resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
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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