resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
October, 2009, Vol. 9, Issue 10
Thumb Pain and the Brachialis Muscle
By David Kent, LMT, NCTMB
While I was lecturing at the Florida State Massage Therapy Association convention, some therapists asked about the causes of pain on the dorsal side of the base of the thumb (carpometacarpal joint) and the adjacent web space between the thumb and finger.While there are many reasons for pain in this region, this article will discuss the role of referred pain from trigger points in the brachialis muscle and methods for treating it with massage.
Anatomy: The brachialis muscle lies deep to the biceps brachii muscle. It attaches above the elbow, proximally, on the lower half of the anterior surface of the humerus. Just below the elbow, distally, it attaches on the coronoid process of the ulna. (Photo 1)
Function: The brachialis flexes the elbow and works synergistically with the biceps brachii and the brachioradialis muscles. The antagonist to brachialis is the triceps brachii. The movement created by the contraction of the brachialis muscle is determined by which attachment is fixed and which attachment moves. When the humerus is in a fixed position and the brachialis muscle contracts, such as during a bicep curl, the forearm moves toward the humerus. When the forearm or distal attachment of the brachialis muscle is fixed, such as during a pull-up exercise, the brachialis moves the humerus toward the forearm.
Referred Pain: Trigger points in the distal region of the brachialis produce "referred pain [that] is felt in the base of the thumb at rest and often with the use of the thumb. Diffuse soreness of the thumb is characteristic of its referred tenderness."1 (Photo 1)
Nerve Entrapment: The brachialis muscle can entrap the superficial sensory branch of the radial nerve, which is a cutaneous-monitoring nerve. When entrapment occurs, it can produce dysesthesia on the dorsum of the thumb. Dysesthesia is an impairment that produces sensitivity to touch, tingling and numbness. Additionally, the coracobrachialis muscle can entrap the musculocutaneous nerve that innervates the brachialis.
Perpetuating Factors: Trigger points can form and remain in the brachialis due to elbow flexion movements that overstress the muscle and/or require the muscle to remain in a flexed position for an extended period of time. Some examples include holding a child, lifting heavy tools, carrying groceries or boxes, and playing an instrument such as a violin or guitar. "Related trigger points are frequently found in the brachioradialis, supinator or the adductor pollisis."1
Precautions: Integrate muscle testing to identify each muscle, as well as to avoid treating neurovascular structures located on the medial side of the arm. Be cautious of the brachial artery and the median, musculocutaneous and ulnar nerves. These are positioned, on the medial side of the arm, between the anterior compartment containing the biceps, brachialis and coracobrachialis and the posterior compartment containing the triceps.
Pressure: Check in with the client frequently to determine if treatment pressure is appropriate and look for warning signs of too much pressure, such as muscle tightening, teeth clenching or pulling away. Additionally, if the tenderness in the area of treatment and/or the intensity of the referred pain does not ease up within eight to 12 seconds of holding static pressure on the trigger point, leave the area and return later, using less pressure.
Step 1 - Positioning: Place the client in the supine position with the elbow passively flexed between 30 and 45 degrees and the forearm appropriately supported. Stand at the level of the client's abdomen, facing their head. This position shortens the brachialis and biceps, and will allow you to displace the superficial biceps medially and laterally so the deep brachialis can be thoroughly treated.
Step 2 - Ulna Attachment: The attachment of the brachialis on the coronoid process of the ulna is approximately one inch distal to the crease of the elbow (Photo 1) on the pinkie side of the forearm. To treat this attachment, supinate the client's hand, with the palm facing upward. Apply friction integrating with fiber and then cross-fiber movements on the attachment (Photo 2).
Step 3 - Humeral Attachment (Lateral Side): Apply lubrication to treat the large attachment of the brachialis on the humerus from the lateral and medial side; muscle-test the biceps to determine its location. Treat the lateral aspect by using your non-treating hand to move the biceps medially, while the other hand treats the lateral aspect of brachialis on the humerus. Apply treatment at a 45-degree angle against the humerus while gliding distal to proximal, stopping just above the level of the deltoid tuberosity (Photo 3).
Step 4 - Humeral Attachment (Medial Side): Next, treat the medial attachment on the humerus. Use the non-treating hand to move the biceps laterally, while the other hand treats the medial aspect of brachialis on the humerus. Apply treatment at a 45-degree angle against the humerus while gliding distal to proximal, stopping just above the level of the deltoid tuberosity (Photo 4).
Step 5 - Muscle Belly: Face the pads of your thumbs toward each other with one thumb on the medial side and the other on the lateral side of the brachialis muscle, deep to the biceps, at the level of the elbow. Use your fingers to cup the arm while they make contact with the triceps muscle (Photo 5). Glide distal to proximal.
Clients will typically seek your services when pain begins affecting their activities of daily living. Educate every client on the causes of their muscular pain, treatment options you provide and proactive self-care steps that they can use outside of the treatment room. Advise them that pain is a symptom and that it is important to address the cause. Below are some suggested methods of assessment and client education.
We all know the saying, "a picture is worth a thousand words." Postural-analysis photos provide visual documentation of a client's posture, showing which muscles are shortened and which are overlengthened. The better a client understands the relationship of their poor posture, trigger points and pain, the more likely they will be to follow through with a recommended treatment plan. Clients benefit by knowing that one reason trigger points form is due to the stress caused by poor posture.
Trigger-point charts and other types of charts help educate clients about referred pain patterns. Some trigger-point charts show which muscles refer pain to specific regions of the body, like the base of the thumb in this case. This information is also helpful to developing and implementing an effective treatment plan.
Review the advantages of proper ergonomics and instruct your client on the ways they can incorporate ergonomics into daily activities. Teach clients stretching exercises that will help prevent their symptoms from returning.
If you use topical analgesics in your sessions, educate your clients on how to use them to control their discomfort between treatments. Selling topical analgesics will provide you with additional income, as well.
Remember that a client's pain is typically a symptom and its origin is often in an area other than the region of the pain. Your clients appreciate every bit of knowledge you share. Give them the knowledge to make informed decisions about their care.
I wish you the greatest of successes in the treatment room.
Click here for more information about David Kent, LMT, NCTMB.
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