic adjustment, a finding similar to a previous study in which pelvic adjustment helped reduce FLLI and the pressure difference between soles).
In this study, stretching was not associated with increased VJH, while pelvic adjustment was. In a previous study by Ryan et al. in which subjects jogged for 5 minutes in order to improve VJH, a barometer for leg strength, and then performed dynamic stretching, VJH was increased as compared with a control group that only jogged for 5 minutes). In the present study, it is suspected that VJH did not increase because only static stretching was applied. Hedlund et al. reported that VJH showed a statistically significant increase following 3 weeks of chiropractic HVLA manipulation in 22 female handball players with talocrural joint dysfunction, which is similar to the findings of the present study).
Pelvic adjustment balances the left and right pelvic height and left and right anterior and posterior rotation of the hip bones, which, in turn, leads to FLLI improvement. It also balances the left and right muscle lengths of the rectus femoris and sartorius, which are involved in the hip bone�s anterior rotation, and the hamstring and gluteus maximus, which are involved in posterior rotation. This seems to explain the improvement in vertical jump ability. We recommend that pelvic adjustment be applied for decreasing FLLI and increasing VJH, a barometer for leg muscle strength, in the future.
Research now indicates that receiving Chiropractic Adjustments to the pelvis can�increase vertical jump height. �This research solidifies many professional and collegiate teams that�provide chiropractic care for their athletes. In addition to injury prevention this research proves that chiropractic care results in greater athletic performance.
Tony Robbins, the #1 personal growth and business leader, talks about his experience with�Network Chiropractic and Donny Epstein.
Network Spinal Analysis� could be described in this way, arising as it did when in 1982, New York Chiropractor, Dr Donald Epstein began �networking� various chiropractic techniques. Through meticulous observation and by comparing the findings and results of one method with another, he began to see the efficacy of marrying certain techniques in a manner which enables the practitioner, through the use of light touch, to release large amounts of spinal tension from a patient. Although this might not sound very dramatic, it is a fact that the absolutely remarkable �life-changing� ways in which patients respond to this method of care has become a hallmark of NSA. This unique approach to health is a synthesis of long standing chiropractic methods, quantum mechanics, neuroanatomy and neurophysiology while also acknowledging changing perspectives in health care. In Dr Epstein�s case, these changes involve an expanded interpretation of the concept of �wellness�.
What is Network Chiropractic?
Here is an interview with Dr. Epstein from the Positive Health Online website:
Dr Epstein: �Network Spinal Analysis� sits within a new paradigm which I have been developing internationally and that�s called the Wellness Paradigm. Wellness is not about whether a person has disease. It�s about their internal experience of their body, the ability to make constructive healthy choices, and their ability to enjoy life and be well. Wellness is that state of concern in which you are relatively invincible, nothing can ruin your day, you feel alive, vital and confident and experience a high state of well-being. When you experience wellness, your circumstances of the moment do not easily upset your internal state.�
Findings from Network Care have been documented in major university studies which examine the social science and bio-medical indicators of wellness by looking at a variety of different things people do to increase their health levels. A person who meditates daily, has buns of steel from exercise and the most expensive urine on the planet from supplements, and who has stopped doing the destructive things, will double their perceived wellness factor. However, if that person then adds Network Care, their wellness factor � their ability to make healthy life choices and stick to them � trebles!
Dr Epstein: �What we are looking at here is an experience of life beyond the usual form. A more subtle engagement with the parts of the brain that allow a person to express their higher level of humanity and function occurs so that a greater capacity to express more connections of compassion and love arises. I call these �higher end social changes�, because there are spiritual connotations involved. The individual is different in the way they relate to others and their environment. They can be instrumental in helping create a more compassionately productive community.
�To understand the �mechanics� of NSA, we must first remind ourselves that the spine is composed of bones sitting on top of each other with discs or pads in-between. These bones or vertebrae have holes like donuts in them. These holes create a spinal-canal for the spinal cord which extends from the base of the brain to the tail-bone. The central nervous system comprises the brain and the spinal cord, and is supported by an intricate system of tissues called the meninges that are filled with fluid which nourishes and protects the nervous system, all of which sits within the spinal canal, protected by the bony vertebrae. Connective tissue attaches this system to the top and bottom of the spine and this tissue is subject to stresses, tension and distortion.
�We perceive our world through the nervous system. It is also through the nervous system that we coordinate the function of every cell, organ and tissue in the body. Every region of the body and every emotion is expressed through the nervous system. Also, it�s the part of us with which we reason and which adapts us to stress and it�s the vehicle we use to create our conscious reality. So, when an event occurs that our brain decides is not safe for us to fully experience at that particular time, the energy and information of the event is translated into vibration and tension, which is then stored in the body. This tension begins to distort the spinal system: Spinal bones (the vertebrae) lose their normal alignment, and muscles and ligaments strain and pull. Nerves can become compressed or stretched and irritated which results in abnormal function. As the nervous system is put under pressure, the spine is no longer able to right itself without outside help. Our body then �closes off� the offending energy and tension, but over time, muscular tightness, spinal distortion, reduced breathing into the area occurs and consequently reduced movement results. Until it is safe to experience that energy again, and digest the information from the trauma, we cannot really feel whole or well.
�This is a very real thing � anyone who is at the crossroads of life, physically, emotionally or spiritually, or anyone who cannot get further than they were before, needs Network Care to help their brain to move from stress physiology which results in a person�s structure being fixed in defense posture. In fact, most of us remain in defense mode throughout our lives and this can retard the higher, more evolved area of the brain from developing its unique properties and evolving new strategies for experiencing and responding to life. There are many people whose vertebrae, ligaments and tissues are locked into stress patterns, creating so much tension, that their focus in life is just getting through another day! Network care allows the brain to move from the stress physiology into safety.�
So How Does The Practitioner Go About Relieving This Stress?
Dr Epstein: �I found that by using gentle and specific touches in a consistent sequence, where the spinal cord attaches to the spine, a patient�s own body learns to release complex patterns of tension and areas of disablement. Once this has been achieved, a further unwinding of deeper tensions from the spine occurs. These �touches� consist of gentle finger or hand contacts applied at �spinal gateways�� or �access points� along the neck and lower spine. They are applied in such a way as to engage the higher part of the brain, the frontal lobes of the cerebral cortex. This is the most recently developed region of our brain and is the area through which we observe ourselves and make choices regarding our behavior. This is the area through which we can reach a higher level of humanity, one which embraces spirituality and evolution.�
During Network Spinal Analysis� Care, two �healing waves� develop. One is a breathing wave which releases tension throughout the spine and body and relaxes a person. The other is called somatopsychic (or body-mind) wave, which is associated with undulation or movement of the spine.
Dr Epstein: �The mathematics of this wave are unique because it appears that this type of wave has not been reported anywhere else, so it has to be a signature in Network care. The theory being purported now suggests that as the individual progresses through levels of care, that wave, that signal along the spine is organizing high levels of complexity. That means there�s more letters in the language � more words available and ultimately more information becomes accessible. There is an evolutionary aspect to this in that there is an increase in the ability of the system to self-organize so it can have more appropriate views about the environment and become more energy efficient. Thus an outcome is produced, that is significantly beneficial to the species and that was not there before.
�What we are looking for in Network is for the system itself to reorganize and develop strategies for experiencing and releasing tension on its own. In the first level of care, which may last a few weeks, the person develops a strategy to connect the brain to the body more effectively and to develop a capacity for self-correction of the tension patterns. The care program encourages the development of spontaneous stretching movements and breath movements which help release tension in the spine. In the second level of care, we are looking for the brain to be aware of the person�s tension, and actually temporarily amplify that tension and redirect it so that the tension actually becomes the fuel for further healing and transformation. Tension is what holds a person anchored in a position of non-safety. Lack of safety is the basis for all physiological stress and the way we accumulate this stress is directly associated with the way we experience our world.
�I would like to see Network Spinal Analysis� practitioners in places like cancer clinics and working with people who have had recent heart attacks; serious trauma patients and those who have had emotional traumas as children. I see Network Care not as competing with the existing medical paradigm, but instead offering a totally different approach that says no matter what you do about the disease, allow that person to be upgraded from say a 64k computer to a Pentium. Allow them to develop new strategies that they never had before and that person will make healthier choices. They will become more at peace and ease with their life and they will have a greater capacity to heal, which often means the disease going away. And if the disease doesn�t go away, at least that person�s life is going to be richer than it was before. Network Care is an approach to wellness that embraces everyone. Babies, children, seniors. All can develop these strategies which allow a higher level of function.
�A man who came to a talk I was giving, told me he had metastatic prostate cancer. He had had surgery and radiation treatments and the cancer had gone away but now it was back and spreading and he was very worried. I asked him what he was afraid of and if he was afraid of dying. He said, �No, I�m afraid of the way I have to die if I go for further chemotherapy and radiation.� It is upsetting that the treatment has to take away a person�s dignity which in my opinion can never heal. But I asked him what he would have to do differently if he was going to die. He said that he would have to get his affairs in order so I asked him what he meant by that. �Well,� he said, �I haven�t spoken to my son in 20 years and I never forgave my wife for dying�. And he went through a variety of things. I asked him why he would have to do these things. He said so that he could die in peace and I said, �Sir, this is a mistake, it�s so you can live in peace�. For some people, the only way they can make the changes which will enable them to live in peace is at the very end of their life.
�And the point of this is � there are people who have cancer who never know it and who live full and perfectly wonderful lives. I know of one Network doctor I met at a seminar recently who told people that she is more alive, more compassionate and responsive with more feelings of gratitude than ever before. Six months previously, she had a breast removed, and for six weeks before that she had received chemotherapy. The other people who had had chemotherapy and surgery at the same time were not receiving Network Care. Her internal state of wellness was so high irrespective of her circumstance, that she could be well and produce the physiology that would allow for a person to heal.
�When someone comes to me for care, I do not have to know what it was that caused that person�s problem. What I do know, is how to intervene, to help their system to observe itself and to make a change. I have clinically dedicated myself to furthering the knowledge of the biological links which will help us express a greater range of our humanity. I believe that by optimizing an individual�s biology, Network Spinal Analysis� will facilitate positive transformation on a global scale, changing the world, a spine at a time�.
In 1982, New York Chiropractor, Dr Donald Epstein began �networking� various chiropractic techniques. Through observation, comparing the findings and results of one method with another, he began to see the efficacy of marrying certain techniques in a manner which enables the practitioner, to release large amounts of spinal tension from a patient. �Dr. Jimenez is proud to be a practitioner that combines not only the “Network Techniques” discussed above as well as the established “Advanced Diversified Procedures.“
are impairments in detecting, modulating, interpreting, or responding to sensory stimuli. One study estimates that 5 percent of elementary aged children met the criteria for SPD. These conditions are closely related to other neurodevelopmental disorders and often overlap with autism and ADHD. Recent studies have shown the benefits of chiropractic in enhancing the functionality of individuals with SPD and Autism.
In 2011, we have more children and young adults affected by neurodevelopmental disorders than ever before in history. There are many factors involved in this such as birth and/or early childhood trauma, environmental toxins, food allergens, the avoidance of breast feeding and heavy vaccination. These are all areas that show promise as causative factors in the formation of neurodevelopmental disorders.
Birth trauma can come in the form of a forceps or vacuum extraction delivery. Even normal vaginal or cesarean birth processes can be particularly traumatic. The most vulnerable area of the infant�s body is the upper cervical spine. This also happens to be the area where the brain stem ties into the top of the spinal cord. Birth trauma can significantly damage this region andcreate a neurological insult that is referred to as subluxation.
Subluxation alters neurological processing
Subluxation is a term used to describe mechanical compression and irritation to spinal joints and nerves. Subluxation scrambles the neurological feedback loop by causing altered rhythms of neurological flow. Subluxation insults the neurology of the infant and affects normal development and maturation. This can often create an environment conducive to the formation of neurodevelopmental disorders such as autism, ADHD andSPD.
Many chiropractors specialize in the location, diagnosis and correction of subluxation patterns in infants and young children. These chiropractors often have unique training with digital technology that uses thermographic and surface electromyography to calibrate the function of the nervous system and identify areas of neurological insult. They are also gifted with palpation, posture and body motion observations to locate specific biomechanical and neurological imbalances in the young child.
Spinal Decompression Therapy
Two recent studies published in the 2011 edition of the Journal of Pediatric, Maternal & Family Health showed the benefits of chiropractic on SPD and Autism. In both cases the children were diagnosed with upper cervical subluxation patterns that were thought to have occurred from early childhood traumas. The children also showed signs of neurological imbalance and subluxation in other regions of the spine. Results of their care were startling and would naturally be considered major breakthroughs in the medical model.
The children�s care consisted of specific chiropractic adjustments for a period of weeks to remove subluxation and balance the neurology. They also followed an anti-inflammatory nutritional program that involved a gluten-free, casein-free diet and nutritional supplements such as probiotics and digestive enzymes.Most natural health practitioners would agree that the majority of children with neurodevelopmental disorders have neurological and digestive damage. The digestive issues typically involve leaky gut syndrome, gut dysbiosis, Candida infections and chronic food allergens. These problems typically present together and can be remedied with an anti-inflammatory diet and nutritional supplements.
There are 10 other case studies of children with similar neurodevelopmental issues who have seen significant improvements through chiropractic care. This is evidence of the role that subluxation plays in affecting normal sensory system maturation and development.
Hopefully these recent studies will shine a light on the impact of subluxation correction on healthy neurological balance. This can range from immune system disorders, chronic disease and neurodevelopmental problems. More research dollars should be spent on inexpensive, low risk, non-invasive modalities such as chiropractic care for childhood health problems and normal brain and immune system maturation processes.
Sensory Processing Disorders (SPD) are impairments in detecting, modulating, interpreting, or responding to sensory stimuli. One study estimates that 5 percent of elementary aged children met the criteria for SPD.
Automobile accidents are the most common cause of whiplash. Any type of accelerated motion that thrusts the head forward and then backwards with extreme force can lead to whiplash. Sports accidents can also cause whiplash-associated injuries. An unpredicted head jolt can damage the complex structures of the cervical spine, leaving tendons and ligaments intensely irritated and inflamed. The tendons and ligaments as well as other tissues of the neck may become overly stretched and torn.
A whiplash type injury may be suspected if the individual involved in an�automobile accident experiences�the following symptoms: neck pain and stiffness; worsening pain with movement; loss of range of motion in the neck; headaches, most often starting at the base of the skull; tenderness or pain in the shoulder, upper back or arms; tingling or numbness in the arms, fatigue and dizziness. Other individual�s may experience: blurred vision; ringing in the ears; sleep disturbances; irritability; difficulty concentrating; memory problems; and even depression. While these are some of the most common symptoms of whiplash, they may also suggest the presence of another type of injury or condition resulting from the automobile accident.
Thus, it�s essential to visit a qualified healthcare professional who can properly identify a whiplash injury and offer the required treatment to eliminate the resulting pain and symptoms.
Apart from assessing the doctor�s experience and qualifications, the victim of an automobile accident must primarily consider their geographical location and the type of insurance they are covered by when deciding on the type of doctor to visit following a whiplash type injury. Other factors that should influence the affected individual�s decision include whether they are represented by an attorney and whether they are living in a state where PIP, or personal injury protection, is mandatory.
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Whiplash Injury Practitioners
People who�ve sustained injuries from auto accidents fail to receive the kind of medical care they require. It has been previously determined that the outcome of the patient�s rehabilitation depends on the type of doctor they receive care from.
Many individuals who�ve been involved in an automobile accident, regardless of the severity of the collision, will generally visit the emergency room, or ER, to have their injuries evaluated. The majority of ERs are designed to take patients out of life threatening situations. First, they immediately assess any visible injuries, such as open wounds and broken bones, treating them effectively on the spot. They may even prescribe medications to temporarily relieve the painful symptoms following a�traffic collision. However, many victims are not treated for their whiplash injuries. The trained specialists from the ER, provide first-aid, X-rays and medications to remove individuals from life-threatening situations but they don�t readily treat soft-tissue injuries like whiplash. From there, patients are sent to see their primary care physician, or PCP, to assess the rest of their injuries, yet, they may still face hardships to finally receive the proper care they deserve for their injuries.
Primary Care Injury Specialists and Whiplash
Many primary care physicians do not have the full qualifications in treating automobile accident injuries. Many of these doctors may even deny patients treatment. Whiplash associated disorders have been misunderstood in the medical field and many doctors believe whiplash is not a legitimate injury. However, those whom are suffering from whiplash can account for how painful it really is.
Other doctors refuse treatment to whiplash patients because they may not accept any kind of 3rd�party billing, a paying method where the doctor seeing the car accident victim has to bill the party at fault�s insurance company or utilize PIP or med pay to receive compensation.�This is a commonly well-known reason for denial of treatment as a large number of primary care physicians, or PCPs, still don�t have the required authorizations to accept 3rd�party billing.
Besides primary care physicians, medical doctors, orthopedics, chiropractors and physical therapists are several types of qualified healthcare professionals that specialize on treating automobile accident injuries such as whiplash. Among these, chiropractic treatment is the most popular, alternative treatment option for treating various soft tissue injuries or conditions.
Chiropractic Treatment for Car Wrecks
Many people from the legal and medical industry dismiss seeking a chiropractor for auto accident injury treatment. However, the fact is that a chiropractors are some of the only doctors who offer therapeutic treatments to accident victims. Treatment offered by medical doctors might include the use of drugs, although in many cases, they may also recommend physical therapy. This automatically highlights the importance of chiropractic care for whiplash victims because chiropractic care and physical therapy are very similar forms of treatment.
Whenever an individual who�s been involved in an automobile accident visits a chiropractor and complains of pain in the neck, the medical specialist will carry out a series of tests to determine whether the patient has suffered whiplash. Instead of focusing solely on the specific injury, chiropractors are trained to inspect the affected individual�s entire spine. Aside from soft tissue injuries like whiplash, chiropractic doctors may also check for: disc trauma or injury, tightness or tenderness, restricted mobility, muscle spasms, joint injuries, ligament injuries, posture and spinal alignment. They may also analyze the patient�s gait.
Besides checking for the above, chiropractors might also request X-rays and MRI of the patient�s spine in order to find out whether the spine features any degenerative changes which might have developed before the accident. To offer the best possible treatment, it is extremely important to determine which problems existed prior to the accident and which ones resulted from the accident. In most cases, insurance companies may argue that every single injury in the victim�s body is preexisting. This makes the role of the chiropractor considerably important as they will make sure to document all the previous and new injuries separately to ensure the insurance company pays for the patient�s treatment. In addition, the evaluation performed by the chiropractor also allows them to create the most effective treatment plan for each individual whiplash victim.
Main Stages of Care
The leading concern for chiropractors who treat whiplash-associated disorders involve alleviating inflammation in the neck. Chiropractors often recommend ice therapy, or the application of ice pack against the affected area, multiple times a day. This remedy is capable of reducing both pain and inflammation. Once the inflammation subsides, they often carry out a variety of manual therapeutic techniques to restore and increase the individual�s strength, flexibility and mobility.
The kind of chiropractic treatment the individual will require depends largely on the severity of the whiplash encountered. However, it has been previously determined that the majority of individual�s with whiplash find spinal manipulations useful. The most common chiropractic treatment techniques involve, spinal adjustments and manual manipulations, to carefully re-align the structures of the spine and help reduce symptoms. The following spinal techniques are also used to treat whiplash injuries: Instrument-assisted treatment, which involves the use of handheld instruments to provide a gentle massage by applying force onto the spine without utilizing any kind of thrust.
Instrument-assisted chiropractic therapy is used mostly to treat older patients with degenerative joints; flexion-distraction, this technique involves the use of a non-thrusting motions, best described as a slow pumping action; specific spinal manipulation, this therapy involves the use of a mild thrusting technique and is mostly used for restoring motion to the affected joints. Specific spinal manipulation helps stretch the soft tissues, which makes the job of restoring motion to the affected areas of the spine easier; instrument-assisted chiropractic therapy, also known as the Graston Technique, is used during this form of chiropractic therapy to perform repetitive strokes on the injured body part; therapeutic massage, performed to ease muscle tension and stress in the injured region; interferential electrical stimulation, where a patient undergoing this type of therapy will see the chiropractor passing electrical current at a very low frequency through their body. This low frequency current helps stimulate the muscles and reduces inflammation; trigger point therapies, as the name suggests, involves the application of direct pressure onto specific points to alleviating muscle tension; and finally ultrasound therapy, capable of decreasing stiffness, pain, and muscle spasms in the affected areas. When ultrasound is passed through the patient�s muscle tissues, it warms up the treated region and increases blood circulation.
Neck Trauma and Auto Injury
Chiropractic Treatments
Ultimately, chiropractors can help victims of whiplash in many ways. These health care providers can ensure that an individual� whiplash and its associated symptoms may subside completely. They always make sure to create a patient-specific treatment plan to make the process of recovery simpler for every individual.
Other than recommending immediate treatment for reducing the acute pain and inflammation, the chiropractor might additionally recommend a series of stretches and exercises, to help speed up the rehabilitation process as well as help increase the individual�s strength, flexibility and mobility.
Whiplash injuries, when left untreated, can cause severe complications. If you or a loved one have been involved in an automobile accident, visit a chiropractor immediately. By being prompt, you can even reduce your recovery time significantly. That�s not all; the chiropractor will also provide the required assistance to your lawyer, proving that the injury resulting from the accident wasn�t a preexisting injury or condition.
When you are injured in a car accident, you must get acquainted with your rights as soon as possible to receive the proper compensation and treatment for your specific situation. There is no such thing as a simple car crash.
Certain injuries or conditions which may have developed following an automobile accident may become chronic or permanent if left untreated. If an individual is experiencing neck stiffness or headaches after a traffic collision, it�s absolutely wrong to assume that this will subside in a few days. A minor discomfort could turn out to be a more serious complication.
Often, people injured in auto accidents develop scar tissue that remains with them throughout the rest of their lives and without the necessary treatments or exercises, these can become stiff and greatly limit an individual�s ability to move properly. The above issues generating from a car accident show how important it is for people to seek immediate legal and medical help. Chiropractors are known for their expertise in managing soft tissue injuries and the resulting chronic and traumatic pain; as a result, they are often considered to be the best healthcare professionals to consult�after a car accident.
Auto accidents can create enormous confusion and frustration. Most injuries associated with car accidents include trauma to the cervical spine. Dr. Jimenez discusses treatment options and procedures used in assisting patients reach optimal recovery. Choosing the right clinical team is always important. Many legal experts agree that a specialist focusing on soft tissue injuries is a search requiring great insight and assistance. Doctors of chiropractic and physical therapy along with surgical experts are best suited in assisting patients find the correct treatment options. If you have more questions please feel free to call 915-850-0900 in order to speak to Dr. Alex Jimenez.
Women often seek out chiropractic care during their pregnancies. One of the main reasons for this is that if they are having musculoskeletal pain, their Obstetrician or Midwife generally has very limited options for conventional medical treatment. They are less likely to prescribe medication, which presents an amazing opportunity for us as chiropractors. What initially began as a strange combination of a sports certification and a prenatal/pediatric certification has created a successful and in-demand niche for us. For the most part, I cannot imagine treating prenatal patients without having the sports background. First, most women at some point in their lives have been or currently are an athlete. And second, one of the most common complaints women have during pregnancy is myofascial pain, and who better to treat that than a sports chiropractor? Here are 5 common and easy-to-treat complaints during pregnancy:
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One: Pubic Bone Pain
This pain is very common during the second and third trimesters of pregnancy. Women will often describe it as exquisitely tender, worse with rolling over in bed at night, walking or climbing stairs. Conventional medical opinion is that the ligaments during pregnancy are much more relaxed (due to the hormone, relaxin) causing separation of the pubic symphysis and thus inflammation and pain. Sports chiropractors are uniquely qualified to assess this joint, and the common causes of pain can include:
1. Adductor hypertonicity easily addressed with myofascial release or techniques such as Graston, which can be done over leggings or on skin.
2. SI Joint fixation or Pubic Symphysis fixation. While I am generally a diversified adjuster, an activator adjustment to the superior or more-tender pubic rami will go a long way in terms of providing relief. I strongly discourage any audible manipulation of the pubic symphysis.
3.�Kinesiology taping�of a �RockTape Baby Belt� or modified version of this can provide significant relief and is much more comfortable than a pelvic support belt.
4. Using an ice pack for 15 minutes prior to going to bed at night will decrease pain and inflammation while sleeping.
Two: Rib Pain
Rib pain, especially in the lower and floating ribs, is common as the weight of the abdomen is pulling on the oblique abdominal muscles and their attachments at the ribs. Adjusting the ribs at the thoracic spine and incorporating myofascial release or Graston Technique will work quickly (often in just 1 treatment). Finish up with a few strips of kinesiology tape and your patient will feel significantly better.
Three: Upper Abdominal Numbness
Upper abdominal numbness is a common symptom during the later stage of pregnancy. It often presents as numbness but can also be painful and worse with sitting. One of the easiest ways to provide relief is with one simple strip of kinesiology tape over the top of the abdomen directly under the rib cage.
Four: Swelling in the arms and legs
Swelling in the arms and legs is very common and can lead to numbness, tingling or pain. Before beginning treatment, be sure to assess if the swelling in the feet is significant and test for pitting edema which can be a warning sign of preeclampsia. This can be corroborated with a high blood pressure reading and is very dangerous. Two very effective sports techniques for use with lower extremity swelling include 1.�NormaTec PULSE Recovery System�which is not contraindicated in pregnancy. Patients can do a few 20-30 minutes sessions per week to promote circulation and decrease swelling. 2. Kinesiology taping for edema on the ankles.
Five: Lower Back Pain
Lower back pain in pregnancy is very common. Evaluating a pregnant patient prone is very easy if you have pregnancy cushion that sits on top of your table. If you do not, you can evaluate the lower back in the seated or side lying position. Lower back pain can generally be addressed with diversified adjustments (without any rotation as to not stress the abdomen). In addition, the Webster Technique for pregnancy is a valuable tool for assessing and treating lower back pain during all stages of pregnancy. There are also valuable kinesiology tape applications for lower back pain,�RockTape features a pregnancy taping pdf online. In addition, there are no contraindications to using the Graston Technique to address myofascial pain in the lower back.�
Most of the taping techniques discussed above can be done by patients themselves after a one-time demonstration. Have an assistant or patient�s family member take a video of the application for reference at home. Many sports chiropractic techniques can be used very effectively on prenatal patients.
This is one of the most common questions asked by people seeking or considering chiropractic care along with:
�What are the risks?�
�Can I receive spinal adjustments without the chiropractor adjusting my neck?�
�Do chiropractic adjustments cause arthritis or even strokes?�
With media scrutiny over natural health procedures, specifically chiropractic and cervical adjustments, these are very important and serious questions, especially when one�s health is a priority. As a practicing chiropractor, I welcome the opportunity to address these questions. Chiropractic care is profoundly safe, and this article summarizes the current research, providing answers to these common questions and misconceptions.
Myths vs. Facts
In 1990, when I started working in the chiropractic profession, a common concern that patients had about chiropractic care was that �too many adjustments would cause arthritis.�� Years later, science has affirmed what chiropractors have always seen and known to be true in clinical practice � that in fact chiropractic care is not only one of the most popular forms of care for people with arthritic conditions but one of the most effective.
Unfortunately, for hundreds of years, health care practices have been permeated by folklore, sometimes known as �old wives tales.�� The trend continues today.� A 2010 study of over 1,000 board-certified American pediatricians found that over 75% of the doctors subscribe to at least one known health care myths. These include the myths that eating chocolate causes acne, listening to Mozart will make a baby smarter, and swimming within 30 minutes of eating is not safe.� Many doctors in this study were also found guilty of not knowing the expected protocols for treating burns, healing wounds, administering Aspirin to children, and safely dealing with seizures.
A review of the current literature indicates that frequent or extreme complications of chiropractic care should also be included in the list of the most common medical myths prevalent even in our medical offices.
Chiropractic vs. Traditional Care Preventing Back Pain
Spinal Care vs. Chiropractic Care
The spinal column�s role in overall health cannot be undermined as it houses the brainstem, spinal cord, and central nerve system.� Thus, for optimal health the spinal column must be examined and cared for by a skilled doctor.
Specifically, the foundation of chiropractic care teaches that damage to the spine, and misalignments of the vertebrae (subluxations) create interference in the nerve system, which are therefore reduced and corrected through specific chiropractic adjustments.
On that basis, chiropractic adjustment techniques have historically been rooted in precision and accuracy.� Although there are now many unique chiropractic techniques taught in professional schools and in continuing education, these techniques commonly focus on the evaluation and measurement of subluxation patterns in the spine and the specific protocols used to reduce the areas of misalignment.� In contrast, most other health care practices addressing the spine, never mind non-medical procedures attempted at home, are for the most part, generalized treatments of pain, global mobilizations of joints, and overall tractions of entire regions of the spinal column.
Receiving a specific chiropractic adjustment to reduce a subluxation is immensely different from receiving any form of �treatment� on the spine.� Admittedly, I did not understand this practice in my first 20 years of receiving chiropractic adjustments.� Until I attended chiropractic school and learned the techniques and analyses used in chiropractic science, I thought that chiropractic adjustments were all one-of-the-same.� I can understand how the general public might also construe this misconception � I did and I grew up in a chiropractic family.� Subluxations and adjustments are specific; the more extensive the analysis used by the chiropractor, the more precise the adjustment, and thus the better improvement in the patient�s health.
In my experience, the majority of the �chiropractic horror stories� shared in folklore, and even many of the cases cited by medical research, fall into one of two categories:
(a)��� The case of a the patient receiving care without extensive and correct analysis
(b)�� A person receiving spinal care incorrectly identified as �chiropractic care� administered by someone other than a licensed Doctor of Chiropractic
In fact, a 1995 report in the Journal of Manipulative and Physiological Therapeutics revealed that many �manipulations,� incorrectly attributed to chiropractors, had been rendered by non-chiropractic professionals including GPs, osteopaths, and physiotherapists, and even laypeople including a wife, a Kung-Fu practitioner, a blind masseur, and an Indian barber. Therefore before someone suggests they were hurt or injured by a �chiropractor,� it is imperative to learn more about their experience.� In all likelihood some level of scrutiny was overlooked � or they weren�t seeing a licensed chiropractor at all.
Modern chiropractors use advanced technological analyses such as X-ray, surface electromyography (sEMG), thermography, and digital postural analysis, along with traditional chiropractic methods of motion and static palpation, leg length analysis, and visual postural inspection to make a diagnosis and determine the appropriate adjustment.� Naturally, to use layman�s terminology, if a patient presented to the chiropractor with a low left hip, and the chiropractor adjusted the left hip �even lower,� the patient would get worse.� For this reason, your Doctor of Chiropractic is not only highly trained but expected under every state and provincial law to thoroughly assess your spine and condition prior to making recommendations or giving adjustments.
MRI Scans Show Immediate Benefits of Chiropractic
What about stroke?
Since the 1990s, the most extreme fallacy about chiropractic care is that �adjustments of the cervical spine cause strokes.�� As a practitioner, I am pleased to observe greater inter-professional cooperation between physicians and chiropractors, but I am disappointed by the increasing number of patients who have consulted me following a discussion with their medical doctor and told to �not get their necks adjusted.�
A basic understanding of the origins of chiropractic care, and the critical function, anatomy, and physiology of the central nerve system demonstrates why the suggestion that patients should �not get their necks adjusted� is absurd.� While chiropractors are concerned with the reduction of nerve system stress caused by spinal subluxations throughout the entire spine, one must understand that all spinal nerves first pass through the upper cervical spine.� Therefore, interference to the nerves passing from the brain through the spinal cord to any area of the body could occur either at the associated spinal segment where the peripheral nerve exits the spinal column, or at any place higher, including the upper cervical spine.� Historically, Dr. B.J. Palmer, who developed the modern chiropractic profession, focused the majority of his research and efforts into the reduction of upper cervical spine subluxations, expressing that upper cervical subluxations were the foremost cause of disease and dysfunction compared to other subluxations in the spine.8 Years later, science continues to affirm the importance of upper cervical alignment.� It has been demonstrated that abnormal cervical alignment is a leading cause and an almost universal finding related to not only cervicogenic pain and headaches, but also the development of scoliosis9,10 and even sudden infant death syndrome (SIDS). This awareness of the basic physiology of the nerve system is enough to understand the utmost importance of reducing subluxations in the cervical spine, above all other areas of the nerve system.
The �stroke hypothesis� stems from the theory that the irritation of the vertebral arteries, which pass through the cervical vertebrae, could lead to an ischemic stroke by causing accumulated plaque in the arteries to be dislodged.� As strokes may cause serious, permanent impairments in a person�s health, there has naturally been much interest and research in this topic.
Consider how plaque develops in the arterial system of the body.� Exposure to the known risks of poor diet, alcohol consumption, and smoking over a period of many years may cause molecular plaquing in the arteries, and it is true that when those molecules become dislodged, they can affect the brain, which is known as a stroke.� Unfortunately, your family doctor or your chiropractor can�t prevent this from happening � you would need immediate emergency medical attention in hospital to prevent this from occurring.
Warning signs that a stroke may be about to occur include upper back pain, neck pain, and headaches.� Naturally, people dealing with these symptoms may consult their chiropractor, hoping for a resolution of pain.� Many may also consult their MDs and/or other trusted health care providers.� Unfortunately, such pre-stroke symptoms as back pain, neck pain, and headaches may not explicitly appear to be the early stages of a vascular incident without the �red-flag� accompanying symptoms of blurred vision, dizziness, slurred speech, facial drooping, and lack of coordination.� Therefore, as it is not standard practice for chiropractors or medical physicians to refer every case of back pain or headaches to the emergency room, patients may receive chiropractic or medical intervention without knowing that a stroke is ensuing.
When is a chiropractor or medical doctor negligent?� If a patient visits the doctor�s office with neck pain and headaches while showing the classic signs of stroke (slurred speech, dizziness, poor coordination, etc.), the doctor is obligated to identify this and ensure that a stroke is not about to happen. �If, after examination, a doctor identifies that a stroke may be forthcoming, the doctor must see that the patient receives the necessary immediate medical attention.� Doctors who do not rule out the possibility of an imminent stroke or do not ensure necessary medical attention if a stroke is indeed forthcoming, would indeed be negligent � but this is very far from �causing� the person�s stroke, whether or not any treatment was rendered.
In fact, although a chiropractic adjustment would not slow down the incidence of the stroke, 2008 research shows that it would no more accelerate it than a visit to the medical doctor.� In an article published in SPINE, a multi-disciplinary team of researchers found that while strokes are very rare events in the general public, there was only an increased correlation between chiropractic visits and the occurrence of stroke, due to patients with headaches and neck pain seeking care before their stroke. Notably, the correlation of medical visits and strokes matched that of chiropractic visits and strokes; neither form of care was shown to increase the risk of stroke.� In either case, the unfortunate patient was headed for a vascular incident.� The occurrence of a stroke after a visit to the chiropractor (or the medical doctor) provides no association of cause, only correlation.
Is your chiropractor required to warn you about the possibility of a stroke with a chiropractic adjustment?� Interestingly, Dr. Christopher Kent, who is an attorney, independent researcher, and president of the Foundation for Vertebral Subluxation, has expressed that �such informed consent must be based on appropriate information and since there is no scientific evidence that chiropractic adjustments or neck manipulations actually cause strokes, it is inappropriate to require a doctor to suggest that such a risk exists.� Nevertheless, most state and provincial laws require Doctors of Chiropractic to disclose a remote risk of stroke to their patients, for this is common practice for �material risks� even when the likelihood of occurrence is very small.
Long-term Benefits of Chiropractic Care
Rather than study isolated reports of adverse incidences which may (or may not) occur within one visit to the chiropractor, it is more revealing to measure the long-term benefits of chiropractic care.� Ultimately, studies consistently demonstrate that a healthier spine relates to a healthier person.
Beyond symptomatic relief, a growing number of chiropractors place emphasis on corrective care and spinal hygiene, to maintain and promote the health of the spinal column and nerve system.
Without maintenance of spinal health, we now know through numerous studies that posture misalignment not only affects neurology but also the vascular system.� A 2004 study revealed that older men and women with hyperkyphotic postures have increased rates of death, specifically associated with increased atherosclerosis. With atherosclerosis increasing the incidence of an ischemic stroke, it is only logical for health-conscious individuals trying to prevent strokes to maintain healthy posture through chiropractic care.
Further, whereas a 2005 study showed that the reversal of the normal cervical curvature results in vascular changes in the spinal cord, the maintenance of this proper alignment should be of highest importance to those interested in the prevention of vascular incidents.
Statistically, the incidence rates favour those individuals receiving chiropractic care.� In 1995, the Journal of Manual and Physiological Therapeutics published the risk of fatal stroke associated with chiropractic cervical adjustments.� Although no cause was shown in the article, the correlation is estimated to be 1 in 400,000 or 0.00025%.20 Newer studies suggest the risk may be as low as 1 in 6 million, 0.00002%. Notably, the National Center for Health Statistics indicates the mortality rate from stroke in the general population is more than twice the rate of the most conservative estimates correlating chiropractic.� The risk in the general population is 1 in 175,000 or 0.00057%.
Not only is the risk of death from stroke after a cervical adjustment substantially less than the risk of fatal stroke in the general population, other long-term studies of chiropractic patients have shown:
Improved lung capacity, athletic ability, and vision
Better functional capacity, and reduced relapse of prior disability
Better overall health and greater activity levels
Enhanced DNA repair and enzyme activity; reduced impact of oxidative stress
Fewer hospital visits, reduced pharmaceutical costs, and medical expenditures
Improvement in health, wellness, and quality of life
The Final Verdict: Malpractice Claims
Lastly, as it is always possible that research could be slanted based on who was conducting it, perhaps the best measures of safety are the malpractice insurance costs for chiropractors and the actual frequency and success of claims filed against them.� No one pays closer attention to injury statistics than Malpractice Insurance carriers.
According to the Canadian Medical Protective Association, annual malpractice rates for Ontario medical doctors range from $1,572 for the family physician and $7,332 for the neurologist, to $44,520 for the Obstetrician.30 By comparison, the Canadian Chiropractic Protective Association�s standard rate for chiropractic malpractice insurance is less than $1,300 per year.� Notably, the first-year doctor of chiropractic is extended a new member discount of approximately 50% (as opposed to an increased premium), not reflecting any greater risk for a patient seeing a doctor with less experience.
American rates reflect the inter-professional differences to an even greater degree.� Whereas the U.S. physician could pay $25,000 to $50,000 per year for malpractice coverage, U.S. chiropractors pay annual rates less than $5,000.32,33 The chiropractic profession has a well-established record of safety and efficacy, and the chiropractor�s malpractice insurance rates remain among the lowest across health professions.34 The varying rates are directly related to the risk involved in the doctors� procedures, the claims filed against them, and the likelihood of future lawsuits.
Although they are sensationalized in the media when they do occur, claims against chiropractors are very rare.� Your chiropractor�s office consistently proves itself to be one of the safest health care facilities you can choose for your family.
Moving Forward
Unquestionably, there have been decades of misinterpretations, and unfortunately chiropractic myths have been passed down through generations.� Certainly, professional bias has also played a role in the public�s misunderstanding of the safety and efficacy of chiropractic care.� (The U.S. Court of Appeals determined in 1990 that the American Medical Association had engaged in a �lengthy, systematic, successful and unlawful boycott� designed to restrict cooperation between medical doctors and doctors of chiropractic.)� Fortunately, we are long past that day. �What you would hope to find in the 21st century are cooperative teams of health care professionals working together for your benefit.
My personal recommendation is to seek a chiropractor who not only uses current technology and techniques to analyze and render care to his or her patients, but also is willing to engage in dialogue with your other health care providers.� I recommend the same when choosing an M.D.
With this better understanding of chiropractic myths and the benefits of maintaining a healthy spine, I trust that you can comfortably move forward, integrating chiropractic care into your wellness lifestyle.
Sciatica is generally described as a set of symptoms, primarily characterized by pain and discomfort, along with tingling sensations and numbness. Athletes frequently report experiencing symptoms of sciatica, however, there are many factors as well as a variety of injuries and conditions which can manifest these well-known symptoms. Piriformis syndrome is a disorder that is frequently confused with symptoms of sciatica.
The piriformis muscle is commonly known among athletes and healthcare professionals as a significant muscle in the posterior hip. This muscle functions to control hip joint rotation and abduction and it is also a distinguishable muscle due to its inversion of action in rotation. The piriformis muscle also raises awareness as the various causes of piriformis syndrome, a condition suspected to be a potential source of pain and dysfunction, not only in athletes, but in the general population as well.
Contents
Anatomy of the Piriformis Muscle
The piriformis muscle originates on the anterior surface of the sacrum and it is securely held to it by three tissue attachments found between the first, second, third and fourth anterior sacral foramina. Occasionally, its origin may be so broad that it joins the capsule of the sacroiliac joint with the sacrotuberous and/or sacrospinous ligament. The piriformis muscle is a thick and strong muscle that travels out of the pelvis through the greater sciatic foramen, dividing the foramen into the suprapiriform and infra-piriform foramina. As it courses through the greater sciatic foramen, the muscle decreases to a point where it forms a tendon that attaches to the superior-medial surface of the greater trochanter, frequently integrating with the tendon of the obturator internus and gemelli muscles.
The nerves and blood vessels found within the suprapiriform foramen are known as the superior gluteal nerves and vessels, and those found in the infra-piriforma fossa are known as the inferior gluteal nerves and vessels, including the sciatic nerve. Because of its broad size in the greater sciatic foramen, there�s a risk the numerous vessels and nerves that exit the pelvis may become compressed.
The piriformis muscle is closely associated with other short hip rotators as well, such as the superior gemellus, obturator internus, inferior gemellus and obturator externus. The primary difference between this muscle and other short rotators is its connection to the sciatic nerve. The piriformis muscle passes behind the nerve while the other rotators pass before it.
Anatomical Variants
Several anatomical variations have been previously diagnosed among the piriformis muscle. First, there may be additional medial attachments to the first and fifth sacral vertebrae and to the coccyx. Second, the tendon may merge with the gluteus medius or minimus or with the gemellus. Also, in approximately less than 20 percent of cases, the piriformis muscle may be divided into two different segments, through which part or all of the sciatic nerve may travel. Then, the muscle may blend with the posterior hip joint capsule as a conjoined tendon with the obturator internus. Additionally, the distal attachment of the piriformis muscle has been demonstrated to vary in proportion and position on the supero-medial surface of the greater trochanter. It can stretch across 25 to 64 percent of the anterior-posterior length along the greater trochanter, with 57 percent of it attaching more anteriorly and 43 percent more posteriorly. Last but not least, researchers studied its insertion point broadly and discovered that four types of insertions existed and these were characterized based on the relationship to the obturator internus. The variation of placement and width of the distal attachment of the piriformis muscle may influence the effectiveness of the concept known as the inversion of action.
Furthermore, the connection between the piriformis muscle and the sciatic nerve has been a highly debated complication. It�s been previously concluded that there are several anatomical variations among the piriformis muscle and its connection to the sciatic nerve. The sub-types of this variation include: type 1-A, where the muscle is pear shaped with the nerve running anteriorly and inferiorly to this, found in 70 to 85 percent of cases; type 2-B, where the piriformis muscle is divided into two sections with the common peroneal nerve running between the two parts and the tibial nerve travels anteriorly and below, found in 10 to 20 percent of cases; type 3-C, where the peroneal portion loops over the top of the muscle and the tibial portion is found below, found in 2 to 3 percent of cases; and type 4-D, where the undivided nerve passes through the piriformis muscle, found in approximately 2 percent of cases.
Moreover, it is also speculated that two other, very rare variations may occur, demonstrated by letters E and F in the diagram. Type 1-A is the most common variation, displaying the sciatic nerve as it passes below the piriformis muscle.
Function of the Piriformis Muscle
The fundamental functions of the piriformis muscle are to provide hip external rotation and allow abduction at 90 degrees of hip flexion. During weight-bearing, the piriformis muscle restricts femoral internal rotation in the stance phase of walking and running. Also, it assists the short hip rotators in compressing the hip joint and stabilizing it. Because it can exert an oblique force on the sacrum, it may produce a strong rotary shearing force on the sacroiliac joint. Otherwise, this would dislocate the ipsilateral base of the sacrum forward and the apex of the sacrum backwards.
Since the piriformis muscle is the furthest behind of the hip external rotators because of its attachment on the anterior surface of the sacrum, it has the greatest influence to apply a rotation effect on the hip joint. Occasionally, healthcare specialists have found issues with the piriformis muscle where it appears to be tight and hypertonic, while the other short hip rotators which are found closer to the axis of rotation become inhibited and hypotonic.
Inversion of action
The most argumentative complication relating to the function of the piriformis muscle is its reversal-of-function role, best referred to as the inversion of action role. Researchers have suggested that as the hip approaches angles of 60 to 90 degrees and greater, the tendon of the piriformis muscle shifts on the greater trochanter. As a result, its line of pull becomes ineffective as a hip external rotator, however, it does contribute to internal hip rotation. Consequently, it reverses its rotation function at high hip flexion angles.
The role of the piriformis muscle at several joint angles is an essential consideration for healthcare professionals who evaluate and treat the causes of piriformis syndrome. Frequently, it�s recommended to stretch the hip into flexion, adduction and external rotation to stretch the piriformis muscle over the glutes by utilizing the reversal of function concept.
Nonetheless, more recent studies conducted through anatomical dissection have demonstrated that the attachment of the piriformis muscle onto the greater trochanter can change and, in some instances, it may insert in a position by which it may be unable to reverse its function, for example, in a more posteriorly placed attachment. Thus, stretching the piriformis muscle into external rotation when the hip is flexed beyond 90 degrees, based on the inversion of action role, would be ineffective as a treatment or misleading as an examination technique.
MSK Dysfunction and Causes of Piriformis Syndrome
Many decades ago, it was suggested that in some cases, sciatica symptoms may originate outside the spine as a result of the piriformis muscles. This hypothesis was supported soon after when specialists successfully improved an individual�s symptoms of sciatica by surgically dividing the piriformis muscle. Based on cadaver anatomical dissections, the researchers believed that the spasm of the piriformis muscle could be responsible for the irritation of the sciatic nerve.
The medical term piriformis syndrome then became associated to sciatica symptoms, believed to be caused by a usually traumatic abnormality in the piriformis muscle with a focus on ruling out more common causes of sciatica, such as nerve root impingement caused by a disc herniation. It soon became an accepted interpretation but with no consensus about the exact clinical signs and diagnostic tests to differentiate it from other sources of sciatica.
Understanding the Causes of Piriformis Syndrome
Piriformis syndrome can be defined as a clinical entity whereby the interaction between the piriformis muscle and the sciatic nerve may irritate the nerves and develop posterior hip pain with distal referral down the posterior thigh, resembling symptoms of true sciatica. Distinguishing the damage to this region typically follows exceptions of the more common causes of sciatica and buttock pain.
More specifically, reports of buttock pain with distal referral of symptoms are not unique to the causes of piriformis syndrome. Similar symptoms are prevalent with the more medically evident lower back pain syndromes and pelvic dysfunctions. Therefore, a complete evaluation of these areas must be performed to rule out any underlying pathology. It has been suggested that the causes of piriformis syndrome can be held responsible for approximately 5 to 6 percent of sciatica cases. In the majority of instances, it develops in middle-aged individuals, an average or 38 years and it�s more common among women.
Pathogenesis of Piriformis Syndrome
The causes of Piriformis syndrome can be associated to three primary causing factors: First, the referred pain may be the result of myofascial trigger points. Second, the entrapment of the nerve against the greater sciatic foramen as it passes through the infrapiriform fossa or within a variating piriformis muscle. And third, sacroiliac joint dysfunction causing piriformis muscle spasms.
Other researchers presented an additional number of factors behind the causes of piriformis syndrome as follows: gluteal trauma in the sacroiliac or gluteal regions, anatomical variations, myofascial trigger points, hypertrophy of the piriformis muscle or spasms of the piriformis muscle, secondary to spinal surgery such as laminectomy, space occupying lesions such as neoplasm, bursitis, abscess and myositis, intragluteal injections and femoral nailing.
Symptoms
The general symptoms described with the causes of piriformis syndrome include: a tight or cramping sensation in the buttock and/or hamstring, gluteal pain in up to 98 percent of cases, �calf pain in up to 59 percent of cases, aggravation through sitting and squatting if the trunk is inclined forward or the leg is crossed over the unaffected leg and possible peripheral nerve signs such as pain and paresthesia in the back, groin, buttocks, perineum and back of the thigh in up to 82 percent of cases.
Physical findings and examinations
When palpable spasm within the surrounding piriformis muscle occur and there is obturator internus pain and external tenderness over the greater sciatic notch, found in approximately 59 to 92 percent of cases, the individual must perform the Sims position to follow up an evaluation. The piriformis line should overlie the superior border of the piriformis muscle and extend immediately from above the greater trochanter to the cephalic border of the greater sciatic foramen at the sacrum. The examination will continue where the line is divided into equal thirds. The fully rendered thumb presses on the point of maximum trigger-point tenderness, which is usually found just lateral to the junction of the middle and last thirds of the line.
It�s important to keep in mind that hip flexion with active external rotation or passive internal rotation may aggravate the symptoms of dysfunction. Additional findings for the evaluated causes of piriformis syndrome have demonstrated a positive SLR that is less than 15 degrees on the normal side. Other tests used to evaluate the causes of piriformis syndrome include, positive Freiberg�s sign, used in 32 to 63 percent of cases, involves the reproduction of pain on a passively forced internal rotation of the hip in the supine position, believed to result from passive stretching of the piriformis muscle and pressure of the sciatic nerve at the sacrospinous ligament. Pacers sign, used in 30 to 74 percent of cases, involves reproducing pain and weakness on resisted abduction and external rotation of the thigh in a sitting position. Pain in a FAIR position used to evaluate dysfunction, involves the reproduction of pain when the leg is held in flexion, adduction and internal rotation. Furthermore, an accentuated lumbar lordosis and hip flexor tightness predisposes an individual to increased compression of the sciatic nerve against the sciatic notch by a shortened piriformis. Electro-diagnostic tests may also prove useful to diagnose piriformis muscle complications.
Investigations
Conventional imaging, such as X-ray, CT scan and MRI, tend to be ineffective in diagnosing the presence and causes of piriformis syndrome. However, some value may exist in electro-diagnostic testing. The purpose of these tests is to find conduction faults in the sciatic nerve. Findings such as long-latency potentials, for instance the H reflex of the tibial nerve and/or peroneal nerve, may be normal at rest but become delayed in positions where the hip external rotators are tightened.
It�s been established that the tibial division of the sciatic nerve is typically spared, the inferior gluteal nerve that supplies the gluteus maximus may be affected and the muscle becomes atrophied. However, testing of the peroneal nerve may provide more conclusive results as they�re more likely to be the impinged portion of the sciatic nerve. The H-wave may become inactive during the painful position of forced adduction-internal rotation of the affected leg.
Piriformis Syndrome Myths
Researchers argued that piriformis syndrome is a frequently over-used term to describe any non-specific gluteal tenderness with radiating leg pain. It was discussed that only in rare cases is the piriformis muscle involved in nerve compression of the sciatic nerve to legitimately qualify as one of the causes of piriformis syndrome. It was cited that there is only limited evidence and cases where the diagnosis of the causes of piriformis syndrome can be made. First, where there is compressive damage to the sciatic nerve by the piriformis muscle. In several isolated studies, the sciatic nerve was seen to be compressed by the piriformis muscle in instances such as hypertrophy of the muscle, general anatomical abnormalities such as a bifid piriformis muscle and due to compression by fibrous bands.
Also, trauma and scarring to the piriformis muscle can involve the sciatic nerve. It is possible that rare cases of true piriformis syndrome have been caused by direct heavy trauma to the piriformis muscle due to a blunt trauma to the muscle. This is termed as post- traumatic piriformis syndrome.
Researchers supported this argument by stating that it is more likely that, given the anatomical relationship of the piriformis muscle to the various nerves in the deep gluteal region, the buttock pain represents entrapment of the gluteal nerves and the hamstring pain entrapment of the posterior cutaneous nerve of the thigh, rather than the sciatic nerve alone. This demonstrates the medically analyzed circumstance in the absence of distal sciatic neurological signs. Whether the piriformis muscle is the cause of the compression has not been clearly established. It is possible that the obturator internus/gemelli complex is an alternative cause of neural compression. The researchers have suggested utilizing the term deep gluteal syndrome rather than piriformis syndrome.
Treatment
When it is believed that a factor which is considered one of the several causes of piriformis syndrome exists and a healthcare professional feels that a proper diagnosis has been made, the treatment will usually depend on the cause behind the dysfunction. If the piriformis muscle is tight and it spasms, then initially conservative treatment will focus on stretching and massaging the tight muscle to remove the piriformis muscle as being the source of the pain. If this fails, then the following have been suggested and may be attempted: local anesthetic block, typically performed by an anesthesiologist who has expertise in pain management and in performing nerve blocks; steroid injections into the piriformis muscle; botulinum toxin injections in the piriformis muscle; and surgical neurolysis.
Therapist-directed interventions, such as stretching of the piriformis muscle and direct trigger point massage, can also be used as treatment. It�s been encouraged that piriformis muscle stretches are done in positions of hip flexion greater than 90 degrees, adduction and external rotation to utilize the inversion of action effect of the piriformis muscle to isolate the stretch to this muscle independent of the other hip external rotators.
However, recent evidence utilizing ultrasound investigation demonstrated that there was no interaction between hip flexion angle and the thickness of the piriformis muscle tendon in both internal and lateral hip rotation stretching, which suggests that the piriformis muscle does not invert its action. Furthermore, researchers who performed cadaveric studies found that the piriformis muscle insertion is a lot more complex and varied than initially believed. It is possible that the piriformis muscle may invert its action only in some subjects but not in others.
As a result, due to the disagreements and confusions over the inversion of action concept, it is recommended that healthcare professionals should performs two variations of a piriformis muscle stretch: stretches in flexion, adduction and external rotation and stretches in flexion, adduction and internal rotation.
Pigeon Stretch for left piriformis muscle: hip flexion, neutral adduction and maximal hip external rotation.
Stretch for left piriformis muscle: hip is in flexion, neutral adduction and maximal external rotation.
Short leg posterior chain stretch for right piriformis muscle: hip is in 90 degree flexion, adduction and neutral rotation.
Trigger Points and Massage
The most appropriate suggestion to palpate the piriformis muscle trigger points is in the following recommended position. In this posture, the healthcare professional can feel for the deep piriformis muscle trigger points and apply a constant pressure to relieve the trigger points as well as apply a flush massage to the muscle in this position. In this position, the large gluteus maximus is relaxed and it is easier to feel the deeper piriformis muscle.
The piriformis muscle is a deep posterior hip muscle that is closely related anatomically to both the sacroiliac joint and the sciatic nerve. It is a muscle that is a dominant hip rotator and stabilizer, with a tendency to shorten and become hypertonic. Therefore, stretching and massage techniques are best recommended and utilized to reduce the tone through the muscle. In conclusion, it has also been suggested in compression and irritation of the sciatic nerve, most commonly referred to as piriformis syndrome.
In athletes, piriformis syndrome is a common disorder identified by the irritation and inflammation of the piriformis muscle which can generally result in the compression of the sciatic nerve. This impingement of the nerves and its surrounding tissues can cause the symptoms of sciatica to manifest, characterized by pain and discomfort, along with tingling sensations and numbness, affecting an athlete’s performance.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Headache After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. Whiplash is a common result of an auto collision, affecting the bones, muscles, tendons, ligaments and other tissues around it, causing symptoms such as head pain. Headaches are a common symptom after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
A total of 30 female university students with an FLLI of more than 10?mm between the left and right legs were selected and randomly assigned to one of two groups: the pelvic adjustment group (adjustment group, n = 15) and control group (stretching group, n = 15). The exclusion criteria were as follows: anatomical LLI; degenerative osteoarthritis; muscle, bone, or nervous system problems; ankle joint, knee joint, hip joint, or lumbar pain; limited range of motion due to burn or postsurgical scarring; and regular leg exercise. This study was approved by Korea Nazarene University�s Institutional Review Board, and the safety of all subjects was protected during all parts of the experiment. All subjects understood the purpose of this study and provided written informed consent prior to participation in accordance with the ethical standards of the Declaration of Helsinki.
