resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
April, 2011, Vol. 11, Issue 04
Iliosacral Pain You Can't Touch
By David Kent, LMT, NCTMB
As a practicing therapist, I know the anxiety one can feel to produce results during a therapy session. Throughout your career, clients will present you with iliosacral pain that is very sensitive to the touch.In some cases, they report no longer wearing tight-fitting pants or jeans because the pressure on their sacrum or coccyx produces too much pain. So how do you provide relief in this area if you can't touch it?
The information in this article can be easily applied and integrated into any therapy setting and with any application of treatment techniques. While iliosacral pain can have numerous origins, this article will focus on the trigger point patterns that exist along with practical tips to produce positive outcomes.
Pain is a symptom and we want to address the cause. Determine the contributing and/or perpetuating factors influencing your client's pain with intake forms, pain scales, accident questionnaires and headache diaries to help guide and support your physical assessment. Read "Tools to Succeed for Massage Therapists" (MT, May 2009).
Before a surgeon operates, a dentist drills or a chiropractor performs an adjustment, they review images from X-rays, CT scans or MRI and information from other tests. Then the healthcare provider designs a multi-session treatment plan to help their client achieve specific goals. Our clients also expect us to assess and provide a solution.
Standout from your competition by taking five minutes to quickly evaluate your client's gait pattern as they walk down the hall to the therapy room, perform a quick postural analysis (Read "Getting Comfortable With Postural Analysis" MT, July 2008), check range of motion (ROM), and perform orthopedic assessments.
I use the camera on my cell phone to take postural analysis photos and instantly zoom in on the images to review my findings with the client. I quickly review the different postural views and correlate/translate their posture photo to answer:
Which myofascial tissues are shortened and which are lengthened?
Which structures are under the greatest stress?
Review the trigger point patterns that could be involved.
"Connect the dots" as to how and why their posture, restricted ROM, trigger points and pain are related.
Just like other healthcare providers, you must proceed to explain the origin of your client's symptoms and a solution while referencing the tests (orthopedic, ROM) and postural analysis photos as supporting evidence.
Before moving onto my palpation exam and treatment, I educate my client's about trigger points. I circle on a trigger point chart the pain referral patterns of the eight muscles involved with iliosacral pain based on the research of Drs. Travell and Simons, authors of Myofascial Pain and Dysfunction: The Trigger Point Manual.
I explain the "X" in the trigger point images indicates the common location of each trigger point and the red indicates the common referral zones. Each trigger point produces a unique referral pattern and some are similar from one muscle to another. Being familiar with each pattern, will allow you to ask better questions and be precise with your evaluation and treatment. I will briefly review the common location of each trigger point and the associated referred pain pattern. This will reinforce and help you remember the information you should review with your clients.
The eight muscles with trigger points involved in iliosacral pain include:
Gluteus Medius: Two of the three trigger points found in the gluteus medius muscle refers over the iliosacral region. Trigger point 1 (TrP 1) is located lateral to the posterior superior iliac spine (PSIS) and inferior to the iliac crest. It produces a referral that includes the posterior crest of the iluim, the region over sacroilac joint and half the sacrum on the ipsilateral side. (Fig. 1)
Trigger point 3 (TrP 3) is rare but when present is located just posterior to the anterior superior iliac spine (ASIS) and just below the iliac crest. Referred pain is primarily produced in the low back and over the sacrum bilaterally. Read "Back Pain: Often a Pain in the Gluteus Medius" (MT, March 2009).
Gluteus Maximus: Three trigger points in the gluteus maximus can be involved. (Fig. 2) TrP 1 is located just lateral to the sacrum and refers over the sacroiliac joint. Trigger point 2 (TrP 2) is very common and located slightly superior to the ischial tuber-osity. It refers over most of the gluteal region ending below the iliac crest. TrP 3 is located in the fibers close to the coccyx and refers pain over the coccyx.
Multifidi: Trigger points in the lower segments around S1 and S4 may refer to the coccyx, making it hypersensitive to pressure. (Fig. 3) This is often identified as coccydynia.
Quadratus Lumborum: The trigger points located more medially in the quadratus lumborum (Fig. 4, See #1 and #2) refer pain posteriorly to the sacroiliac joint and lower buttock. Symptoms include low back pain upon standing upright or walking. Pain in the quadratus lumborum may be exacerbated by coughing or sneezing.
Soleus: TrP 3 is a very rare trigger point and located in the lateral mid-calf that refers deep into the ipsilateral SI joint. Even more rare, this trigger point could create a pattern similar to TrP 1. A couple of times this very exceptional trigger point has been observed creating severe pain to the ipsilateral face. Trigger points in the soleus do not appear to be involved in leg cramps like the trigger points of the gastrocnemius; however, they have been associated with "growing pains". Trigger points in the soleus and gastrocnemius may contribute to chronic Achilles tendon tension. (Fig. 6)
Coccygeus and Levator ani: If you suspect trigger points in the coccygeus and/or levator ani muscles, address them with stretching, post-isometric relaxation techniques and corrective seated posture and refer them to a specialist. (Fig. 7)
Trigger points can be treated with an array of techniques found in the massage therapy profession from Swedish to Thai massage, myofascial release (MFR) to active isolated stretching (AIS), and the list goes on. The key is to know the anatomy and the common location of each trigger point and their associated pain referral patterns. It is impossible to memorize every trigger point pattern in the body, so it is practical and efficient to use trigger point charts. In the treatment rooms of my clinic, I hang wall charts. I use flip charts when wall space is limited to provide a professional image when doing outcalls, chair massage or when meeting with other healthcare providers to ask for referrals.
I wish you much success in life and in the treatment room.
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.