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Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
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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