resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
Diagnosing Flexion-Intolerant Lower Back Pain (Part 2): Exercise Rehab
One of the things that has puzzled us for years is the presentation of the flexion-intolerant patient. We have realized there is a large overlap with sacroiliac indicators. In acute lumbar pain, the SI often twists, subluxes, goes haywire.
The Power of Words: DCs Share Drug-Free Approach
There's no doubt that words are powerful and important – especially in the chiropractic profession, where we have been struggling for years to find the right words to describe who we are and what we do.
Eucommia Bark Helps Maintain Strong Bones
Eucommia bark is a major tonic herb used in Asia, and now throughout the world, that supports and helps mend the skeletal structure and its related tissues. Eucommia bark is collected from Eucommia ulmoides trees that are more than 10 years old.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
News in Brief
Patriot Project: Serving Those Who Served; CTCA Chiropractor Receives Clinical Innovation Award.
Weighing in on Weight Loss
If your practice trends anything like the U.S. population, you are probably noticing over two-thirds of your patients could benefit from weight reduction, particularly if their main complaints include chronic back or joint pain.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
Grape Seed Extract: A Multifaceted Herb for Promoting Healthy Circulation
One of my favorite herbs is grape seed. Modern research has identified some intriguing health benefits attributable to the seed of this ancient fruit. I particularly use grape seed as an extract standardized for OPCs (oligomeric procyanidins).
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
Giving Testosterone Levels a Boost (Part 3)
Since testosterone and insulin status are inversely correlated, it's important to keep insulin low so testosterone will remain high.
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
VA Names Sites for Pilot Chiropractic Residency Program
The Veterans Administration has announced the five VA medical facilities that will serve as initial sites for the administration's recently established pilot chiropractic residency program.
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Managing Hallux Hypomobility Disorders (Part 2)
In part one of this series we discussed the unique properties and significance of the first toe in the propulsive phase of gait. In particular, we discussed the importance of the first metatarsophalangeal joint (MPJ).
Ever Heard of the Lateral Raphé?
We have all had acute patients enter our offices listing laterally to the side at the level of the lumbar spine or expressing pain on lateral lumbar bending.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
Don't Believe It
One of our staff came into my office last week, very concerned about an article she had just read on a news media website. The article suggested researchers found "no health benefits" associated with taking multivitamins.
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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