These assessment and treatment recommendations represent a synthesis of information derived from personal clinical experience and from the numerous sources which are cited, or are based on the work of researchers, clinicians and therapists who are named (Basmajian 1974, Cailliet 1962, Dvorak & Dvorak 1984, Fryette 1954, Greenman 1989, 1996, Janda 1983, Lewit 1992, 1999, Mennell 1964, Rolf 1977, Williams 1965).
Clinical Application of Neuromuscular Techniques: Medial Hamstrings and Adductors
Assessment for shortness in medial hamstrings (semi-membranosus and semi-tendinosus as well as gracilis) and short adductors (pectineus, adductors brevis, magnus and longus)
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Method (a) The patient lies so that the non-tested leg is abducted slightly, heel over the end of the table. The leg to be tested is close to the edge of the bed and the practitioner ensures that the tested leg is in its anatomically correct position, knee in full extension and with no external rotation of the leg, which would negate the test.
The practitioner should effectively stand between patient’s leg and the table so that all control of the tested leg is achieved with his lateral (non-table-side) arm/hand, while the table-side hand can rest on and palpate the inner thigh muscles for sensations of bind as it is taken into abduction. Abduction of the tested leg is introduced passively until the first sign of resistance is noted (see Fig. 4.3). Effectively, there are three indicators of this resistance:
- A sense that the motive hand carrying the leg picks up as an increase in required effort at the moment that the first resistance barrier is passed
- The sense of bind noted by the palpating hand at this same moment
- A visual sign, movement of the pelvis as a whole, laterally towards the tested side, as the barrier is passed.
If abduction produces an angle with the mid-line of 45° or more, then no further test is needed, the abduction is normal, and there is probably no shortness in the short or long adductors (medial hamstrings or, more correctly, gracilis and biceps femoris). If, however, abduction ceases before a 45° angle is easily achieved (without effort or a sense of bind in the tissues), then restriction exists in either the medial hamstrings or the short adductors of the thigh.
Figure 4.3 Assessment and treatment position for medial hamstrings. Adductor shortness may be evaluated and treated in the same relative position but with the knee of the leg to be treated in flexion.
Screening Short Adductors from Medial Hamstrings
As in the tests for gastrocnemius and soleus, it is necessary to screen between shortness of the one and two joint muscles (in this case the short adductors and the medial hamstrings). This is achieved by abducting the leg to its easy barrier and then introducing flexion of the knee, allowing the lower leg to hang down freely.
If (after knee flexion has been introduced) further abduction is now easily achieved to 45°, this indicates that any previous limitation into abduction was the result of medial hamstring shortness, since this is no longer operating once the knee has been flexed. If, however, restriction remains (as evidenced by continued ‘bind’ or obvious restriction in movement towards allowing a 45° excursion once knee flexion has been introduced to the abducted leg), then it is apparent that the short adductors are continuing to prevent movement, and are short.
Assessing for shortness in medial hamstring (03) /short adductors (04)
Method (b) The patient lies at the very end of table (coccyx close to edge), non-tested leg fully flexed at hip and knee and held to chest by patient (or sole of patient’s foot resting against practitioner’s lateral chest wall) to stabilise pelvis in full rotation, so that the lumbar spine is not in extension. Tested leg is grasped both above and below the knee and taken into abduction to the first sign of resistance. The practitioner has two free hands in this position, one of which can usefully palpate the inner thigh for bind during the assessment.
If abduction reaches 45°, then the test has revealed no shortness. If a restriction/resistance barrier is noted before 45°, then the knee should be flexed to screen the short adductors from the medial hamstrings as in method (a) above. In all other ways the findings are interpreted as above.
MET Treatment of Shortness in Short and Long Adductors of the Thigh
Precisely the same positions may be adopted for treatment as for testing, whether test method (a) or test method (b) was used. If the short adductors (pectineus, adductors brevis, magnus and longus) are being treated, then the leg, with knee flexed, is held at the barrier (acute) or a little short of the barrier (chronic).
An isometric contraction is introduced by the patient using around 20% of available strength (longer and somewhat stronger for chronic than acute) employing the agonists (the push is away from the barrier of resistance) or the antagonists (the push is towards the barrier of resistance) for 7–10 seconds. Appropriate breathing instructions should be given (see notes on breathing in Box 4.2).
After the contraction ceases and the patient has relaxed, the leg is eased to its new barrier (if acute) or painlessly (assisted by the patient) beyond the new barrier and into stretch (if chronic), where it is held for not less than 10 seconds (longer if possible), in order to stretch shortened tissue. The process is repeated at least once more.
If the medial hamstrings (semi-membranosus, semi-tendinosus as well as gracilis) are being treated, all elements are the same, except that the leg should be held in extension, with no bend of the knee (Fig. 4.4).
Figure 4.4 Position for treatment of shortness in adductors of the thigh.
Whichever position is used, the subsequent stretch, on an exhalation, is used to (acute) or through (chronic) the barrier to commence normalisation of the short muscles.
Caution and Alternative Treatment Position (Fig. 4.5)
The major error made in treating these particular muscles using MET relates to allowing a pivoting of the pelvis and a low spinal sidebend to occur. Maintenance of the pelvis in a stable position is vital, and this can most easily be achieved via suitable straps or, during treatment, by having the patient side-lying with the affected side uppermost.
Figure 4.5 Sidelying position for treatment of two-joint adductors of the thigh.
Method (c) Patient is side-lying. Practitioner stands behind and uses the caudad arm and hand to control the leg and to palpate for bind, with the treated leg flexed or straight as appropriate. The cephalad hand maintains a firm downwards pressure on the lateral pelvis to ensure stability during stretching. All other elements of treatment are identical to those described for supine treatment above.
Dr. Alex Jimenez offers an additional assessment and treatment of the hip flexors as a part of a referenced clinical application of neuromuscular techniques by Leon Chaitow and Judith Walker DeLany. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
MEET THE STAFF
These canons of professional ethics are based upon fundamental principles of moral and professional behavior and recommended for all doctors of chiropractic and chiropractic assistants. The following basic principles should be guiding factors in the practice of chiropractic and upheld at all times:
Consider the well-being of the patient. The primary effort and ultimate goal is for the greatest good of our patients.
- Dr. Alexander D. Jimenez D.C., C.C.S.TChief Clinical DirectorPhone: 9155408444Email: email@example.com
Specializing in Severe Pain: Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Patient Focused Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems.
Message from: Dr. Alex Jimenez D.C., C.C.S.T
( Biography and my promise to you )
My name is Dr. Alex Jimenez, I am Chiropractic Doctor specializing in advanced therapies focused on total joint health, strength training and complete fitness conditioning. We use patient Focused Diet Plans, Advanced Chiropractic Techniques, Agility Training, Cross-Fit and the PUSH System to treat patients suffering from various injuries and health problems. Our goal too is to help your body heal itself naturally. When your body is truly healthy, you will arrive at your fitness level and proper weight efforlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25+ years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs...
My goal too is to help the body heal itself naturally. When your body is truly healthy and balanced, you will move pain free and ultimatly arrive at your optimal fitness levels and proper weight effortlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25 years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs. These programs are natural, and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.
The focus on spinal and skeletal adjustments is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. This hallmark chiropractic adjustment, however, is not the only procedure a chiropractor may employ in managing a patient's care. I am very proud to bring my patients a variety of treatment options beyond the typical scope of care. With the advances in physical therapies and modalities we bring El Paso option that better aid in the rehabilitation process. Tissue healing is a wonderful process that begins the moment an injury occurs. How the injury is managed determine the final outcome in terms of healing. It is critical we implement immediate procedures as soon as we can in order to gain optimal recovery. The old day of let it rest until it gets better is not the only option.
Letting it rest may even be an irresponsible approach considering what we now know. The implementation of active and movement based treatments have clearly shown increased and improved outcomes in many instances.
As a doctors focused on the greater good for a patient, we must assess each patient individually and apply the appropriate protocols. It is also very important to denote, that El Paso has fine doctors in many specialties of healing and repair. The direct relationship we have with specialist of these disciplines is clearly what allows us to bring the highest quality of care to our patients.
My promise to my patients is clear for all to read here. I, with Gods help, will do what ever it takes to assist you in your recovery. I too will draw upon all the specialist in this town to find you the collaborative care that is required with the disorders being tended to.
With Great Regards to you.Read moreRead lessEducation:
Affiliations and Certifications:
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Truide has been working for the past 20 years in claims resolutions. She works hand in hand with patients and is availible to resolve dispute resolutions.
Truide Torres (Bio)
Driven by the passion of doing what is in the best interest of the patient, I wake up every morning with the drive to help those in need. The claims process for health care is full of pits, valleys and difficult obstacles designed to strike fear in those in need. My duty is to do what is within the confines of the law, "what ever it takes" to get those involved to pay attention to those who need help. That is what I am honored to do for our patients.
Personally, I have seen great injustices transpire on those that do NOT have a voice. Whether, a language barrier or just not knowing the rules. My job is to find out how I can help. If I personally can not help, I will find the right sources to open the possibilities. I get the job done.
As a wife and mother of 2 children, 3 dogs and 2 Cats. My passion is for God, Family and the mission of serving my fellow man.
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Daniel Alvarado is the owner and the top trainer at PUSHasRx® CrossFit Fitness Facility. Since becoming a Trainer Daniel has kept up to date on many continuing educational classes, ensuring that his clients receive the most comprehensive and advanced training. Working directly with the Doctors, he develops and collaborates on care plans that are patient specific. No patient ever gets the same clinical protocol. His expert clinical kinesiology experience spans over 2 decades. He has trained injured patients and NCAA National Champion Athletes. His technical ability to create programs that are clinically sound and second to none. He too has used his physical therapy and recovery experience to take broken top tier athletes into strict recovery protocols assisting them to achieve highly competitive national championships. He certainly will not admit it but, he is a top national champion trainer. Daniel, also develops youth programs that are sport specific to aid young athletes achieve great success. His mastery of clinical recovery is applied applied to all patients and top tier athletes alike. All patient programs are specifically designed with patient focused recovery priorities. He is happily married to beautiful Victoria Alvarado has one child. He enjoys strength training, movies, singing, conducting, writing poetry and being a CrossFit champion. Just a way cool dude. We think you will agree.Read moreRead less
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Dennise has been at Injury Medical & Chiropractic Clinic for four years. Known as the master multi-tasker. Dennise, handles patient care from the moment you walk in the door. She is akin to the air traffic controller. She will assist you in matter requiring clinical preparation and effective inter-office communication. She unifies all department and clinical providers making sure all important information reaches all clinicians in a timely manner. She also loves to work out, stay in shape, watch movies and help people.Read moreRead less
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Sandra has been working at Injury Medical & Chiropractic Clinic for over 5 years. As the head Licensed Massage Therapist, she manages and directs critical aspect of clinical care. The patients love her ability to make you laugh while removing those pesky trigger points causing pain. She is able to relax and bring comfort to all she touches. There just simply is no patient that escapes her talented touch. Trained in advance myofascial techniques, she is an integral part of patient recovery. You will never see anything but a kind smile and resolute persona ready to correct your condition and aid in your recovery. She definitely enjoys helping people, has 1 dog and loves movies. She loves flowers too.Read moreRead less
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Alejandra works in accounts & billing. She is the radar of the bunch. Nothing appears to escape her mind. Highly intelligent and appears not to need a computer for recall of facts. She provides information retrieval for patients and clinical staff. She has been at Injury Medical & Chiropractic Clinic for three years and ready for any task at hand. She performs interoffice communications with attorneys and medical director of ancillary offices. She loves her family and places know how to prioritize well.Read moreRead less
- Mike ContrerasPersonal TrainerPhone: 915-203-8122
Big Mike was born and raised in El Paso and is an excellent personal trainer and CrossFit coach. Mike works hand in hand with each patient’s clinical care plan in order to achieve optimal outcomes. A trusted clinical representative of the PUSHasRx System along with his advance protocols. Mike not only trains the injured and recovering. Mike is a sincere human that has great talent of brining out the best in every individual he works with. He will never admit it, but we will share with you a secret. He with his God given talents trains the greatest athletes and champions in El Paso. Many champions in our community know of his commitment. As a youth, he also played football (wide receiver), basketball, and track at Bel Air High School. Educated in Clinical Human Kinesiology at UTEP and loves playing football and basketball with his little nephews in his free time. Mike has three sisters and one brother, most of which live nearby in El Paso. When he’s not watching the Cowboys or Spurs play, he’s usually lifting, sleeping or watching movies. We are blessed to have this soul on our team.Read moreRead less
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Alexander Isaiah Jimenez leads the power and agility education programs for the high school athletes. While still studying for his medical degree he provides physical performance testing in order to collaborate with clinicians. He is gifted in creating physical performance programs no matter what the clinical presentation is. As national fitness champion and collegiate wrestler, he too understands what performing at high levels entails. He too has had to recover from debilitating injuries only to return better then before an win national titles. He understand how the recovery process is different for clients, patients and extreme athletes. We are blessed to have his counsel.Read moreRead less
- Ethan PadillaPersonal Trainer & Strength CoachPhone: 915-203-8122
Ethan was born and raised in El Paso and is one of our most outgoing and friendly coaches. Ethan earned his nickname “rampage Ethan” from his years at El Dorado High School, where he played inside linebacker. He has placed twice in the Strongman Competition and also recently competed in the Desert Games with his fellow PUSH Athletes as a team and placed 4th overall! Ethan is currently pursuing his Bachelor’s Degree in Kinesiology at UTEP. His focus on clients is obvious to all. Ethan is able to manage very large groups of individuals like no other. His awareness of the dangers while exercising is his greatest concern. When he’s not coaching or studying for class, he likes to spend time with his family (who are here in El Paso) or with his weimaraner puppy. Fun fact: Ethan loves any food with sprinkles (especially donuts with sprinkles) and is a diehard Seattle Seahawks fan.Read moreRead less
- AndresRecovery & Nutrition
Andres has been at PUSHasRx for two years. He brought his company Recovery and became the official juicer. Andy will fix you right up. Andres, will make sure that your nutritional recovery programs fits within your standards. Also, there is great care in making sure the nutritional requirement are clinically met. Patients and high performance athletes depend on high performance nutritions. Upon your completion of the physical medicine portion of therapy you will be offered specialized organic recovery drinks and supplementation to help aid in your recovery. You will be confident that from your pushing to recovery, you will be taken care of.Read moreRead less
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ylene has been working with us for over 4 years. In her spare time she enjoys working out and running. She has 2 dogs and loves movies. Iylene is extremely aware of body mechanics and mindfully watches rehabilitation movements. She is always standing ready to assist and respond to client needs. Her commanding voice is always clear to all, no matter what floor you are on. Iylene is always ready and willing to answer any question you may have regarding fitness and recovery.Read moreRead less
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Most early-rising PUSHasRx members know Rick well as a fantastic coach who focuses strongly on form and will always make you laugh. He was born and raised in El Paso and loves to train his athletes and coach CrossFit. Rick is a very diligent, kind and considerate trainer. He is always mindful of client techniques and aware of client goals. When he’s not coaching, Rick loves to work on cars, especially his ’69 Chevelle (his next car will hopefully be a ’69 Charger). He not only became a certified Automotive Mechanic at 17, but while working on his certification at EPCC, he won 1st place in a bench competition when he was 16 (approx. 56 reps at 155#). His favorite movements are clean & jerks and snatches. He loves oreos (eats them every night), loves watching the CrossFit games, and loves his three bulldogs. He spent one year full-time personal training before he started coaching CrossFit two years ago. He is CrossFit Level 1 Certified and hopes to get his Level 2 Certification soon. Rick has competed in several competitions, including WOD for Toys in 2014, where his team placed 1st.Read moreRead less
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Astrid has been at Injury Medical & Chiropractic Clinic for about three years. Astrid has taken her love for writing to an new level. She is a gifted and talented copywriter able to create amazing storylines. She creates content for patient consumption. She is able to bring words to life in a way that perplexes even the elite authors of the day. She loves nutrition and the healing power of clean eating. A naturalist at heart you will never see her eating processed foods that would be contra to clean living. She enjoys movies and creating storylines for Anime.Read moreRead less
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Adam has been at Injury Medical & Chiropractic Clinic for about a year. He enjoys designing and various forms of art. A story teller by trade he can see things people don’t see until his masterpieces are revealed. Adam is a director of many medias using the top graphics, audio and video medias to tell the story of our patient. Modest to the core, you would never know what he is about to create. We are blessed to have his talents telling the world about Chiropractic using any and all medias available.Read moreRead less
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Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.
We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.
We've been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.
As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.
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