resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
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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