Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
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.
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