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It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
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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