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A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
From the Other Side of the Table
People come to us to gain freedom from pain, to feel better, to live better. As D.D. Palmer stated, "We Chiropractors work with the subtle substance of the soul." Therein also lies the rub.
Don't Forget About the Performers
Donald Petersen Jr.'s recent article, "Your Chance to Go Back to High School" [May 1, 2014 DC], focused on the injuries incurred by high-school athletes and the subsequent opportunities for the chiropractic profession.
Decompression-Traction: A Core Treatment Method in Chiropractic's Future
We're all competing for new patients. We're competing for new patients with physical therapists, massage therapists, medical specialists and hospital fitness centers. We're even competing with side-effect-ridden medications that quit working every four hours.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Detoxification for Athletes: The Key to Winning Performance
One of the most dangerous culprits that affects an athlete's ability to perform at an optimum level also happens to be one of the most elusive.
Take Care of Your Skin: Tips to Pass on to Your Patients
Many of our patients are not aware that the largest organ in the human body is actually the skin. Accounting for 16 percent of total body weight and covering up to 22 square feet of surface area, the skin is more than just a "covering," as originally thought.
Your Patients' Best Health Resource
There is nothing as powerful as information. The right information has won wars, saved lives and changed hearts; lack of information has led to hesitation, poor decisions and unintended consequences.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Building the DC-MD Bridge
From MDs practicing integrative holistic medicine to the family internist, many DCs are enjoying unprecedented attention from their allopathic colleagues.
Ringing in a Fiscal New Year With a Recommitment to Cost-Effectiveness
Back when the Foundation for Chiropractic Education and Research was in its heyday, I used to send out New Year's greetings and virtual noisemakers to some close friends on July 1 – the beginning of our new fiscal year – wishing for prosperity in the year ahead.
News in Brief
Oregon Gov. John Kitzhaber (a medical doctor, no less) proclaimed October 2014 "Oregon Chiropractic Health and Wellness Month" in an official proclamation signed Aug. 25, 2014.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Watch Out for Red Herrings
In clinical practice, when one condition mimics another, it makes it difficult to obtain an accurate and timely diagnosis.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
The Life & Legacy of James Sigafoose, DC (1933-2014)
Surrounded by his family and closest friends, Dr. James M. Sigafoose passed away quietly on Thursday, July 3, 2014. With his wife of 60 years, Patsy, along with his children, Tina, Daun, Kieth, Selina and Carey – all chiropractors – at his side.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
How to Find Your Ideal Patient – and Help Your Ideal Patient Find You
Just imagine: You're at the front desk looking at the scheduler and a smile creeps across your face. Row after row, name after name, hour after hour; you're blessed with an entire day of ideal patients. Every day should be like this, you whisper. Exactly!
August, 2014, Vol. 14, Issue 08
Searching for Trigger Points: Tips to Consistently Relieve Pain
By Valerie DeLaune, LAc
How much do you really know about trigger point therapy? Most likely you received 15 to 30 hours of training in trigger points in your massage school, or at least have purchased charts with referral patterns and books on trigger points.But did you learn a systematic approach to identifying likely culprits and resolving perpetuating factors – the things that cause and keep trigger points activated? Would you like to dramatically increase your success rate with resolving your client's pain? Since about 75% of pain is caused by trigger points, learning how to treat them is essential to a successful medical-massage practice.
Your Brain on Trigger Points
What you do with your brain is far more important than what you do with your hands. Massage therapists can successfully treat trigger points by applying pressure for eight to sixty seconds, by repeated stroking or with a combination of or variations on those techniques. But for any technique to work (whether manual therapy or needling), it must be applied in the correct place.
Trigger point therapy is like doing "detective work," you need to know how to use the "pain guides" to determine which muscles to search for trigger points. You also need to know how to assess your clients for perpetuating factors, the conditions that cause and keep trigger points activated. Teaching self-help techniques helps your clients participate in their healing process and provides them with tools they can use in the future.
Medical histories and pain mapping: get a comprehensive medical history from your client which at a minimum identifies all of the potential perpetuating factors that may be causing their trigger points. Go through the medical history at the beginning of the first treatment and ask questions to clarify the information they have given you; this should take about 1.5 hours for the first session. Continue to ask them questions as your treat them and spend a few minutes checking in with them and taking notes at the beginning of each subsequent treatment.
Have them mark their pain patterns on some kind of outline of the body before each treatment (known as "pain mapping") and ask them to rate the intensity and frequency of their symptoms so that you can track progress, or lack thereof. Try and get them to be as specific as possible so that you can match their referral patterns with common patterns on charts. Don't let them mark "x"'s or big circles, or color in large areas a solid color. Show them your trigger point referral pattern charts and explain to them that you are trying to match their pain patterns with some common patterns so that you will know where to start looking for the source of their pain.
Even if they are not improving, you can use that information to modify your treatment. Chances are you haven't located all of the trigger points that need treatment, there are perpetuating factors that still need to be addressed, or you need to refer them out for further evaluation since about 25% of pain is caused by conditions other than trigger points.
Use pain guides: about 74% of commonly found trigger points are not located within their area of referred pain. Unless you know where to search for trigger points, and you only work on the area where your client feels pain, they probably won't get relief. Familiarity with referral patterns gives us a starting point of where to look for the trigger points that are actually causing pain, but you must understand how to use the pain guides so that you will know which muscles to check.
For example, if your client has pain in their temple area, you need to know to check the temporalis, upper trapezius, sternocleidomastoid and some of the muscles in the posterior neck. Of these muscles, only the temporalis may contain trigger points which are located within the area of pain referral, so most of the time, unless you know which muscles to check, you won't come across the trigger point by accident.
It's not sufficient just to have a set of charts on your wall to look at and try to find referral patterns, since none of them have all of the potential referral patterns diagrammed. You also need to keep in mind that the books and chart sets only diagram the most common referral patterns and trigger point locations. Your client may have an uncommon referral pattern and trigger point locations. Pain guides and referral pattern diagrams are only a starting point.
Also, keep in mind that trigger point referral patterns from multiple trigger points can overlap, causing a composite referral pattern, as is often the case with migraines and other headaches. Buy at least one comprehensive trigger point book that includes pain guides so that you can see a list of muscles to check for any given part of the body, and buy a set of referral pattern charts to keep on your treatment room walls.
Often trigger points in different muscles can cause very similar referral patterns. For example, common referral patterns caused by trigger points in the supraspinatus, infraspinatus and scalenes are almost identical. One way to narrow down the culprit(s) is to know the symptoms and perpetuating factors for each muscle.
Spend some time reviewing your clients medical history form, pain mapping diagrams, and your chart notes and compare them with information for each muscle found in a comprehensive trigger point book. Trigger points can cause many non-pain symptoms which can help you narrow it down. For example, if your client comes to you with symptoms such as headaches in the frontal area and/or base of the skull, but also reports eye or ear symptoms such as tinnitus or eyelid twitching, that would be a clue to check the sternocleidomastoid muscle for trigger points. Trigger points can cause symptoms such as diarrhea, urinary frequency, menstrual cramps, dizziness and buckling or locking knees – symptoms most clients or health care providers wouldn't think to associate with trigger points.
You should decide which trigger points to treat first. Doctors Travell and Simons, who wrote the two-volume set of medical texts on trigger point treatments, listed muscles in their book's pain guides in the order they found were most likely to be causing the pain referral. In the previous example, they list the trapezius first and the posterior neck muscles last. But keep in mind, that depending on your geographic locale and practice specialty, you may find the order might be different for your practice; your clients will have different patterns depending on their work and hobbies and underlying medical conditions.
You also need to be familiar with primary trigger points and satellite trigger points. Once a trigger point has referred symptoms to any given area for any length of time, trigger points will form within the zone of referral, known as satellite trigger points. Then the satellite trigger points will cause their own symptom referral pattern, causing what I call a "trigger point chain-reaction." For example, there are at least eleven muscles that may contain trigger points which refer pain to the posterior portion of the deltoid muscle (the levator scapula, scalenes, supraspinatus, teres major, teres minor, subscapularis, serratus posterior, latissimus dorsi, triceps and iliocostalis thoracis). If you only treat the satellite trigger points in the deltoid, the deltoid pain will keep returning because you didn't treat the primary trigger points.
If your client has multiple symptomatic areas, don't try to treat everything in one session. Have your client prioritize their two areas of most concern, and focus on those. If you try to do too much, you likely won't treat any one area well. If your client has widespread pain, chances are they have some kind of systemic perpetuating factor that needs to be addressed and you will need to refer out to a practitioner who can order laboratory or other tests. During subsequent treatments, you may decide to continue working on the same area before moving onto another symptomatic area, or you may decide that other areas of pain are related and need to be addressed before the primary area of pain can be completely resolved.
Any decrease in intensity and/or frequency of symptoms, or decrease in size of the symptomatic area is an improvement that indicates that you treated at least some of the pertinent trigger points. Be sure to ask how they felt immediately after the last treatment. If they felt better even for awhile, ask what they were doing when their symptoms returned. Often that is a clue to at least one of their aggravating perpetuating factors and an indication that it needs to be addressed for lasting relief.
Next, identify and eliminate perpetuating factors. Trigger points may form after a sudden trauma or injury or they may develop gradually. Common initiating and perpetuating factors are mechanical stresses, injuries, nutritional problems, emotional factors, sleep problems, acute or chronic infections, and organ dysfunction and disease, though there are many more. If perpetuating factors aren't identified and treated, your client may improve temporarily, but their symptoms will keep returning. Most clients will have multiple perpetuating factors. When you buy a trigger point book, make sure it contains extensive sections on perpetuating factors and become very familiar with each factor and its symptoms.
Because resolving these factors are crucial for long-term relief, you need to be familiar with all of the potential perpetuating factors and the symptoms of each. For example, if your client is suffering from fatigue, depression and insomnia, you might suspect anemia or hypothyroidism, and you may need to refer your client to a health care provider who can order laboratory tests.
Even if it is not within your scope of practice to diagnose and treat many of these perpetuating factors, as a massage therapist, it is important that you have some ideas of whom you can refer your client to, who can diagnose and treat particular perpetuating factors that you suspect.
Learn self-help techniques so you can teach them to your clients, if it is within the scope of your practice. Refer them to books that reinforce self-help techniques for perpetuating factors, pressure techniques and stretches, especially if it is not within the scope of your practice. Clients who use self-help techniques and eliminate their perpetuating factors get better at least five times faster than those who just have you work on them.
Be careful not to overwhelm your client with too many suggestions; if you give them too many, they likely won't do anything. My recommendation is to recommend to clients no more than two self-help techniques per session, typically one pressure and stretch combination and one perpetuating factor to resolve. Help them find a way they can be successful so they will want to do more. For example, if you think walking would be beneficial for your client, suggesting an hour per day five days per week might be unrealistic for that client. Ask them if they could manage 20 minutes per day for three days per week. At their next visit, ask them how it went. If they weren't able to do it, find out why and problem-solve with them to see if you can find something they can/will do. Once they feel the benefits, they will likely want to do more. Above all, don't criticize them for failing to follow your suggestions. Keep a problem-solving dialogue going with them to try to find something they can achieve and feel successful.
A Protocol, Not a Technique
The trigger point protocol developed by Dr. Janet Travel and Dr. David G. Simons includes additional diagnostic techniques such as range-of-motion evaluation and gait analysis, but the treatment tips given here are the most easily integrated into your existing medical massage practice and most likely within the scope of your practice.
While there is a lot of information to learn about trigger points and how they develop in each muscle and manifest symptoms, fortunately there are now several good sets of charts and reference books to choose from. Trigger point continuing education classes are offered around the country, including several 100+ hour programs that teach the full protocol. Learning about trigger points will improve both your assessment skills and your success rate.
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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