resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
June, 2009, Vol. 09, Issue 06
Back Pain Caused by Rectus Abdominis Trigger Points
By David Kent, LMT, NCTMB
When clients schedule a treatment session, they expect results and regardless of which massage modality or technique you've mastered, you want to deliver.Back pain is a common complaint among massage clients, and symptoms such as pain across the mid-back or low-back pain over the sacrum below the iliac crest in the gluteal region could be the result of myofascial trigger points in the rectus abdominis. (Figure 1) According to Simons and Travell, "An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level."1 The authors also state that "In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions."1 (Figure 1).
Although many trigger points have been identified in the rectus abdominis muscle, this article will cover two primary trigger-point patterns that cause back pain in these regions, as well as tips about how to treat them and how to educate your clients about the nature of their pain.
Trigger points can form in the rectus abdominis muscle due to visceral disease, direct trauma, emotional stress, poor posture and over-exercise, to name a few. Examples of trauma include surgery in the area or injury to the muscle during a motor vehicle accident. These muscles can also become overstressed by everyday activities, including certain exercises or rigorous housework.
Before treating the rectus abdominis, however, it is important to rule out other muscular possibilities. Referred pain from myofascial trigger points into the lower thoracic region can also be produced by muscles in the back, such as the latissimus dorsi, serratus posterior inferior, illiostalis thoracis, multifidi, intercoastals and insterspinales.
Lower lumbar, sacral and gluteal pain often includes trigger points from the quadratus lumborum, gluteul muscles, piriformis and the hamstrings. In addition to the rectus abdominis, the iliopsoas is another muscle that refers pain into both of these regions.
Encourage clients to reveal important clues about their pain by having them complete a thorough health history and intake form. This useful tool also enables you to ask intelligent questions relevant to the possible causes of the client's pain.
In addition to the health history and intake forms, have your clients complete a visual-pain chart to specify and document the regions of their discomfort; this tool will help you easily spot the trigger-point patterns and treat them accordingly. (Figure 2)
And before getting started, remember to communicate with the client to rule out potential contraindications, such as recent surgery, abdominal aortic aneurysms, or pregnancy, for example. This information should also be documented on the intake form.
Using analogies can help your client understand the cause and effect of trigger points and their pain. For example, some trigger points are similar to a gun and bullet. When pressure is applied to the "trigger" of a gun, it shoots a bullet, which produces an effect at the point of impact. Likewise, when a therapist applies pressure to a "trigger point" in myofascial tissue, it produces referred phenomena (shoots a bullet) to another area of the body; that effect is usually described as pain, numbness, tingling, weakness or other like complaints.
Therapists and clients must communicate with each other to determine the presence of trigger points. Instruct your client to let you know if you reproduce the pain when you palpate a myofascial trigger point. Only the client can tell you if the region being palpated is tender and referring pain elsewhere. Once you have identified the culprit, you can treat the appropriate muscle.
Place the client in the supine position with support under the knees and the arms at the side to avoid tightening the skin over the abdomen. (Note: These same techniques can also be used with the client in a side-lying position).
Determine the borders of the rectus abdominis by asking the client to tense the muscle; he can do this by moving into a semi sit-up position as you palpate the region. Make sure that the client relaxes the muscle before you start treatment. Check for muscle sensitivity by palpating with your fingers using static compression.
Release the attachments around the xyphoid process (Figure 3) and costal margin (Figure 4) with your fingers or thumbs. The pubic attachments can be easily located by asking the client to place their thumb over their belly button and extend their middle finger down until they palpate the pubic symphysis. Use static pressure initially. If the area is not too sensitive, add a combination of friction movements in the direction of the muscle fiber (superior and inferior) and across the muscle fiber (medial and lateral). It will be more comfortable for the client if the intention of your pressure is more dominant in one direction.
Lubricate the muscle belly; then stabilize the skin with the non-treating hand. With the other hand, treat with the muscle fiber using a scooping movement with the fingers (Figure 5), followed by cross fiber (Figure 6).
Make sure to check in with the client frequently about the level of pressure. The body is reflexive, and it responds automatically to stimulation. For example, when you touch a hot surface with your hand, you automatically, or "reflexively," pull away to avoid burning the skin.
This concept is also true in massage therapy. If the client is reflexively protecting him or herself by pulling away, tightening the muscle, holding his breath, squinting his eyes or clinching his teeth, then you are applying too much pressure. Additionally, if the tenderness in the area and/or the intensity of the referred pain does not ease up within 8 to 12 seconds of holding static pressure on the trigger point, again too much palpation pressure is being applied, leave the area and return later; and then use considerably less pressure.
Emotions and Sensitivity: The abdominal region can be a sensitive area for clients. Use good judgment and educate your clients to ensure that they are comfortable with having the abdomen treated.
Positioning and Draping: The client must be positioned comfortably on the treatment table in order for the muscle to fully relax. Additionally, your client's privacy must always be protected and respected. There are a host of factors that determine the draping technique that you use. If the client is not comfortable with his/her abdomen exposed during treatment, you can still effectively treat the area through the draping itself.
Ice or Heat: If the injury or trauma is acute and/or swelling is present, avoid the injured area, and use ice when appropriate. Otherwise, a moist heat pack can be placed over the muscle prior to therapy.
Topicals: Topicals can help relieve the client's pain between treatment sessions. You can earn additional income without being in the treatment room. One topical company offers free samples and will even print your contact information on the accompanying promotional materials.
Staying informed by reading articles, textbooks, watching DVDs and taking hands-on seminars to keep your knowledge and skills sharp while helping you perform at your best in the treatment room to meet your personal goals and your clients' expectations. A percentage of the back pain you treat will be from myofascial trigger points in the rectus abdominis. Watch for the clues and patterns, educate your clients, and use all of the tools at your disposal. Wishing you much success.
Click here for more information about David Kent, LMT, NCTMB.
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