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.
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.
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.
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.
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.
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.
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.
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.
"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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.)
Travel-to-Treat Coverage Finally Becoming a Reality?
Long-awaited legislation poised to hit the president's desk extends liability insurance coverage from one state to another for DCs and other state-licensed health care professionals who care for athletes / athletic teams that cross state lines.
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.
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.
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.
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.
October, 2009, Vol. 9, Issue 10
Thumb Pain and the Brachialis Muscle
By David Kent, LMT, NCTMB
While I was lecturing at the Florida State Massage Therapy Association convention, some therapists asked about the causes of pain on the dorsal side of the base of the thumb (carpometacarpal joint) and the adjacent web space between the thumb and finger.While there are many reasons for pain in this region, this article will discuss the role of referred pain from trigger points in the brachialis muscle and methods for treating it with massage.
Anatomy: The brachialis muscle lies deep to the biceps brachii muscle. It attaches above the elbow, proximally, on the lower half of the anterior surface of the humerus. Just below the elbow, distally, it attaches on the coronoid process of the ulna. (Photo 1)
Function: The brachialis flexes the elbow and works synergistically with the biceps brachii and the brachioradialis muscles. The antagonist to brachialis is the triceps brachii. The movement created by the contraction of the brachialis muscle is determined by which attachment is fixed and which attachment moves. When the humerus is in a fixed position and the brachialis muscle contracts, such as during a bicep curl, the forearm moves toward the humerus. When the forearm or distal attachment of the brachialis muscle is fixed, such as during a pull-up exercise, the brachialis moves the humerus toward the forearm.
Referred Pain: Trigger points in the distal region of the brachialis produce "referred pain [that] is felt in the base of the thumb at rest and often with the use of the thumb. Diffuse soreness of the thumb is characteristic of its referred tenderness."1 (Photo 1)
Nerve Entrapment: The brachialis muscle can entrap the superficial sensory branch of the radial nerve, which is a cutaneous-monitoring nerve. When entrapment occurs, it can produce dysesthesia on the dorsum of the thumb. Dysesthesia is an impairment that produces sensitivity to touch, tingling and numbness. Additionally, the coracobrachialis muscle can entrap the musculocutaneous nerve that innervates the brachialis.
Perpetuating Factors: Trigger points can form and remain in the brachialis due to elbow flexion movements that overstress the muscle and/or require the muscle to remain in a flexed position for an extended period of time. Some examples include holding a child, lifting heavy tools, carrying groceries or boxes, and playing an instrument such as a violin or guitar. "Related trigger points are frequently found in the brachioradialis, supinator or the adductor pollisis."1
Precautions: Integrate muscle testing to identify each muscle, as well as to avoid treating neurovascular structures located on the medial side of the arm. Be cautious of the brachial artery and the median, musculocutaneous and ulnar nerves. These are positioned, on the medial side of the arm, between the anterior compartment containing the biceps, brachialis and coracobrachialis and the posterior compartment containing the triceps.
Pressure: Check in with the client frequently to determine if treatment pressure is appropriate and look for warning signs of too much pressure, such as muscle tightening, teeth clenching or pulling away. Additionally, if the tenderness in the area of treatment and/or the intensity of the referred pain does not ease up within eight to 12 seconds of holding static pressure on the trigger point, leave the area and return later, using less pressure.
Step 1 - Positioning: Place the client in the supine position with the elbow passively flexed between 30 and 45 degrees and the forearm appropriately supported. Stand at the level of the client's abdomen, facing their head. This position shortens the brachialis and biceps, and will allow you to displace the superficial biceps medially and laterally so the deep brachialis can be thoroughly treated.
Step 2 - Ulna Attachment: The attachment of the brachialis on the coronoid process of the ulna is approximately one inch distal to the crease of the elbow (Photo 1) on the pinkie side of the forearm. To treat this attachment, supinate the client's hand, with the palm facing upward. Apply friction integrating with fiber and then cross-fiber movements on the attachment (Photo 2).
Step 3 - Humeral Attachment (Lateral Side): Apply lubrication to treat the large attachment of the brachialis on the humerus from the lateral and medial side; muscle-test the biceps to determine its location. Treat the lateral aspect by using your non-treating hand to move the biceps medially, while the other hand treats the lateral aspect of brachialis on the humerus. Apply treatment at a 45-degree angle against the humerus while gliding distal to proximal, stopping just above the level of the deltoid tuberosity (Photo 3).
Step 4 - Humeral Attachment (Medial Side): Next, treat the medial attachment on the humerus. Use the non-treating hand to move the biceps laterally, while the other hand treats the medial aspect of brachialis on the humerus. Apply treatment at a 45-degree angle against the humerus while gliding distal to proximal, stopping just above the level of the deltoid tuberosity (Photo 4).
Step 5 - Muscle Belly: Face the pads of your thumbs toward each other with one thumb on the medial side and the other on the lateral side of the brachialis muscle, deep to the biceps, at the level of the elbow. Use your fingers to cup the arm while they make contact with the triceps muscle (Photo 5). Glide distal to proximal.
Clients will typically seek your services when pain begins affecting their activities of daily living. Educate every client on the causes of their muscular pain, treatment options you provide and proactive self-care steps that they can use outside of the treatment room. Advise them that pain is a symptom and that it is important to address the cause. Below are some suggested methods of assessment and client education.
We all know the saying, "a picture is worth a thousand words." Postural-analysis photos provide visual documentation of a client's posture, showing which muscles are shortened and which are overlengthened. The better a client understands the relationship of their poor posture, trigger points and pain, the more likely they will be to follow through with a recommended treatment plan. Clients benefit by knowing that one reason trigger points form is due to the stress caused by poor posture.
Trigger-point charts and other types of charts help educate clients about referred pain patterns. Some trigger-point charts show which muscles refer pain to specific regions of the body, like the base of the thumb in this case. This information is also helpful to developing and implementing an effective treatment plan.
Review the advantages of proper ergonomics and instruct your client on the ways they can incorporate ergonomics into daily activities. Teach clients stretching exercises that will help prevent their symptoms from returning.
If you use topical analgesics in your sessions, educate your clients on how to use them to control their discomfort between treatments. Selling topical analgesics will provide you with additional income, as well.
Remember that a client's pain is typically a symptom and its origin is often in an area other than the region of the pain. Your clients appreciate every bit of knowledge you share. Give them the knowledge to make informed decisions about their care.
I wish you the greatest of successes in the treatment room.
Click here for previous articles by David Kent, LMT, NCTMB.
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