It's Time to Reward Yourself
An interesting study recently published in the Journal of the American Heart Association (JAHA) confirms what we all learned when we were children – and serves as food for thought as to how you can improve your practice and your personal life.
X-Ray: To Be or Not to Be - That Is the Question
For the past year, I have been asked by many practicing chiropractors, college presidents, faculty and others what my opinion is on the "Choosing Wisely" guidelines the American Chiropractic Association (ACA) recently adopted for its members.
Lead Patients to the Fountain (and Foundation) of Youth
We're all seeking the fountain of youth and marketers are capitalizing on it. (Global demand for anti-aging products, treatments and services was valued at 140.3 billion in 2015, according to Zion Market Research.)
Depression & The Secondary Vessels
As an acupuncturist I see many people suffering from depression. I often think depression is the major imbalance of our culture. I have a patient I've been working with for several years. Her major challenge is chronic stubborn depression.
Neck Pain: Activation Exercises
In observing patients and studying rehab, I have learned that tight muscles are weak muscles and that stretching is sometimes less effective than muscular activation. There is a delicate balance between joints that move too little and joints that are hypermobile.
The Science Behind the Efficacy of Cosmetic Acupuncture
The beauty industry continues to boom and grow constantly, from topical creams, lotions and potions all the way to cutting edge cosmetic surgeries.
More Access to Chiropractic Instead of Opioids: H.R. 5722
With the opioid epidemic both an ongoing public health crisis and a hot topic extending well beyond the health care industry, Congress continues stepping up to the plate.
Vaccine Injury? The Autism Debate (Part 2)
As suggested in my first article on this topic [August 2018],1 my impression is that the vaccine authoritarians and radicals have not helped to mold a proper social / political environment for addressing the issue of vaccine injury.
Working for Someone Else: Know the Rules of the Game
Many of us decide to become acupuncturists because we are healers at heart and want to focus on treating patients, not because we want to own and operate a business. So we work for someone else, which can have great advantages, especially as a new graduate.
An Update From the Acupuncture Now Foundation
Since launching the Acupuncture Now Foundation (ANF), our volunteer leadership has continued to work to achieve our vision of "Creating a World Where the Benefits of Acupuncture are Known and Available to All.
Bringing Acupuncture to Ohio
The jolt of seeing a woman conscious and talking during surgery left a lasting impression in 1971 when acupuncture was on the national news.
Multichannel Access: Software for a Better Customer Experience
It is no secret that today's consumer has high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular with acupuncture practitioners is they allows customers to book appointments and make payments online day or night.
The Importance of the Scapulohumeral Rhythm
The shoulder has the greatest range of motion of any joint in the body. What is often overlooked in shoulder mechanics is that motion in the shoulder is not purely at the glenohumeral joint.
"Don't Crack My Neck": What Do You Do Next?
It's Monday morning and your first new patient of the day, a 35-year-old female, presents with chronic headaches and neck pain. The patient was referred by her primary care provider for evaluation and management without the use of cervical manipulation.
A New NCCIH Director ... One That Backs Acupuncture
The third time is a charm—the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), announced it's newest director, Dr. Helene Langevin.
The Origin of Blood
The Roman doctor, Galen, (2nd century AD) did pivotal work to prove that blood, which he thought was produced by the liver, and the cardio vascular system existed. He conceived that the arteries and veins were two separate networks.
Possession: Blocks to Healing
Before we can approach treatment of a patient's primary elemental imbalance (AKA "Causative Factor" or "CF"), a number of specific energetic blocks must be considered and, if present, removed in order for treatment to be effective. I cannot emphasize this enough.
Your First Impression Always Deserves a Second Chance
Doctor, have you ever had a patient you just couldn't "warm up to"? You know, the kind of patient who "irks" you, who has a hidden agenda to get something you haven't anticipated, perhaps causing you to want to hide in a closet when they come in for treatment.
Support Patients With Multi-Channel Customer Service
It's no secret that today's consumers have high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular is that they allow patients to book appointments and make payments online day or night.
A Historic First for Chiropractic Assistants
The New Jersey State Board of Chiropractic Examiners will begin issuing licenses as early as Nov. 1, 2018 to chiropractic assistants who have undergone a 500-hour training course and passed a competency exam.
That's a Wrap: Compression Bands for Contemporary DCs
Over the past decade, compression bands have been increasingly utilized in trainer and manual therapy offices. I was first introduced to the compression band by Kelley Starrett, author of Becoming a Supple Leopard, and have since been using it as a teaching tool.
Time-Saving Tips for Your Practice & Life
Of all the finite resources we possess, perhaps the most valuable one is time. There never seems to be enough time to accomplish everything that must be done, and all too often we sacrifice things in our personal life to meet the demands of our practice.
Easy, Inexpensive Tools for a Successful Practice (I Promise)
Successful practitioners are the ones who know how to run a business, first and foremost. I became a licensed acupuncturist in 2006. After having worked in chiropractor's offices for nine years, I opened my own office in 2015: four treatment rooms, a back office and a waiting room.
Food for Thought: An Examination of Diet & Digestion
Even an acute poison can become an excellent drug if it is properly administered. On the other hand even a drug, if not properly administered, becomes an acute poison. — Charaka Samhita
The Benefits of Going Paperless
The benefits of going paperless in your practice are profound. If you haven't done it yet, here's why you should.
Chiropractic Management of Patellofemoral Arthralgia
Patient reports with pain in the front part of her right knee, especially during and after her weekly Zumba class. She states there has been no injury of which she is aware. No outward sign of injury is observed.
UHC Up to Its Old Tricks With Latest Headache Policy
A decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven and ineligible for reimbursement.
The international standardization conference was held this year in Shanghai, China (June) - this was the ninth plenary session. Meetings for technical committees, or working groups also took place at the conference.
November, 2008, Vol. 08, Issue 11
Subscapularis: Overlooked and Undertreated
By David Kent, LMT, NCTMB
The subscapularis is an often neglected and/or undertreated cause of posterior shoulder pain with restricted range of motion (ROM). According to Travell and Simons, "Differential diagnosis of subscapularis TrPs includes C7 radiculopathy, thoracic outlet syndrome, adhesive capsulitis and 'impingement syndrome.'" In this article, I will review how you can determine when the subscapularis muscle is responsible for causing shoulder pain and restricted ROM, as well as review its anatomy, function, trigger-point patterns and treatment options.
Intake and health history forms will help you identify some common factors that may contribute to the formation and perpetuation of trigger points, as well as the shortening of the subscapularis muscle. According to Travell and Simons, some of these factors include the following:
Taking a photo of your client in front of a postural-analysis grid chart is an effective method of evaluating, documenting, educating and ultimately showing a client their postural progress over a series of treatments. For example, a constant slumped, forward-head, adducted-scapulae posture will perpetuate trigger points and the shortening of muscles, such as the subscapularis, by continually keeping the humerus in a position of medial rotation.1 (Figure 1)
Trigger Points: When trigger points are present in the subscapularis muscle, they produce referred pain "in the posterior deltoid area ...down the posterior aspect of the arm, and then skip to a band around the wrist."1 (Figure 2) Remember that referred pain is a symptom; we want to address the cause. So intake forms, postural analysis evaluations, range-of-motion and orthopedic assessments, and being familiar with trigger-point patterns are all helpful to designing and implementing a customized therapy plan. But treating a trigger point is only part of the solution. We need to avoid a recurrence in the future. It is therefore necessary to demonstrate to your client which muscles need more lengthening and which ones need more strengthening so that all of the joints are properly aligned and moving through their full range of motion.
Anatomy: The subscapularis is one of four muscles that make up the rotator cuff, along with the supraspinatus, infraspinatous and the teres minor muscles. In my dissection seminars, I always highlight the subscapularis, which is the most anterior of the rotator cuff muscles. (Figure 2) It is a thick triangular muscle that attaches medially on the anterior or costal surface of the scapula on the subscapular fossa; it forms part of posterior wall of the axialla. Laterally, it attaches on the lesser tubercle of the humerus and the lower half of the shoulder joint capsule.
Actions: The subscapularis is primarily responsible for medially rotating and adducting the arm. It also helps to hold the humeral head in the glenoid cavity. To check for shortening in the subscapularis it is necessary to evaluate both abduction and external rotation.
Abduction: According to Travell and Simons, when evaluating a shoulder with restricted abduction, it is first necessary to determine if the restriction is being caused by the inability of the scapula to move on the rib cage, the humerus to properly articulate in the shoulder (glenohumeral) joint, or a combination of the two.1 The difference can be easily determined by placing your hands on the client's scapula to prevent its movement while asking the client to abduct their humerus. (Figure 3) When the subscapularis is involved, it restricts glenohumeral movements like abduction and lateral rotation, but it does not restrict scapular movements on the rib cage. If scapular movements are restricted, it is necessary to evaluate muscles that run from the torso to the scapulae, such as the pectoralis minor, serratus anterior, trapezius and the rhomboids.1
Lateral Rotation: When checking lateral rotation at the shoulder, adduct the arm by placing the elbow at the side. Then bend the elbow 90 degrees to show the amount of rotation at the shoulder joint. (Figure 4) The arm should be able to laterally rotate 90 degrees. In addition to the subscapularis, other synergistic muscles such as the teres major, latismus dossi and pectoralis major also adduct and medially rotate the arm. These muscles must also be evaluated and treated. Keep in mind that the antagonistic muscles are weak and over-lengthened, so they need strengthening. Muscle movement charts can aid in quickly identifying the muscles involved and show the normal range of motion for the muscles and joints being evaluated. (Figure 5)
Treating the Subscapularis: While there are many different approaches to treating the belly of the subscapularis muscle, I find one particularly effective. However, some clients may only be able to tolerate static pressure versus movements with this method, such as with-fiber or cross-fiber techniques.
Before the session ends, advise your client that they will receive the most benefit from your therapy session by actively engaging in self-care stretching techniques, such as the doorway stretch, which will further help improve muscle length, and create and maintain balance in the shoulder. (Figure 10)
You have now identified several factors associated with subscapularis pain and discomfort with the help of assessment aids and tools such as intake forms, charts and postural analysis photos. Continue to study and broaden your skills with hands-on seminars and DVD programs. You can share your tips and experiences in the treatment room by dropping me a line at .
Click here for previous articles by David Kent, LMT, NCTMB.
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