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News in Brief
Oregon Gov. John Kitzhaber (a medical doctor, no less) proclaimed October 2014 "Oregon Chiropractic Health and Wellness Month" in an official proclamation signed Aug. 25, 2014.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Detoxification for Athletes: The Key to Winning Performance
One of the most dangerous culprits that affects an athlete's ability to perform at an optimum level also happens to be one of the most elusive.
The Life & Legacy of James Sigafoose, DC (1933-2014)
Surrounded by his family and closest friends, Dr. James M. Sigafoose passed away quietly on Thursday, July 3, 2014. With his wife of 60 years, Patsy, along with his children, Tina, Daun, Kieth, Selina and Carey – all chiropractors – at his side.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Ringing in a Fiscal New Year With a Recommitment to Cost-Effectiveness
Back when the Foundation for Chiropractic Education and Research was in its heyday, I used to send out New Year's greetings and virtual noisemakers to some close friends on July 1 – the beginning of our new fiscal year – wishing for prosperity in the year ahead.
Decompression-Traction: A Core Treatment Method in Chiropractic's Future
We're all competing for new patients. We're competing for new patients with physical therapists, massage therapists, medical specialists and hospital fitness centers. We're even competing with side-effect-ridden medications that quit working every four hours.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Watch Out for Red Herrings
In clinical practice, when one condition mimics another, it makes it difficult to obtain an accurate and timely diagnosis.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
How to Find Your Ideal Patient – and Help Your Ideal Patient Find You
Just imagine: You're at the front desk looking at the scheduler and a smile creeps across your face. Row after row, name after name, hour after hour; you're blessed with an entire day of ideal patients. Every day should be like this, you whisper. Exactly!
Take Care of Your Skin: Tips to Pass on to Your Patients
Many of our patients are not aware that the largest organ in the human body is actually the skin. Accounting for 16 percent of total body weight and covering up to 22 square feet of surface area, the skin is more than just a "covering," as originally thought.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Don't Forget About the Performers
Donald Petersen Jr.'s recent article, "Your Chance to Go Back to High School" [May 1, 2014 DC], focused on the injuries incurred by high-school athletes and the subsequent opportunities for the chiropractic profession.
From the Other Side of the Table
People come to us to gain freedom from pain, to feel better, to live better. As D.D. Palmer stated, "We Chiropractors work with the subtle substance of the soul." Therein also lies the rub.
Building the DC-MD Bridge
From MDs practicing integrative holistic medicine to the family internist, many DCs are enjoying unprecedented attention from their allopathic colleagues.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
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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