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Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
March, 2016, Vol. 16, Issue 03
Treating Headaches and Migraines with Trigger Point Therapy
By Valerie DeLaune, LAc
Tension headaches, migraines, and cluster headaches account for 90% of all headaches. Tension headaches are the most common and people who experience migraines typically also have tension headaches in between their migraines. Studies have shown that patients who have headaches (including migraines) are almost twice as likely as healthy control subjects to have postural abnormalities, including head-forward posture and also have trigger points in the back of the neck, particularly in the suboccipital muscles.
Patients who suffer from both migraines and tension-type headaches are far more likely to have a greater number of active trigger points. The greater the number of active trigger points, the more frequent and severe the headaches. With one-sided headaches, a greater number of active trigger points are found on the same side as the headache.
The most common causes of tension headaches are trigger points, with underlying perpetuating factors including poor posture and ergonomics, emotional distress, fatigue, noise, glare, and jaw clenching. Tension headaches can also be associated with arthritis, disk problems, or degenerative bone disease in the neck or spine.
About one in ten people get migraines and about 75% are women. Trigger points play a far greater role in migraines than previously thought; one study found that 93.9% of migraine subjects had trigger points with referred pain patterns that reproduced their migraine pain and other symptoms. Pressing the trigger points could reproduce the location of pain, the throbbing quality, light and sound sensitivity, and other symptoms that were common for each subject. The longer the history of migraines and the more frequent the attacks, the greater number of trigger points the subject had in their muscles. In other words, the longer migraines are left untreated, the greater number of trigger points will form, and the more migraines the patient will get – a self-perpetuating cycle. Most of the triggers for migraines are also those that cause and perpetuate trigger points, such as allergies, alcohol, smoking, stress, hormonal changes, caffeine, and insufficient nutrition, water, sleep, or exercise.
Cluster headaches primarily affect men 20 to 40-years-old. As with tension headaches and migraines, triggers such as alcohol, tobacco use, allergies, and sleep apnea (which causes oxygen-deprivation) also cause and perpetuate trigger points.
Neck injuries are the most common cause of post-traumatic headaches. In a study of patients following rear-end motor accidents, 62% of patients reported feeling neck pain within six to seventy-two hours, and of those, 82% also reported headaches. Twelve weeks after their accidents, 73% still had headaches. Injuries are one of the most common initiators of trigger points.
Treating Trigger Points
It is important to have a clear idea of where your patient is experiencing pain. Many patients will refer to facial pain or pain at the C1 level as a headache. In order to decide which trigger points to search for first, have your patient color in their referral patterns on a body drawing.
It is also important to remember that, in general, at least 74% of trigger points are not located in the area in which your patient feels pain. Trigger points in the trapezius, posterior neck, and sternocleidomastoid muscles can all refer upward into the head. These are called primary trigger points. Trigger points in the temporalis, orbicularis oculi, zygomaticus major, frontalis, occipitalis, masseter, lateral pterygoid, medial pterygoid, and digastric muscles can be either primary trigger points, or satellite trigger points (formed due to being within the referral zone of the primary trigger points). You will also need to keep in mind that headaches can be a composite of trigger point pain referral patterns from various muscles of the neck and in and around the mouth and jaw, so it may be impossible to match up common referral patterns with just one muscles' common referral patterns.
Being able to reproduce the referral patterns when palpating trigger points can be a confirmation that you have located at least some of the pertinent trigger points, but being unable to reproduce the referral pattern should not rule that trigger point out. If your patient is experiencing symptoms consistent with that trigger point, treat it and see if symptoms decrease by the next treatment. Also, remember that trigger point referral charts and pictures only show common referral patterns. Your patient's referral pattern may look somewhat to very different from a chart. Gathering information from the patient about all of their symptoms, palpation, and asking if symptoms have decreased in between treatments is the best way to confirm that you have successfully located the pertinent trigger points.
Remember that treating the trigger points is only part of the treatment – all underlying perpetuating factors need to be identified and addressed. Common perpetuating factors include mechanical stresses, injuries, spinal misalignments, nutrient deficiencies, poor dietary habits, food allergies, emotional factors, sleep problems, acute or chronic infections, hormonal imbalances, and organ dysfunction and disease. For this reason, it often takes a team approach to treat trigger points, since no one type of practitioner may be able to diagnose and treat all the pertinent perpetuating factors.
Trapezius trigger points can cause pain behind the eye, dizziness or vertigo (probably indicating simultaneous involvement of the sternocleidomastoid), and stiffness and/or limited range-of-motion (ROM) in the neck. Common perpetuators include postural and ergonomic issues, whiplash injuries, structural inequalities, fatigue, stress, and several types of sports activities, including biking and swimming.
In addition to the pain referral patterns, trigger points can cause pain shooting through the head to the back of the eye, blurry vision, and neck stiffness and/or limited ROM. Common causes and perpetuators include head-forward posture (including compensation for kyphosis), poor posture and ergonomics at a desk including cradling the phone between the ear and shoulder, whiplash, subluxation, stress or depression, and exposure to cold drafts.
In addition to the pain referral patterns, other trigger point symptoms can include sinus congestion (often attributed to a sinus infection, even though there is no discharge), dizziness or vertigo, earaches, nausea and loss of appetite, seasickness/car sickness, one-sided deafness or tinnitus, visual disturbances, eye tearing or reddening, eyelid drooping or twitching, a sore throat, or a dry, tickling cough.
Perpetuating factors include head-forward posture, tilting the head back or to the side for prolonged periods, improper pillows, tight neckties or collars, a chronic cough or improper breathing mechanics, chronic or acute infections, tight pectoralis major muscles, structural inequalities, severe scoliosis, whiplash, and alcohol consumption.
In addition to the common pain referral patterns, other trigger point symptoms can include teeth sensitivity or pain, improper bite alignment, teeth clenching, or the jaw may zig-zag while opening or closing. Common perpetuating factors may include head-forward posture, chronic infections or inflammation, folate deficiency, hypothyroidism, clenching/grinding, gum-chewing, dental work, and primary trigger points in the trapezius and/or sternocleidomastoid muscles.
Frontalis and Occipitalis Muscles
Frontalis trigger points may develop from primary trigger points in the sternocleidomastoid muscle, from raising eyebrows frequently, and from wrinkling the forehead. Occipitalis trigger points can form as a result of primary trigger points in the posterior neck muscles, or squinting due to poor vision or glaucoma.
These are only some of the trigger points, muscles, referral patterns, additional symptoms, causes, and perpetuators of trigger points that can cause headaches and migraines. You may also need to treat the scalene and possibly other muscles if your patient has head-forward posture, even though they don't directly refer symptoms to the head.
By locating and treated pertinent trigger points, and identifying and rectifying causes and perpetuating factors of trigger points, you can likely help your patients reduce or eliminate their headache pain and other associated symptoms. (Click here for a complete set of trigger point referral patterns.)
Valerie DeLaune is a licensed acupuncturist and certified neuromuscular therapist. DeLaune has authored eleven books on trigger point self-help techniques. Pain Relief with Trigger Point Self-Help, a book on CD ROM was released in 2004 and the print format was released in 2011. DeLaune teaches workshops in the U.S. and currently resides in Alaska. For more information, visit www.triggerpointrelief.com.
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