This article is not based on a scientific double blind trial, but is based upon my own personal experience and from borrowing information from other practitioners in the process. Perhaps some chiropractic institution would like to examine some of the points I raise from a more objective point of view. However, I must proceed by sharing what I can as best that I can. Mainly, I have utilized information learned from a former instructor and colleague, Dr. Bertrand Faucret. I have had reenforcement from Drs. Faye and Gillet. Areas of soft tissue treatment have come from Lyn Paul Taylor, RPT.
The Gonstead system of chiropractic, to my knowledge, originally popularized and possibly invented the term AS for anterior and superior. They define the AS with radiographic methods, and I highly respect what they do and their successes. They label it as the AS subluxation. I am labeling it as the AS fixation because the terms fixation and subluxation may not be interchangeable to many; however, the concept is the same.
I have found the AS fixation to occur mostly on the right side, occasionally on the left side, and occasionally on both sides simultaneously. It may or may not be accompanied by a fixation on the opposite side. If there is a fixation on the opposite side, most of the time it is a posterior inferior (PI) fixation.
The following is a list of processes or conditions I have found associated with the AS fixation:
- lengthening of the leg;
- pain/strain, lower abdominal pain/strain, anterior, medial or lateral thigh pain/strain, lateral calf pain. Sometimes, there may be a manifestation of posterior thigh symptoms. It can look like a lumbar radicular pattern, making a disc look probable;
- thigh and leg weakness upon standing;
- gluteal pain on the same side as AS;
- clicking of the hip during thigh flexion -- a key sign;
- The patient can have orthoneuro signs, appearing as nerve root damage or irritation, or functional orthopedic signs of sever facet strain with a (+) Kemp's sign on the same or both sides.
- myofascial signs, such as hypertonic and/or painful muscles -- buttock, thigh, calf. Mostly hip flexor thigh muscles are strained, but posterior thigh muscles may also be symptomatic. There will be signs of inflammation within the muscles if the procedures of Lyn Taylor are utilized to test the muscles. There can also be signs of inflammation at the tendon regions and ligamentous regions. Mr. Taylor developed a "zone finder" used to locate areas over muscles, tendons or joints where inflammation is present. It was developed out of his work with biofeedback and his engineering background. It is used in his practice in Los Angeles and upon race horses throughout the country. He has outlined a protocol of treatment for myofascial inflammatory disorders.
- low back pain.
Basically, I find that the process which created these above symptoms begins with the AS fixation. I will now portray what I believe to be the process involved:
1. The ilium fixates in the AS direction. It must be verified by motion palpation, coupled with visual analysis. This involves the eyes as well as tactile palpation.
2. The gluteal muscles (those which attach to the femur) become overstretched, then develop strain and possible inflammation. The process occurs as follows:
As one flexes the thigh or the hip, as with running or walking, the ilium is supposed to move in a PI direction, following the greater trochanter as it travels in the PI arc. If the ilium is fixed and cannot move fully, the gluteal muscles are forced to overstretch as the trochanter rotates or arcs in the PI direction. This causes wear and tear in the muscles and in the hip joint proper. The hip may begin popping due to the need to create a new axis of motion. This can become the precursor to hip joint degeneration.
3. Because the gluteal muscles have become irritated as described, they tighten and therefore shorten. I might add that earlier studies on joint dysfunction have shown that dysfunction alone disposes the associated muscles to hypertonic activity. This would represent two factors in the hypertonic status of the muscles. They overstretch, becoming irritated, then tighten. As they tighten, they resist flexion of the hip, creating pain and/or popping. To put it another way: shortened or taut gluteal muscles will resist posterior trochanteric motion, leading to their own strain. Also, the hip flexors (anterior thigh) have to work against the gluteals because they are antagonistic muscles. As the hip flexors contract, the gluteals should let go and relax, but the tonic state of increased tension in the gluteals prevents normal faciliatory relaxation. Strain may also be present in the groin, adductors, and abductors. Groin pain may be severe. Areas may be specifically located where inflammation or metabolic dysfunction is present in these tissues with Lyn Taylor's instrument procedure (DSR Zone Finder), which measures areas of increased skin resistance. Naturally, the AS ilium must be corrected with the appropriate adjustment.
I want to comment on the accuracy and practicality of Lyn Taylor's method of locating and treating soft tissue inflammation. It is so accurate that he is known for taking downed race horses, locating their problem, and fixing it. They call him, not vice-versa. I occasionally take my problem soft tissue cases to his clinic and watch him solve problems not solvable by me, and I have learned a lot from him.4. Because the gluteal muscles become irritated and inflamed, the sciatic nerve can become irritated and produce a radicular syndrome. It can become so severe that the patient requires a crutch to walk, due to leg/hip pain and weakness. I often question whether these hip-joint replacement surgeries could have been prevented if proper conservative care had been given years earlier. Some may call the buttock process described as a piriformis syndrome, but I have found that the muscle involvement is more broad than just a piriformis muscle.
1. You must properly adjust the AS fixation. This alone may allow all else to fade away. However, the patient may be so far advanced in the condition that the soft tissue areas have developed an independence and require separate treatment. In other words, even though a soft tissue problem may be secondary to a joint problem, with time it may develop a life of its own and must be treated in addition to the adjustment. As I said, I utilize the methods of Lyn Taylor, who is sympathetic to, and appreciative of, chiropractic. These procedures involve:
A. Electrotherapy. Mr. Taylor uses mainly medium frequency and wide pulse. Medium frequency softens tissues and adhesed areas.
B. Myofascial massage. The premise is that irritated tissue areas develop inflammation, then small adhesions form. This specific technique breaks the adhesions, which is essential to eradicate chronicity.
C. Pulsed ultrasound with ibuprofen ointment. This further softens muscles and delivers the anti-inflammatory effect of ibuprofen.
In treating the groin injuries, I find that even though the groin hurts, the soft tissue work is more distal to the groin. The areas of involvement can be located with the DSR Zone Finder. One finds the following areas needing treatment associated with the groin: buttock muscles, hip flexors/adductors/abductors.
It is not the intent of this article to describe in detail the soft tissue techniques used, but may be possible at a future time. As far as the correction of the AS ilium is concerned, any technique which creates the inferior motion of the ilium during thigh flexation will be appropriate.
Joseph D. Kurnik, DC
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.