Articles

Treating an Anterior Humeral Head

Warren Hammer — Tue, 18 Jan 2011 16:10:16 +0000

Practitioners in the joint world often speak of "bone out of place" or "positional faults."¹ Chiropractors in particular have experienced significant results when using joint-play techniques to treat these types of joint lesions.

According to McKenna, et al.,² anterior position of the humeral head in relation to the acromion may compromise the subacromial space because the humerus is in greater proximity to anterior structures in elevation. These authors proposed a palpation method of evaluating the anteriority of the humeral head in relation to the acromion

Treating an Anterior Humeral Head

Warren Hammer — Tue, 18 Jan 2011 16:02:02 +0000

The Latest on Tendinopathy

Warren Hammer — Tue, 18 Jan 2011 02:45:19 +0000

There is an ongoing debate on the role of inflammation and degeneration in tendons, especially from overuse injury. If the primary problem is due to inflammation, then an anti-inflammatory approach is regarded as the answer - but has not been found to be a satisfactory solution.

An excellent study by Bisset and colleagues¹ showed that in the short term, corticosteroid injections or physiotherapy (elbow manipulation and exercise) was better than a wait-and-see program over the first six weeks, but in the long term, the manipulation and exercise method was recommended over corticosteroid injections.

Biopsy examination of tendons has shown that inflammatory cells are scarce, while degeneration is common. One problem with this statement is that most of the biopsies were taken in the chronic stages, often during surgery. But recent human biopsies of tendons with smaller tears with a less degenerative picture revealed a significant inflammatory infiltrate of mast cells and macrophages.² Still, it appears that in the chronic stage, the term tendinosis is more applicable than tendinitis

Anatomy Texts Got It All Wrong

Warren Hammer — Tue, 18 Jan 2011 02:33:58 +0000

Almost all of the major anatomical textbooks - Netter's Atlas of Human Anatomy and Gray's Anatomy, for example - show beautiful photos and illustrations of muscles attached to bones. Unfortunately, based on this type of muscular description, they are describing only part of a structure and giving the impression that this represents the muscle in its entirety. What is being left out is the part of the muscle that transmits its force and even more importantly, the part of the muscle that allows it to function.

As stated by Jaap Van Der Wall, MD, PhD,¹ at the last fascial conference in Amsterdam, the most important part missing in the term musculoskeletal system is the connective tissue. For years, anatomists have been cutting away an essential portion of the muscles: the fascia. Many muscle fibers insert into intermuscular and epimysial fascia without being attached directly into bone.²

First Multidisciplinary U.S. Soft-Tissue Conference

Warren Hammer — Tue, 18 May 2010 02:21:34 +0000

Before I decide whether to attend a conference, I ask myself two important questions: will the information be beneficial to my understanding of the subject and will I be instituting any permanent changes the following Monday morning? It is often said that if a conference is able to give the practitioner one significant thing they will find useful for the rest of their career, then the weekend is worthwhile.

Palpation for Sciatica

Warren Hammer — Tue, 18 May 2010 02:16:10 +0000

According to a recent study, palpation of inflamed sciatic, tibial and common peroneal nerves can be another procedure added to the slump test and the straight leg raise (SLR), for example, to determine if there is neural involvement.¹ The study by Walsh and Hall states that nerve palpation is one of the key factors in the classification of low-back related leg pain.^2,3 Of the three nerves palpated, the sciatic nerve exhibited the greatest accuracy followed, in order, by the tibial and common peroneal nerves. A negative finding of no positive palpation sites thus indicates that the target condition (sciatic nerve mechanosensitivity) can be ruled out. Two or more positive palpation sites had the greatest overall diagnostic accuracy, so it is important to palpate all three sites.

An Important Shoulder Test Not Often Used

Warren Hammer — Thu, 04 Mar 2010 01:42:02 +0000

As I've said previously, most orthopedic tests for the shoulder cannot truly isolate a particular structure, since when we use tests that compress or stretch an area, adjacent structures also have to be compressed, stretched or contracted.¹ While there is definite truth in this statement, most of us arrive at a diagnosis by using as many credible tests in the literature as possible. There is a test that, while not that specific in determining the exact lesion source, has the ability to determine whether the problem is located in a particular area, which can then be followed by other specific tests. The test is called the internal rotation resistance strength test (IRRST).² This test, as discussed by Zaslav, helps to differentiate between an outlet impingement and a non-outlet impingement.

The Iliopsoas: A Possible Cause of Acetabular Labrum Tear

Warren Hammer — Thu, 04 Mar 2010 01:32:46 +0000

An anatomic study that appeared recently in the American Journal of Sports Medicine¹identified - for the first time - the cross-sectional anatomy of the iliopsoas tendon at the level of the labrum. Several authors have implicated iliopsoas impingement on the anterior labrum as a cause of labral tears. They have stated that a tight iliopsoas tendon could cause compression over the anterior capsulolabral complex, leading to labral lesions. Labral tears at the 2 o'clock to 3 o'clock position of the acetabulum (see image below) are directly under the iliopsoas tendon. This labral tear is considered an anterior tear, while most labral tears caused by trauma, femoroacetabular impingement, capsular laxity/hip mobility, dysplasia or degeneration are usually found at the 11:30 to 1 o'clock position.

Fascial Manipulation

Warren Hammer — Thu, 04 Mar 2010 01:30:34 +0000

This past November, I was privileged to speak on Graston Technique at the 2^nd Fascia Research Conference in Amsterdam. There is much to report about the new material that was presented at the conference, which I will do in this and future articles. I became especially interested at the final day of the six-day conference when I attended a workshop titled "The Fascial Manipulation Technique and Its Biomechanical Model - A Guide to the Human Fascial System." The course was presented by Carla Stecco, MD, an orthopedic surgeon and assistant professor of human anatomy and movement sciences, University of Padova, Italy; and Julie Ann Day, a physiotherapist also from Padova.

Finally, an Accurate Test for a Meniscus Tear?

Warren Hammer — Thu, 04 Mar 2010 01:27:42 +0000

It often appears that when the author of a particular test states high accuracy for the test, other scientists down the line, using MRI or other tests, reach opposite conclusions regarding its validity. This is certainly true for shoulder labral tests.¹ If you've read my previous few articles, you realize this is also probably true for muscle testing. Thus, no matter how logical and accurate any test seems, we must always question it. That is one reason why it pays to use a number of tests to reach any conclusion.