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Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
November, 2011, Vol. 11, Issue 11
Gastrocnemius: A Cramp in the Calf
By David Kent, LMT, NCTMB
At some point, patients with posterior leg cramping and pain will seek your services. A multitude of factors produce these symptoms, from dehydration, overuse, poor conditioning, muscle fatique, to low levels of potassium, sodium and or carbohydrates.Let's focus on the gastrocnemius muscle, reviewing key points, showing its four myofascial trigger point locations, pain referral patterns and treatment techniques. If the gastrocnemius muscle is the cause of the pain and not properly treated, the pain will become more persistent and intense.
Gastrocnemius is a two-headed muscle that crosses two joints, the knee and ankle. The medial head is slightly larger and longer than the lateral head. The two heads of the gastrocnemius merge to form the inferolateral and inferomedial boundaries of the popliteal fossa. The gastrocnemius, along with soleus, and plantaris comprise the superficial group of muscles in the posterior compartment of the leg. (Image 1) A three headed calf muscle formed by the two-headed gastrocnemius and soleus. This large muscle merges into the calcaneal tendon or achilles tendon. It plantar flexes the ankle joint, raising the heel off the ground against body weight, as when a person is walking or balancing on their toes.
Complaints from myofascial trigger points in the gastrocnemius muscle include: night cramps and might be activated by climbing up steps, steep slopes, running uphill or riding a bicycle with the seat is adjusted too low. Patients with active trigger points may complain of pain while walking in the soft sand of a beach or on a slanted surface. Any of these activities coupled with cold air temperature, might contribute to the development of trigger points in the gastrocnemius. Other factors that might promote the development of trigger points include having the ankle in a cast, wearing clothing that restricts circulation or reclining chairs that reduce blood flow.
While you may know the location of trigger points and their specific pain referral patterns, your patients do not and they will respect the professional level of patient education you are providing. For example, in photo 2, "X" indicates the common location of trigger points within a muscle. When a trigger point is activated during treatment, it will produce referred phenomena (pain, tingling, pressure, etc) which is shown in red. (Image 2) 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.
Locations and Patterns
The most common trigger point (TrP ) in the gastrocnemius is TrP 1. It is located just distal to the posterior knee, near the medial border of the medial head. It has a strong referral pattern to the ipsilateral instep with a spillover pattern that extends from the distal posterior thigh, along the medial aspect of the calf to the medial maleolus. The next most common trigger point is TrP 2, which is located slightly more distally then TrP1, in the lateral head and refers mostly in a regional pattern near the trigger point. (Image 3) TrPs 3 and 4 are located just distal to the knee and also refer very regional patterns near the location of the trigger point.
There are numerous techniques for releasing myofascial trigger points. The patient must always be comfortable with your treatment pressure, so communicate before, during and after the session. If during a treatment session, your patient is reflexively contracting muscles, pulling away, holding their breath or cinching their teeth because the therapy hurts, then your pressure should be released immediately. Assume the treatment pressure was too much, discontinue treating the sensitive area and return a few minutes later with less pressure.
Muscle Belly: Patient's knee is flexed. Glide distal to proximal, starting at the calcaneus treating the muscles of solues and gastrocnemius. (Image 4)
Lateral Head: Patient's knee is flexed. Using pincher compression, treat the lateral head. (Image 5)
Medial Head: Patient's knee is flexed. Using pincher compression, treat the lateral head. (Image 6)
Tendon: Shorten the calcaneal tendon. Useing pincher compression, treat the lateral, medial, anterior and posterior aspects of the tendon. (Images 7) Next, flex the knee and ankle slightly to lengthen the achilles tendon. Glide distal to proximal, starting at the calcaneus treating the posterior, lateral and medial aspects of the calcaneal tendon. (Image 8)
Calcaneus: Treat the tendon attachment on the calcaneous. Check for sensitivity first by treating with your fingers. If necessary a pressure bar can be used to assist the treatment of this attachment. (Image 9)
The gastrocnemius can be a "real" cramp in the calf. It can produce a great deal of pain and dysfunction for your patients. Educate your patients of the contributing causes and symptoms of gastrocnemius trigger points.
Click here for more information about David Kent, LMT, NCTMB.
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