resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Chiropractic Prevents ADHD? Research Shows...
Now that I have your attention, let me tell you what the latest study actually states. As you may have noticed, research over the past few years has begun to reveal that acetaminophen (the primary ingredient in Tylenol) is not as safe as once thought.
Collaboration for a Cause
The Patient Protection and Affordable Care Act strongly encourages the formation of multidisciplinary practitioner teams called Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
What is a Discipline in Medicine?
In my now prolonged dialogue with physicians, one question emerges with enough regularity to deserve mention and naming: what is a discipline?
Are You Guilty of Paternalism in Your Approach to Patient Care?
Einstein is purported to have said, "When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it's longer than any hour. That's relativity." In some way, everything is relative to one's point of view.
Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Part 1)
In 1926, Hans Selye first used the word stress in a biological context, referring to the nonspecific response of the body to any demand placed upon it.
Monoculture of the Mind: Part II
Cases are built within boundaries. Such bounds may be a program, event, activity or individuals. In this instance, a medical case has boundaries that include clinical interactions that are comprised of history, signs, symptoms, diagnoses, treatment plans and treatments.
Resilience is the New Longevity
Sometimes we must enter a room through one door and not another, even though they both lead into the same space. I am talking now of the recent cachet with the concept of "resilience" regarding health, chronic pain and longevity.
News in Brief
Hamm Elected New President of the ACA; WFC / ACC 2014 Education Conference: Call for Papers; F4CP Recognizes Standard Process as $1 Million Supporter; Texas Chiro. College Begins Search for New President; League of Chiropractic Women Hosts Women's Success Summit.
Get That Shoulder to Move: Restoring Internal Rotation
How many times have you mobilized, performed ART, Graston, FAKTR and PIR, and stripped a patient's posterior capsule, yet on re-exam, discovered it was still blocked?
Flexion-Intolerant Lower Back Pain (Pt. 3): Mobilization & Soft-Tissue Treatment
What is the biggest challenge to the chiropractor in treating discogenic pain? You have to completely reframe the purpose of your manipulation. It is rarely about unlocking a stuck segment at the disc involvement level; it is not about putting a joint back in alignment.
Successful Strategies in Integrating Acupuncture and Shiatsu in a Hospital Oncology Program
Colleagues from the Network of Researchers in Public Health in CAM recently published an article of interest to our Traditional Asian Medicine community.
Green Tea Catechins Lower PSA, Other Biomarkers in Men With Localized Prostate Cancer
A 2006 study (Cancer Research) was the first human investigation to show that green tea catechins (GTC) are highly effective in reversing premalignant prostate lesions (high-grade prostate intra-epithelial neoplasia), an established precursor to prostate cancer.
Steven Rosenblatt: Birthing A Cross-Cultural Acupuncture Profession
The existence of a cross-cultural acupuncture profession in the United States, one that is legalized, licensed, supported by formalized, academic training and inclusive of non-Asian practitioners, is an important part of the medical landscape in this country and is responsible for improving the lives of hundreds of thousands of Americans.
AAAOM – Making Promises They Can't Keep
When the AAAOM first formed in 2007, their mission was clear: to support the profession through education, resources and legislative advocacy. The first years of the organization were filled with promise and hope.
Risk Factors for Heel Problems
Heel pain and gait disability are common occurrences in adults, often the result of thinning heel pads and a lifetime of exposure to heel-strike shock. One condition experienced by many people is plantar fasciitis.
Epigenetics: The Western Science Supporting Essence
Since the days of Darwin, western medicine has touted that our genes were set in stone, that our genetics were our destiny. We were told that the diseases that ran in our family were likely coming to us as well.
The Healing Properties of Light: An Interview With Researcher Anna Cocliovo
This interview is with Anna Cocliovo, a light researcher and Acupuncturist in Arizona. During my own research in light, I came across the article she published for the American Journal of Acupuncture and sought her out as a result.
Creating Child-Friendly Clinics with ABT
The Zurich Dojo was scattered with toy ducks, dolls, trains, exercise balls and teddy bears during my recent pediatric workshop.
Why DCs Need to Understand the Principles of "Inclusive Design"
In the past few columns, I've written about the negative effects of prolonged sitting at work. I've attempted to make the point that prolonged sitting (or prolonged standing) takes a toll on workers. Now let's discuss a related issue: the concept of "inclusive design."
AAAOM – The Beginning of the End (Part II)
In 2012, the AAAOM board members met in Chicago for their annual meeting. The goal was to come to a consensus on a long list of issues the AAAOM needed to work on including a functional board and budget.
Leaving a Lasting Legacy: Donna Liewer
For the past 31 years, Donna Liewer has been on a personal mission "to comfort the afflicted and afflict the comfortable." In her role as executive director of the Federation of Chiropractic Licensing Boards, Liewer has accomplished that and much, much more.
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.
comments powered by Disqus