resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Head and Shoulder Pain from the Splenius Cervicis
When clients report symptoms of pain in the head or eye, it is always of serious concern and they should seek medical care to determine the cause(s) and treatment options. Physicians and other healthcare providers are excellent referral sources to your practice, since a percentage of their patients are suffering with many issues that may include myofascial pain. Let's examine the splenius cervicis muscle, its anatomy, the location of myofascial trigger Points (TrPs), the associated pain referral patterns of each TrP, some treatment and self-care tips.
The splenius cervicis along with the splenius capitis muscle are the most superficial of all the extensors in the cervical region. The deepest of the extensor muscles are very short in length and attach to the next vertebra. In contrast, the splenius cervicis is long and crosses many vertebrae. Below the splenius cervicis attaches to the spinous process of the third through sixth thoracic vertebrae and the fascia over them. Above it attaches to the posterior tubercle of the transverse process of the upper two to four vertebrae. (See photo 1A)
Unilateral contraction of the splenius cervicis muscle produces extension, lateral flexion and rotation of the neck, turning the face toward the same side. Bilateral contraction produces extension of the neck.
Clients typically report a "stiff neck," limited cervical range of motion and/or pain in the shoulder, neck, head and or eye. Drs. Simons and Travell et, al, identified two (upper and lower) myofascial trigger points in the splenius cervicis muscle. In photo 1, "X" indicates the common location of trigger points. Solid red areas identify essential pain zones, the regions of referred pain that is present in nearly every person with active trigger points. The dotted red regions indicate spillover pain zones or the regions of referred pain on some, but not all, patients with active trigger points.
The splenius cervicis Upper TrP is located, as the name implies, in the superior portion of the muscle in the musculotendinous junctions. It can "refer a diffuse pain through the inside of the head that focuses strongly behind the eye on the same side, and sometimes refers into the ipsilateral occiput."1 (See photo 1A, B) The splenius cervicis Lower TrP is classified as a central TrP and located in middle of the muscle belly. It "refers pain upward and to the base of the neck."1 (See photo 1A, C)
During this technique, many posterior neck muscles are treated. Palpation of boney landmarks will help you determine your location. A combination of subjective complaints, objective findings, precise palpation and knowledge of TrP pain patterns will help you determine if the splenius cervicis muscle is involved. A few other muscles in the region that should also be assessed include: trapezius, levator scapulae, sub occipitals and scalenes.
The client is supine on a table. The therapist is seated at the end of table with the shoulder of the treating hand aligned with client's head, neck and body. The thumb of the treating hand is positioned at the base of the occiput, with the pad of the thumb palpating the posterior aspect of the transverse process. Avoid intruding on the nerve root by never treating the lateral aspect of the transverse processes. The therapist's non-treating hand will support the client's head while creating extension of the cervical spine. (See photo 2A)
While lowering the head toward the table, glide the thumb inferiorly, applying pressure anteromedially, to treat the posterior aspect of the transverse process, repeat three or four times. Turn the head 45 degrees away from the treating side and repeat the above step three or four times. Examine the same region using cross fiber movement will help to thoroughly check for TrPs. (See photo 2B)
In photo 3, the non-treating hand continues to support and control movement of the head and neck. The fingers of the treating hand cup the cervical spine as the thumb is positioned anterior to the upper trapezius. The thumb is pointing toward the client's feet with the pad of the thumb facing medially. It is important for the thumb to always remain posterior to the transverse processes to avoid pressing on the brachial nerves. Rotate the client's head toward the treating side with the side of the patient's head now resting on the therapist's forearm. Apply pressure with pad of thumb pointing 45-degrees anteromedially.
When you palpate an active TrP in a client, they recognize the referred phenomena. If the referred pain does not release after applying sustained pressure for a maximum of eight seconds, then release and check the spot later with less pressure.
Keep in mind that trigger points can form for a number of reasons. Examples include direct trauma during a motor vehicle accident, to sustained stress from poor posture, to improper biomechanics, to poor ergonomics at work and throughout the day. Discuss their activities of daily living. Do they drive for hours everyday? If so, the seat, stirring wheel and mirrors likely need to be properly positioned. Do they work on computer all day? If so, does the monitor, keyboard or chair need adjustments? At home, do they rest on the couch with their neck in extreme flexion?
Empower your clients with self-care tips they can utilize between treatments. Show them how to stretch. Give them the locations, times and tips to perform simple stretches throughout their day in the kitchen, bathroom, while walking the dog, at the beginning and end of everyday. They will feel better and appreciate your efforts.
Pain in the head or neck can create a great deal of anxiety for anyone. Sometimes a little therapy and a few lifestyle changes can make all the difference. Clients want to know what caused the pain and if there is anything they can do to prevent it in the future. If you provide effective solutions, people will refer their family, friends and co-workers. While many muscles could be involved, remember the splenius cervicis can cause pain from head to shoulder.