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5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
July, 2011, Vol. 11, Issue 07
Frontal Headaches and Myofascial Trigger Points
By David Kent, LMT, NCTMB
A fundamental key to treating the muscular component of most pain, regardless of the modalities and techniques you specialize in, is to know which muscles to treat based on the location of the patient's pain.This article will review the five muscles that produce frontal headache pain based on the research of Drs. Travell and Simons', the common location of the trigger points in each of those muscles and their referral pain patterns. The muscles are: Sternocleidomastoid (clavicular head), Sternocleidomastoid (sternal head), Semispinalis capitis, Frontalis and Zygomaticus Major.
Most forms of bodywork treat trigger points. When you stimulate a trigger point during treatment, it can produce referred pain to other areas of the body. For example, trigger points in the Sternocleidomastoid muscle, located in the front of the neck, can refer pain into the forehead (Photo 2). It is important that each patient understands that you are not pressing on a nerve when treating a trigger point. Using visual aids like trigger point charts, provide multiple advantages. They educate your patients, provide you with a quick review of the trigger points and help you customize a logical treatment plan. This type of visual education also uniquely sets your practice apart from the competition. Trigger point charts are available in travel flip size or wall versions. Read Headaches: Trigger Points and Practice Building (MT, August 2010) and Practice Building: Getting Inside Your Patient's Head (MT, January 2011).
Let patients know how your charts work. For example, in photo 1 "X" indicates the common location of trigger points within a muscle. When a trigger point is activated during treatment, it will produce referred pain, which is shown in red. Solid red areas indicate an essential pain zone or area of pain experienced by nearly every patient that had that trigger point activated. The red dots indicate spillover pain zones. These are areas of pain experienced by some, but not all, patients outside of the essential pain zones. (Photo 1)
Each division or muscle belly of the sternocleidomastoid muscle has its own unique trigger point patterns. Typically, neither division refers pain into the neck, however each refers pain to the face and cranium. (Photo 1 & 2) This muscle is shortened bilaterally with a forward head posture. The claviclar division will be shortened on the high shoulder side.
Trigger points at the midlevel of the sternal division of sternocliedmastoid refer pain in an arch over the eye into the forehead, deep behind the eye and into the cheek. (Photo 1)
Trigger points at the upper end of the sternal division commonly refer pain to the occipital ridge and to the top of the head (vertex). Attachment trigger points at the lower end of the sternal division can refer into the upper chest.
Trigger points in the mid level of the clavicular division of sternocliedmastoid refer pain to the forehead. On rare occasion, the pain extends across the forehead. (Photo 2) Trigger points in the upper portion of the muscle refer into the ear and posterior to the ear.
The semispinalis capitis and other posterior neck muscles sustain enormous tension as patients maintain a forward head posture throughout their day while writing, reading, working at a computer, driving and maintaining poor posture.
There are two trigger points in the semispinalis capitis muscle that produce the same referral pattern. These trigger points project a band of pain forward that encircles one side of the head, with the intensity focusing in the temple region, then continuing to wrap around to the forehead. (Photo 3) Trigger points labeled Location 1 are found where the muscle attaches to the skull. Location 2 trigger points are located in the upper third of the muscle. Trigger points in the middle and lower portions of the muscle are shown as Location 3 and refer into the back of the head on the same side.
Trigger points form in the frontalis from direct trauma, over stress from prolonged intense frowning or wrinkling of the forehead. The referral pattern for the frontalis is local and spreads upward over the forehead. (Photo 4)
Next we will review key and satellite trigger points. A Key Myofascial Trigger Point is responsible for activating one or more satellite trigger points. It is clinically defined when an inactivated key trigger point results in the inactivation of the satellite trigger points. Satellite Myofascial Trigger Points can form for many reasons, one being in the pain referral zone of a Key Myofascial Trigger Point. Since satellite trigger points can form in the frontalis as a result of key trigger points, be sure to examine and inactivate key trigger points in the clavicular division of sternocliedmastoid (Photo 2) or the Zygomaticus major. (Photo 5)
When the zygomaticus major contracts, it makes us smile by pulling the corner of our mouth upward and laterally. Referred pain from zygomaticus major trigger points project along the side of the nose into the forehead. (Photo 5) Be sure to examine and inactivate key trigger points in muscles like the clavicular division of sternocliedmastoid that refer into the zygomaticus major region. (Photo 2)
Patients appreciate when you take a few minutes prior to the therapy session to educate them of the strategies you implement to identify and address the muscular components of their pain. Photos are powerful visual aids that leave a lasting impression in the patient's mind and help you to quickly deliver a clear message. The saying "a picture is worth a thousand words" speaks volumes when conveying postural analysis findings. Trigger points are often within the myofascial tissues involved in the postural distortions.
Keep the postural analysis process fast and simple. Using the camera of a cell phone, you can take postural photos and instantly give a report of findings to your patients. An anterior view photo will easily pinpoint a high shoulder, while lateral view photos make it easy to show a forward head posture. (Photo 6) Photos allow patients to finally see and understand why they hurt and how you can help. Postural analysis photos are extremely effective even when patients are wearing shoes and/or loose fitting clothes. Read Getting Comfortable With Postural Analysis (MT, July 2008).
Using a postural analysis grid chart with a plumb line makes it easy for anyone looking at the photos to spot postural asymmetries. Pictures also are an excellent way to document change over time. After patients understand the postural stresses their muscles are enduring, they understand why you took the time to educate them.
Treating the muscular components of Frontal headaches is easy when you know which muscles to treat based on the research. The five muscles in this article should be checked, unless contraindicated, for frontal headaches. As always, based on the patients subjective complaints, your objective finding and other factors, you will design customized treatment plans that produce positive clinical outcomes. Stay in touch and I wish you great success in your treatment sessions.
Click here for previous articles by David Kent, LMT, NCTMB.
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