resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
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 previous articles by 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.