resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
Ever Heard of the Lateral Raphé?
We have all had acute patients enter our offices listing laterally to the side at the level of the lumbar spine or expressing pain on lateral lumbar bending.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
Weighing in on Weight Loss
If your practice trends anything like the U.S. population, you are probably noticing over two-thirds of your patients could benefit from weight reduction, particularly if their main complaints include chronic back or joint pain.
Eucommia Bark Helps Maintain Strong Bones
Eucommia bark is a major tonic herb used in Asia, and now throughout the world, that supports and helps mend the skeletal structure and its related tissues. Eucommia bark is collected from Eucommia ulmoides trees that are more than 10 years old.
Grape Seed Extract: A Multifaceted Herb for Promoting Healthy Circulation
One of my favorite herbs is grape seed. Modern research has identified some intriguing health benefits attributable to the seed of this ancient fruit. I particularly use grape seed as an extract standardized for OPCs (oligomeric procyanidins).
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
Asymmetrical Pronation: Effect on Adjustments
When your patients don't respond as well as expected to their chiropractic adjustments, oftentimes there is a source of interference in the pedal foundation – asymmetrical pronation.
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Diagnosing Flexion-Intolerant Lower Back Pain (Part 2): Exercise Rehab
One of the things that has puzzled us for years is the presentation of the flexion-intolerant patient. We have realized there is a large overlap with sacroiliac indicators. In acute lumbar pain, the SI often twists, subluxes, goes haywire.
The Power of Words: DCs Share Drug-Free Approach
There's no doubt that words are powerful and important – especially in the chiropractic profession, where we have been struggling for years to find the right words to describe who we are and what we do.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
VA Names Sites for Pilot Chiropractic Residency Program
The Veterans Administration has announced the five VA medical facilities that will serve as initial sites for the administration's recently established pilot chiropractic residency program.
Don't Believe It
One of our staff came into my office last week, very concerned about an article she had just read on a news media website. The article suggested researchers found "no health benefits" associated with taking multivitamins.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
Managing Hallux Hypomobility Disorders (Part 2)
In part one of this series we discussed the unique properties and significance of the first toe in the propulsive phase of gait. In particular, we discussed the importance of the first metatarsophalangeal joint (MPJ).
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
Giving Testosterone Levels a Boost (Part 3)
Since testosterone and insulin status are inversely correlated, it's important to keep insulin low so testosterone will remain high.
News in Brief
Patriot Project: Serving Those Who Served; CTCA Chiropractor Receives Clinical Innovation Award.
August, 2009, Vol. 9, Issue 08
Trigger Points and Treatment of the Serratus Posterior Superior
By David Kent, LMT, NCTMB
Trigger points in the serratus posterior superior frequently cause pain near or under the shoulder blades, or in other regions throughout the upper extremities. This article will discuss ways to identify trigger-point patterns in the serratus posterior superior, as well as provide tips for treating the area.
Symptoms: Pain from the serratus posterior superior is often described as a constant "deep ache" under the upper portion of the scapula. Pain can extend down the posterior aspect of the shoulder and arm to the ulnar side of the forearm, hand and little finger (Fig. 1). It sometimes manifests as numbness into the C8-T1 distribution of the hand.
The pain often increases when the patient performs movement that causes the scapula to press against the trigger points of the serratus posterior superior. Movements include lifting objects with outstretched hands, such as placing dishes or other objects on a shelf. Sleeping on the same side can also cause the scapula to press against the trigger points.
Perpetuating Factors: To determine if the serratus posterior superior is involved in producing a patient's pain, it is important for therapists to make use of the tools at their disposal, including intake forms, questionnaires, postural analysis, trigger-point charts and physical assessment. Once it has been determined that serratus posterior superior is involved, you will be able to develop a treatment plan.
Common causes of trigger points in the serratus posterior superior muscles include illness and certain movements and postures. According to Simons and Travell, "Trigger points in the serratus posterior superior muscles are activated by overload of the thoracic respiratory effort because of coughing...and by paradoxical breathing (use of diaphragm and abdominal muscles out of phase)."1
Trigger points in the region can also be brought on by poor movements and postures caused by "sitting for long periods writ-ing at a high desk or table, when the shoulders are elevated and rotated forward to permit the arms to reach the high surface; repeatedly reaching to the rear of a high work surface...and protrusion of the thorax against the scapula by scoliosis," among other things.1 However, "scalene trigger points may mimic, in part, the pain pattern of the serratus posterior superior [Fig. 2]. The neck should always be examined for scalene trigger points if a trigger point is found in the serratus posterior superior."2
Anatomy: The serratus posterior superior is cover by two layers of muscle. The superficial layer is formed by the trapezius. The second layer is formed by the rhomboid minor that covers the upper half of the serratus posterior superior and the rhomboid major that covers the lower half. (Fig. 1)
The serratus posterior superior attaches at midline to the lower portion of the ligament nuchae, the spinous processes of the C6-T2 vertebrae and the intervening interspinous ligaments. The muscle fibers run at an approximately 45-degree angle, inferiorly and laterally, to attach on the 2nd-5th ribs. The lateral portion of the serratus posterior superior is covered by the scapula. (Fig. 1)
The serratus posterior superior also crosses over two muscles of the erector spinae group: the longissimus thoracis and iliocostalis thoracis. Some describe the serratus posterior superior and serratus posterior inferior acting as retinacular tissue directly super-ficial to the erector spinae; functionally this would help increase the force generated by the erector spinae.
Function: The serratus posterior superior raises the ribs to which it attaches, subsequently expanding the chest and aiding respiration. Other muscles that act synergistically with the serratus posterior superior include the scalenes, diaphragm, intercostals and levator costae muscles.
Treatment: It may be difficult for you to palpate any trigger points or taut bands of tissue in the serratus posterior superior muscle because it is covered by skin, adipose, and the trapezius and rhomboid muscles. If referred phenomena like pain, burning or tingling are present, it is likely that you have located a trigger point. Pay attention to pressure, as these areas can be painful. Patients who reflexively pull away, hold their breath or clench their teeth are acting out protective responses. In these situations, you should immediately decrease pressure, leave the area for a few minutes, then return using less pressure.
If you have applied oil or lotion, your fingers will slide when attempting to apply a friction technique. Place a tissue or linen on the skin first then apply the technique through the tissue. Treat the muscle attachments at midline along the lateral aspects of the spinous processes from C6-T2 (Fig. 3).
To treat the muscle attachments on the 2nd-5th ribs, abduct the scapulae and move it laterally to uncover the entire serratus posterior superior. Use with fiber and cross-fiber friction movements to release the rib attachments. (Fig. 4) Apply lubrication and glide on the muscle belly using multidirectional movements to ensure thorough treatment.
Education: Postural analysis photos can help display stresses on the muscle from poor posture. Use trigger point charts to show pain referral patterns, especially those which display the muscles in columns, superficial to deep. This makes it easy to show clients the layers of muscle you must work through to address the condition.
Review proper breathing techniques with patients and become familiar with their activities of daily living. Review proper ergonomics so that they can prevent the perpetuation or return of their symptoms.
The serratus posterior superior muscle is quick and easy to treat. This article reinforces the key information necessary to ensure a thorough treatment.
Click here for more information about David Kent, LMT, NCTMB.
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