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Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Business Building: What's Your Strategy?
I know some in our profession love to debate about whether or not spinal curvatures change as a result of our chiropractic adjustment, but I have a question that hits a little more close to the belt than that: Are chiropractors capable of change?
Covering Chiropractic as a Profession, Not a Single Service
Recently Dynamic Chiropractic published a front-page article about various state essential health benefits and referred to Oregon and four other states not currently providing chiropractic as a covered benefit.
In a previous column, I discussed the history and definition of evidence-based practice (EBP), and expressed concerns with how the concept has been narrowly construed by some academics and payers.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
History Repeating Itself in Wisconsin?
Thirteen years ago, the Wisconsin Chiropractic Association (WCA) "agreed to settle Federal Trade Commission allegations that [the association] orchestrated a conspiracy among WCA members to increase prices for chiropractic services and to boycott third-party payers to obtain higher reimbursement rates."
Exercises for Back Pain: Low-Compression Training Program
This program is intended for two groups of people: 1) those who want to engage in resistance exercises for the major regions of their body without developing back pain in the process; and 2) those who already have back pain and want to do resistance exercises, but consistently re-irritate their back when trying to do so.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
Chiropractic Research: A Moral Issue
This year I've had the opportunity to go to three great chiropractic research conferences; the ACC-RAC, the Fédération Internationale de Chiropratique du Sport (FICS) Congress and the World Federation of Chiropractic Congress.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
The Pallof Press for Core Stability Evaluation
Many people become injured because of instability, weakness and poor neural-sequencing patterns in the core. Lack of bracing and support from the inner core cylinder during coronal and transverse movements makes the body vulnerable to compensation injuries.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Telecommuting and Technology: Ergonomic and Worker's Comp Considerations
As our world becomes more and more reliant on technology, equipment becomes more dependable and we become increasingly more comfortable with e-mail, the fax machine, the Internet and the smartphone, it is becoming easier and easier to work away from the office.
Spinal-Cord Injuries: Saying No to Steroids
With steroids, epidural and otherwise, in the news lately for their overuse when treating back pain (and their danger when tainted by fungal meningitis), it was high time for a policy change, and we've got one, from the Congress of Neurological Surgeons and the American Association of Neurological Surgeons.
Medical Payola (Part 2)
Not only has Medtronic made billions selling expensive screws and hardware for highly controversial spine fusions, but a Senate investigation also found Medtronic felt compelled to write and edit medical journal articles attributed to outside physicians that downplayed the risks of the company's best-selling bone graft, Infuse.
Wisconsin Exam in the Spotlight
You've passed your national boards with flying colors, including Part IV, the practical examination, at a combined cost of more than $3,000.
Repeating Bone-Density Tests
The U.S. Preventive Services Task Force recommends that women older than age 65 undergo bone-density testing. However, organizations in general have not stated when repeat bone-density testing should be done.
Calcium Supplements and Mortality
When the National Institutes of Health's AARP Diet and Health Study reported that men who took calcium supplements had a higher risk of dying from cardiovascular disease compared those who didn't, it was the third large cohort in six months with alarming findings regarding calcium supplements.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
News in Brief
Cancer Treatment Centers of America Continues Support of Chiropractic; ACBOH Announces 2013 Practical, Written Exam Dates; PCORI Approves Funding for Research on Spinal Stenosis; Macquarie University to Cease Offering Chiropractic Program.
July, 2011, Vol. 11, Issue 07
Frontal Headaches and Myofascial Trigger Points
By David Kent, LMT, NCTMB
A fundamental key to treating the muscular component of most pain, regardless of the modalities and techniques you specialize in, is to know which muscles to treat based on the location of the patient's pain.This article will review the five muscles that produce frontal headache pain based on the research of Drs. Travell and Simons', the common location of the trigger points in each of those muscles and their referral pain patterns. The muscles are: Sternocleidomastoid (clavicular head), Sternocleidomastoid (sternal head), Semispinalis capitis, Frontalis and Zygomaticus Major.
Most forms of bodywork treat trigger points. When you stimulate a trigger point during treatment, it can produce referred pain to other areas of the body. For example, trigger points in the Sternocleidomastoid muscle, located in the front of the neck, can refer pain into the forehead (Photo 2). It is important that each patient understands that you are not pressing on a nerve when treating a trigger point. Using visual aids like trigger point charts, provide multiple advantages. They educate your patients, provide you with a quick review of the trigger points and help you customize a logical treatment plan. This type of visual education also uniquely sets your practice apart from the competition. Trigger point charts are available in travel flip size or wall versions. Read Headaches: Trigger Points and Practice Building (MT, August 2010) and Practice Building: Getting Inside Your Patient's Head (MT, January 2011).
Let patients know how your charts work. For example, in photo 1 "X" indicates the common location of trigger points within a muscle. When a trigger point is activated during treatment, it will produce referred pain, which is shown in red. 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. (Photo 1)
Each division or muscle belly of the sternocleidomastoid muscle has its own unique trigger point patterns. Typically, neither division refers pain into the neck, however each refers pain to the face and cranium. (Photo 1 & 2) This muscle is shortened bilaterally with a forward head posture. The claviclar division will be shortened on the high shoulder side.
Trigger points at the midlevel of the sternal division of sternocliedmastoid refer pain in an arch over the eye into the forehead, deep behind the eye and into the cheek. (Photo 1)
Trigger points at the upper end of the sternal division commonly refer pain to the occipital ridge and to the top of the head (vertex). Attachment trigger points at the lower end of the sternal division can refer into the upper chest.
Trigger points in the mid level of the clavicular division of sternocliedmastoid refer pain to the forehead. On rare occasion, the pain extends across the forehead. (Photo 2) Trigger points in the upper portion of the muscle refer into the ear and posterior to the ear.
The semispinalis capitis and other posterior neck muscles sustain enormous tension as patients maintain a forward head posture throughout their day while writing, reading, working at a computer, driving and maintaining poor posture.
There are two trigger points in the semispinalis capitis muscle that produce the same referral pattern. These trigger points project a band of pain forward that encircles one side of the head, with the intensity focusing in the temple region, then continuing to wrap around to the forehead. (Photo 3) Trigger points labeled Location 1 are found where the muscle attaches to the skull. Location 2 trigger points are located in the upper third of the muscle. Trigger points in the middle and lower portions of the muscle are shown as Location 3 and refer into the back of the head on the same side.
Trigger points form in the frontalis from direct trauma, over stress from prolonged intense frowning or wrinkling of the forehead. The referral pattern for the frontalis is local and spreads upward over the forehead. (Photo 4)
Next we will review key and satellite trigger points. A Key Myofascial Trigger Point is responsible for activating one or more satellite trigger points. It is clinically defined when an inactivated key trigger point results in the inactivation of the satellite trigger points. Satellite Myofascial Trigger Points can form for many reasons, one being in the pain referral zone of a Key Myofascial Trigger Point. Since satellite trigger points can form in the frontalis as a result of key trigger points, be sure to examine and inactivate key trigger points in the clavicular division of sternocliedmastoid (Photo 2) or the Zygomaticus major. (Photo 5)
When the zygomaticus major contracts, it makes us smile by pulling the corner of our mouth upward and laterally. Referred pain from zygomaticus major trigger points project along the side of the nose into the forehead. (Photo 5) Be sure to examine and inactivate key trigger points in muscles like the clavicular division of sternocliedmastoid that refer into the zygomaticus major region. (Photo 2)
Patients appreciate when you take a few minutes prior to the therapy session to educate them of the strategies you implement to identify and address the muscular components of their pain. Photos are powerful visual aids that leave a lasting impression in the patient's mind and help you to quickly deliver a clear message. The saying "a picture is worth a thousand words" speaks volumes when conveying postural analysis findings. Trigger points are often within the myofascial tissues involved in the postural distortions.
Keep the postural analysis process fast and simple. Using the camera of a cell phone, you can take postural photos and instantly give a report of findings to your patients. An anterior view photo will easily pinpoint a high shoulder, while lateral view photos make it easy to show a forward head posture. (Photo 6) Photos allow patients to finally see and understand why they hurt and how you can help. Postural analysis photos are extremely effective even when patients are wearing shoes and/or loose fitting clothes. Read Getting Comfortable With Postural Analysis (MT, July 2008).
Using a postural analysis grid chart with a plumb line makes it easy for anyone looking at the photos to spot postural asymmetries. Pictures also are an excellent way to document change over time. After patients understand the postural stresses their muscles are enduring, they understand why you took the time to educate them.
Treating the muscular components of Frontal headaches is easy when you know which muscles to treat based on the research. The five muscles in this article should be checked, unless contraindicated, for frontal headaches. As always, based on the patients subjective complaints, your objective finding and other factors, you will design customized treatment plans that produce positive clinical outcomes. Stay in touch and I wish you great success in your treatment sessions.
Click here for more information about David Kent, LMT, NCTMB.
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