resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
January, 2010, Vol. 10, Issue 01
Shoulder Pain and the Infraspinatus
By David Kent, LMT, NCTMB
Patients with shoulder pain that inhibits them from combing their hair, brushing their teeth or reaching behind their back for their bra strap often can't sleep on the affected side. When these symptoms include deep anterior shoulder pain that extends down the front and side of the arm, the radial forearm and into the hand, the infraspinatus muscle could be involved.This article will provide useful information covering the anatomy, function, trigger point patterns and treatment tips for the infraspinatus muscle.
The infraspinatus is one of the four rotator cuff muscles. The supraspinatus, infraspinatus, teres minor and subscapularis are also referred to as the "SITS" muscles." The primary combined function of these four muscles is to hold the relatively large head of the humerus in the smaller, shallow, glenoid cavity of the scapula. The tendons of the muscles blend with the fibrous capsule of the glenohumeral joint to form a musculotendonous rotator cuff, which reinforces the capsule on three sides (anteriorly, superiorly, and posteriorly) as it provides active support for the glenohumeral joint."1
Portions of the infraspinatus muscle are covered by the trapezius and posterior deltoid. Medially the infraspinatus muscle attaches to the infraspinatus fossa of the scapula and to the adjacent fascia. Laterally it attaches to the middle facet on the greater tubercle of the humerus. (See Figure 1.)
The infraspinatus produces lateral rotation of the arm at the glenohumeral joint along with the teres minor and the posterior fibers of the deltoid muscle. The antagonistic muscles that produce medial rotation at the glenohumeral joint include the pectoralis major, anterior fibers of the deltoid, subscapularis, latissimus dorsi, and teres major.
As mentioned in the anatomy section, the infraspinatus also helps stabilize the head of the humerous in the glenoid cavity of the scapula. It is important to assess, treat, lengthen and strengthen, as appropriate, the synergistic and antagonistic muscles that cross over joint. A muscle movement chart is a quick reference tool that groups joints by body region and then lists the muscles creating each specific joint movement. It also shows the degrees of normal range-of-motion (ROM) for each joint. This information helps you immediately develop a comprehensive treatment plan with goals that include ROM and provides a list of muscles to target.
We live in the age of digital cameras and cell phones with cameras. We all know the saying "A picture is worth a thousand words." It only takes a few minutes to shoot postural photos of your patient, display the images on the screen of the device and show your patients how their posture is attributing to their pain and how you can help. (Read: "Tools to Succeed for Massage Therapists" MT May 2009.)
Using assessment tools likes a postural analysis chart and plumb line will guarantee your patient is positioned correctly and in same place to document improvement over a series of treatments. Another advantage of having the grid chart in the background of the photos is to help the untrained eye of your patients to easily see a high shoulder or forward head posture which again helps reinforce the stresses the muscles are enduring which can lead to the formation of trigger points. Include a "Free Posture Analysis: A $___ Savings" in your therapy package to set your practice apart from others in your area. (Read: "Getting Comfortable with Postural Analysis" MT July 2008.)
Patients are looking to you for answers explaining why they hurt. Besides postural photos, trigger-point charts are the perfect aid for educating your patients about referred pain from myofascial trigger points. This visual helps them immediately see the referred pain patterns for each muscle. A trigger-point and muscle-movement flip chart is the perfect traveling educational tool.
Show your patients how referred pain from trigger points located in the midportion of the infraspinatus muscle is reported as a deep anterior shoulder pain that extends down the ventral and lateral arm, the radial half of the forearm and into the hand. Pain may occasionally be referred into the suboccipital and posterior cervical region. (See Figure 2.)
Include a variety of modalities and techniques in your treatment sessions. The below techniques are another way of treating myofascial trigger points.
Step 1 - Glide
The patient is in the prone position, their shoulder abducted to 90 degrees and the forearm hanging off the side of the therapy table. The therapist is standing at approximately the level of T12, facing the head. Lubricate and glide on the entire muscle in thumb-width strips, lateral to medial. (See Figure 4.)
Step 2 - Specific
Next, palpate for trigger points with fiber and cross fiber movements on the muscle. To prevent your hands from sliding on the patient's skin due to the use of lubrication, simply place a tissue or linen on the skin and work through it to perform the movement. This simple tip will prevent unnecessary stress and pain in your hands from working too hard. (See Figure 5.)
If you have received training in the proper use and handling of pressure bars you can find this tools helpful in treating the tissues immediately inferior to the spine of the scapulae. (See Figure 6.) Otherwise use your finger tips to treat this tissue.
Step 4 - "SIT" Tendons
Since the tendons merge to form a musculotendonous rotator cuff, we treat three of the four tendons from this position. Lubrication is only used during this step if sensitivity prevents specific work. The client's arm is on the table with their palm turned toward ceiling. (See Figure 7.) This properly positions and exposes the facets on the greater tubercle of the humerus for treatment. Palpate with the non-treating hand, the anterior and posterior aspect of the acromion process. Place the pad of the treating thumb halfway between the anterior and posterior aspect of the acromion process and immediately lateral to it. (See Figure 8.) This will place your treating thumb over tendon attachment of the supraspinatus on the superior facet with fiber and cross fiber movements, gently treat the tendon attachment. (See Figure 9.)
Next move your treating thumb immediately posterior one thumb-width placing it over the infraspinatus tendon as it attaches on the middle facet. (See Figure 10.) As before treat the tendon attachment. Next, reposition your treating thumb one more thumb-width posteriorly, placing it over the inferior facet to treat the tere minor tendon. (See Figure 11.)
Patients need to be educated in self-care that includes regular stretching and strengthening. Inform patients about the benefits of products like exercise balls and resistance bands they can use at home anytime to accommodate their busy schedules allowing them to workout and stretch.
Topical analgesics can also benefit your patients and practice. They provide both drug-free pain relief for your patients and additional income for your practice without you spending additional time performing treatments.
Listen carefully to your patients as they will share many clues about the origin of their pain while reporting their subjective complaints. Shoulder pain and restricted range-of-motion from the infraspinatus can interfere with many activities of daily living from interfering with sleep to prevent someone from combing their hair or brushing their teeth. Take a few minutes to assess, educate, treat and determine short- and long-term treatment goals with each patient.
Wishing you many successful treatment sessions.
Click here for more information about David Kent, LMT, NCTMB.
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