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Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
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 more information about David Kent, LMT, NCTMB.
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