resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
March, 2010, Vol. 10, Issue 03
Trigger Points in the Fibularis Tertius Muscle
By David Kent, LMT, NCTMB
Ankle and heel pain is a common complaint. Patients often are surprised to discover their pain is caused by trigger points in the fibularis tertius, a small and easily overlooked muscle in the front of the lower leg. This article will review the anatomy of the fibularis tertius muscle and discuss the trigger points that cause lateral ankle and heel pain, as well as treatment techniques and ways to educate your patients about the causes of their pain.
The name of this muscle has changed over the years. Fibularis tertius has replaced the older term, peroneus tertius. Peroneal was derived from the Greek terminology meaning "a pin." Pointed objects like sewing needles were termed perone by the Greeks. The Latin word fibula also means "a pin or skewer." In some animals, the fibula often is very narrow and has sharp tips (styloid processes), thus it is probable that this bone was named for its resemblance to a pin, or sewing or knitting needle. Tertius is the Latin word for "third," or "concerning the third." This muscle attaches to the lower third of the fibula and is one of three muscles attaching to the fibula that everts the foot.
The lower leg contains two bones: the tibia and fibula. The tibia, the bone on the medial side, is the larger weight-bearing bone and forms the medial malleolus. The fibula, the smaller slender bone on the lateral side, is not a weight-bearing bone and forms the lateral malleolus.
The leg is divided into three fascial compartments: anterior, posterior and lateral. The fibularis tertius is located in the anterior compartment, whereas the lateral compartment contains the fibularis longus and brevis. The interosseous membrane that runs between the fibula and tibia divides the anterior and posterior compartments. The anterior intermuscular septum divides anterior and lateral compartments. The posterior intermuscular septum divides posterior and lateral compartments. (See Photo 1) Proximally, the fibularis tertius attaches to the distal third of the anterior surface of the fibula, the interosseous membrane and the adjacent intermuscular septum. In the foot, it attaches on the dorsum of the base of the fifth metatarsal. (See Photo 2)
The primary actions of the fibularis tertius are dorsiflexion of the ankle and eversion of the foot. The fibularis tertius dorsiflexes the ankle along with three other muscles: fibularis longus, fibularis brevis and tibialis anterior. It also acts to evert the foot, assisting fibularis longus and brevis.
It is important to assess, treat, lengthen and strengthen, as appropriate, the synergistic and antagonistic muscles that cross the joint. A muscle-movement chart is a quick reference tool that groups joints by body region and then lists the muscles that create each specific joint movement. A muscle movement chart also shows the degrees of normal range of motion (ROM) for each joint. This information provides a list of muscles to target and helps therapists develop a comprehensive treatment plan with goals that include improving ROM.
Patient complaints typically include weakness in the ankle and/or pain and tenderness in the ankle, behind and over the lateral malleolus. Whenever a patient reports a trigger point during treatment, take a moment to show them the specific referral pattern on a trigger point chart. Utilizing charts as visual aids to educate your patients about trigger point patterns is a powerful way to demonstrate your knowledge and understanding of the patient's pain. (See "Tools to Succeed for Massage Therapists," MT May 2009.)
Trigger points in the fibularis tertius muscle usually are palpated proximal and anterior to the lateral malleolus. The referral pattern for fibularis tertius trigger points is "pain and tenderness along the anterolateral aspect of the ankle with a spillover patterns projecting downward behind the lateral malleolus to the lateral aspect of the heel."1 (See Photo 3)
There are many reasons trigger points form in the fibularis tertuis. Sometimes they are caused by activities and/or events that occurred months, years or even decades before the onset of the chronic pain. A few examples include inversion sprains of the ankle, wearing too-tight running shoes, work boots or ski boots, direct trauma, a new activity requiring overuse of the muscle, and weakness from prolonged periods of immobility due to injury.
Postural analysis photos will reveal the stresses patients place on their muscles. (See "Getting Comfortable with Postural Analysis," MT July 2008) Intake forms, postural analysis, gait evaluation and orthopedic assessments will help you uncover a lot of information that will prepare you for the hands-on treatment.
Muscle Test: Palpation of the bony landmarks coupled with muscle testing will ensure you are specifically isolating and thoroughly treating the correct muscle. To muscle test the fibularis tertius, place the patient in a supine or sitting position. Support the patient's leg with one hand just above the ankle joint so your palm is cradling the Achilles tendon. With the other hand, apply pressure against the lateral side and dorsal surface of the foot with pressure in the direction of plantar flexion of the ankle and inversion of the foot. Instruct the patient to dorsiflex the ankle and evert the foot while you apply resistance.
Check for Sensitivity: Palpate along the belly and tendon of the muscle to check for sensitivity. Treatment should not cause pain.
Fifth Metatarsal: Treat the tendon attachment on the dorsal surface of the base of the fifth metatarsal. Apply static pressure and then integrate muscle-fiber and cross-fiber techniques. Start on the base of the fifth metatarsal and follow the tendon anterior to the lateral malleolus. (See Photo 4)
Tendon: Apply lubrication to the skin. Using distal to proximal gliding strips on the muscle, follow the tendon along the front of the lateral malleolus.
Belly: Glide distal to proximal on the belly of the muscle. Treat the attachment on the anterior lower third of the fibula. (See Photo 5)
Conclude your sessions with a brief explanation of the problems you identified and how ongoing massage therapy can help. Tell your patients you will design a customized treatment plan to address the soft-tissue components of their pain, and educate them on the use of ice, heat and other methods of self-care. Provide a stretching routine so patients can continue to improve and maintain themselves between visits. Show your patients proper home and work ergonomics (using computers and phones, lifting, etc.).
I wish you best in the treatment room. Please drop me a line to tell me about your results.
Click here for more information about David Kent, LMT, NCTMB.
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