resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
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.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
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?
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
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.
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.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
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.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
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.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
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.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
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.
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.
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.
August, 2010, Vol. 10, Issue 08
Headaches: Trigger Points and Practice Building
By David Kent, LMT, NCTMB
Editor's note: David was the keynote speaker and taught "Headaches: Types, Triggers and Treatment" at the 2010 FSMTA Convention July 7-11 in Orlando, Fla.
While there are many causes for headaches, one contributing factor is the presence of myofascial trigger points and the referred phenomena they produce. Patients commonly report this referred phenomena as a headache or head pain. The causes for the initial formation of myofascial trigger points and the perpetuating factors that influences them over time varies. Research studies by Drs. Simons and Travel have documented the general region within the tissues where trigger points form and the referral patterns they produce. Your ability to educate clients about trigger points can directly affect: whether the client reschedules or upgrades to a package of treatments; in some cases, the amount of your tip; and if they refer other new clients. ("Tools to Succeed for Massage Therapists," MT, May 2009.) The principles and concepts I will cover can be applied to any type of practice: mobile outcall, spa, private clinic, physical therapy, chiropractic and medical office. This article will review common trigger point patterns related to headache pain and include tips on how to educate your clients about trigger points to build your practice.
There are three major kinds of learners: visual, auditory and kinesthetic. We must educate clients about trigger points while considering these different styles. Since some people are visual learners, some auditory learners and some are kinesthetic learners, we must integrate all three into the educational process.
Educate your clients the identical way medical doctors and other health care providers educate their patients by using visuals like charts, diagrams and other imaging. Showing pictures of the trigger point patterns that mimic the client's headache pain is a powerful visual tool to demonstrate your ability to understand and develop an effective treatment plan. (Fig 1)
Explaining the details in the images you are showing is an auditory tool. For example, in Figure 2 the "X" indicates the common location of trigger points and the red color indicates the referral zones, based on the research of Drs. Simons and Travel et al., that patients experienced when trigger points were activated. The referred phenomena reported by subjects, in the referral zones, during the studies included, but were not limited to: pain, tension, burning, tingling, numbness and headache. Areas of solid red indicate a high percentage of subjects reported referred phenomena into a specific zone, while areas showing a red stipple pattern were reported by a lower percentage of subjects.
The treatment of trigger points can be accomplished with many techniques. When you apply pressure onto an active trigger point during a session the client will feel and recognize the referral pattern. It is important that you and the client be certain that you are pressing a trigger point and not a nerve or other vital structure. This is a perfect time to show clients a picture of the trigger point pattern you are treating. I also show clients the connection between their trigger points and their posture. (Fig 3) It is wise to frequently review textbooks, DVD programs and manuals to keep the anatomy of the body fresh in your mind and your skills sharp between attending hands-on treatment seminars.
Upper Trapezius. This is the most common trigger point in the body. Trigger points can form from postural stress like a forward head posture and also play a roll on the high shoulder side. Pain is referred from trigger points in the upper fibers of trapezius into the posterolateral aspect of the neck, into the angle of the mandible, behind the ear, and into the temple. (Fig 2)
Sternocleidomastoid. The sternocleidomastoid muscle has two divisions each producing its own unique pain patterns. Trigger points in the clavicular division can produce frontal headaches, earaches and dizziness. (Fig 4) This trigger point can form in the clavicular head of the muscle for example as part of a high shoulder pattern.
While trigger points in the sternal division of the sternocleidomastoid refers pain into the forehead, the anterior cervical region, and can produce throat pain, discomfort or tightness. Other referral patterns include: the back of the head, into the cheeks, into the eye and distally into the sternum. (Fig 5) These trigger points may be the result of a rotational pattern in the body that must be addressed to fully eliminate and prevent the trigger points from returning. When treating throughout the body we must always be alert and cautious of potential areas we could cause harm. ("Safety Protocols: The Carotid Artery," MT, October 2008.)
Suboccipitals. Referral pain from these four suboccipital muscles radiates pain deep into the head from the occiput toward the back of the eye. (Fig 6) These trigger points are commonly caused by forward head posture, sustained upward head tilt or sustained head rotation with tilt.
I use the camera on my cell phone to take postural analysis photos. We all know the saying "a picture is worth a thousand words" and another great visual tool to educate your clients. Pictures help your clients understand the structural load and stresses their muscles are enduring, why the trigger points have formed and how a series of treatments can help. I can email the postural photos directly to the client from my smart phone. Posture charts are also available for mobile therapists that simply hang over any door, allowing you to perform a high level of assessment and education during an outcall session. (Fig 3) ("Getting Comfortable with Posture Analysis," MT, July 2008.)
Note on Using Charts
Trigger point charts are available in both wall and convenient travel flip chart versions. I use wall charts in my clinic and a corresponding flip chart version to maintain a professional image and convey a consistent message when I am outside of my clinic.
The traveling trigger point flip chart is a perfect solution when performing outcalls, chair massage, educating the public at health fairs, meeting with physicians to ask for referrals, working between multiple locations or when wall space is limited. I also use the flip chart, during a session, to show clients laying on the treatment table, trigger point images that correspond to the referral patterns they are experiencing.
I still treat patients today in my clinic, and have owned and worked with every trigger point chart system on the market since buying my first set in 1991. There are a few things to consider when making your initial investment or upgrading your current charts.
Purchasing charts that are protected with a laminated coating is a wise investment for numerous reasons. First, lamination makes charts more durable to last longer over time. Second, it helps resist stains from oils and lotions on your hands. Third, the laminated coating allows you to write, draw and circle areas on your charts with wet erase markers that quickly and easily wipe clean with just water.
Drawing on your charts gives you the ability to customize your message for each individual client. This level of client education parallels medical doctors and other health care providers educating their patients by drawing on X-rays, MRIs and other imaging. Clients are more likely to be compliant and follow your recommendations when you deliver a first class professional presentation. (Fig 1)
Look for chart systems that are easy to reference. They must be logically designed to allow you to educate others quickly and easily.
A few additional things to consider when purchasing your trigger point chart system: Are the charts color-coded by body region? Are the charts designed the way you work on clients? For example, are muscles grouped by region, action or compartment? Are the muscles placed in columns superficial to deep? Are the images basic black ink line drawings or modern images showing you and the client the muscle, trigger point location and referral pattern superimposed on a real person? Is the information on the wall and flip chart versions designed to work together? Do the charts have additional advanced information designed into them allowing you to instantly develop customized treatment plans based on medical research? For example, do the charts list muscles involved with specific headache patterns or zones (i.e. frontal, temporal, occipital). Are the charts isolated products or part of a complete refined system? Are packages available to save me money if I buy both the wall and flip chart set?
This economy is challenging and more therapists are competing for work than ever before. Clients are watching their budgets and looking to get the best value for their dollar. Build your practice and take it to the next level by educating your clients about headaches and trigger points. Integrating educational visual, auditory and kinesthetic sensory tools is very powerful and produces effective results. I wish you best and look forward to learning of your successes.
Click here for more information about David Kent, LMT, NCTMB.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.