resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. 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.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
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.
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