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Trigger Point Chart | Active vs Latent Trigger Points

What is a trigger point chart?

A trigger point is a hypersensitive spot in any muscle that has the ability to cause pain or other clinical manifestations. Trigger points can either be active or latent and can result in muscle shortness, weakness, and reduced range of motion. Let’s take a look at the difference between active and latent trigger points and how a trigger point chart can help diagnose it.

What is an Active Trigger Point?

An active trigger point means that it causes pain. Not only does it cause pain, it causes the muscles to exhibit tautness or shortening, spasm, and weakness relative to its normal state. Once the trigger points are completely eliminated the muscle will once again return to its normal strength. The longer a trigger point remains active, the more weakness occurs and the more dysfunctional the muscle becomes.

Where can I find a trigger point chart?

What is a Latent Trigger Point?

A latent trigger point won’t cause any discomfort unless it is sufficiently compressed. A latent trigger point is basically an active trigger point in waiting. It won’t cause discomfort unless it is activated. Latent trigger points may persist for months, even years, before they become active trigger points. While it might not be noticeable, the latent trigger point will still cause dysfunction, or prevent full motion and normal muscle strength.

Where Can I Find a Trigger Point Chart?

A great way to determine, and help diagnose a trigger point, is with a trigger point chart. If you are looking for trigger point charts, contact us today at Kent Health Systems.

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Postural Analysis | TMJ Dysfunction and Forward Head Posture

What is a postural analysis?

If you suffer from TMJ syndrome you already know some of the more common symptoms. Did you know though, that problems with your TMJ can be directly related to your posture? Believe it or not, the way you sit or stand can have a direct effect on your TMJ. Let’s take a look at the correlation between TMJ dysfunction and forward head posture and how a postural analysis can help remedy it.

How are TMJ syndrome and Bad Posture Connected?

One of the causes of TMJ dysfunction is poor posture. It’s particularly important because many times it’s the last thing we think of. However, the stress put on your body from forward head posture can put pressure on all different parts of your body, including your mouth and jaw. Luckily, out of all the possible causes, this one is the least expensive and easiest to treat.

Who offers postural analysis?

What Causes Forward Head Posture?

A forward-leaning head is caused by constantly being hunched over. In fact, poor posture while sitting, working and walking can lead to a complete change in the curvature of the neck. This can lead to TMJ pain issues like migraines, stress headaches, plus pain in the back and shoulders.

Can a Postural Analysis Help with Forward Head Posture?

There are two main ways to fix forward head posture. You can either go through rehabilitation, or you can use things like a postural analysis to correct the issue. At Kent Health Systems we offer everything you need to give your patients a proper postural analysis. Contact us today to learn more.

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Postural Analysis: A Professional Tool for Building Your Practice

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By: David Kent, LMT, NCTMB

When patients go to the dentist with a toothache, they expect the dentist to take x-rays, perform an exam, and explain the findings: the patient needs a filling, root canal, crown, or an extraction. Likewise, when patients go to the doctor or chiropractor complaining of headaches or back pain, they usually expect the doctor to run assessment tests and/or take x-rays or an MRI, both of which produce images that pinpoint the nature of the injury and the origin of pain. Doctors often use these images to educate their patients in an effort to instill confidence that the problem can be properly treated. This article will discuss how massage therapists can use postural analysis and photos to educate their clients, as well as deliver their objective findings in a professional manner, while subsequently building their practice.

Permission

First, your health history and intake forms should include wording that gives you permission to take postural analysis photos. Always treat these photos as confidential medical records and inform the client of this as well.

 

Efficiency

The x-ray tech at the dentist’s office can develop and deliver results in just a few minutes. In the same amount of time, you too should be able to conduct a postural analysis that includes photos, report your findings, and describe how your treatments can help. This process must be quick, easy and non-threatening to your client.

Attire

Clients must feel safe, comfortable and respected. For the initial set of postural analysis photos, ask your clients to remove their shoes and jacket, but let them leave on whatever other clothing they came in wearing. The photos will still show key distortions, such as a high shoulder or forward-head posture, and provide enough information to help them commit to a series of therapy treatments.

 

Charts

The human body is designed with a great deal of symmetry, or balance. The body has the same bones and muscles on each side. Muscles in the front and the back of the body balance each other, and muscles also determine where the bones are moved or held in space. Muscular and skeletal charts are useful for showing the symmetry that exists in the body.

Postural analysis grid charts make it easy for anyone to see asymmetries in the body. Charts are available in different sizes and hang easily. Large charts can be hung on a wall; however, when wall space is limited, a space saver version of the chart fits on the back of a door.

A postural analysis chart is most effective when used in conjunction with a plumb line, which is a straight line that suspends a weight or “Bob” on its end. This system has been used since the time of the Egyptians to ensure that structures were being built perfectly upright. When the weight is made of lead (plumbum in Latin), it is referred to as a lead weight or Plumb Bob. A plumb line is used for many reasons during a postural analysis, as it will:

  • ensure the posture chart is hanging straight;
  • guarantee the client is viewed from a 90-degree angle;
  • determine placement of the client’s feet prior to taking postural analysis photos; and
  • supply a visual reference of the midsagittal and coronal planes in the posture photos. This shows clients where their body is being held in space by the muscles, why the muscles hurt, and how you can help.

Hang the plumb line from the ceiling, approximately 3 feet in front of your posture analysis chart. This distance will allow clients of all sizes to stand between the posture chart and the plumb line without touching either one. The Plumb Bob should be suspended from the ceiling and hang approximately ¼-inch from the floor. To get the plumb line out of the way and conserve space when the posture chart is not in use, simply hook it over one of the pins holding the chart on the wall. If you are using the door version of the chart, hook the plumb line behind the hinges.

The use of a construction-grade plumb line to suspend the Plumb Bob will prevent a lot of problems—just make sure the line is securely attached to the ceiling. A professional Plumb Bob kit comes with ceiling anchors and a construction-grade line attached to a professional Plumb Bob.

Positioning

Have the client stand between the postural analysis chart and the plumb line. Be sure his/her body is not touching the plumb line or the posture chart. It is important for the client’s feet to be placed in the identical position from one photo to another to guarantee consistency. Use tape, a template or a piece of Plexiglas on the floor to mark the client’s position.

Anterior and Posterior Views

There are a few things to remember when taking anterior and posterior posture analysis photos. First, place the medial (inside) aspects of the client’s heels shoulder width apart and equally spaced from the plumb line (Photo 2). This position allows the plumb line to indicate the midsagittal plane of the body in your photos. Then you can also use postural analysis photos to show the client that his/her body is to the right or left of the midsagittal plane (Photo 1). Second, position the back or posterior aspect of the client’s heels the same distance away from the posture chart to avoid creating the illusion of a twist, torque or rotation in the body.

By positioning the feet using the medial and posterior aspects of the heels, the client is free to laterally rotate the lower extremities, thereby revealing more postural distortions.

 

Lateral Views

For lateral views, position the client so that the plumb line is immediately anterior to the lateral malleolus. (Photo 5) This position allows the plumb line to represent the coronal plane of the body. Ask the client to place his/her hair behind the ears to expose the external auditory meatus: an anatomical landmark used as a reference point to determine the position of the head on the coronal plane.

 

Camera and Photos

The camera you use does not have to be elaborate. Most massage therapists can simply use a cell phone camera. If using a cell phone camera, however, make sure to implement the necessary safeguards to protect your client’s privacy, such as setting security codes or downloading the photos to a secure computer for storage and retrieval.

Once you have taken the photos, keep it simple. The easiest way to review your findings with the client is on the screen of the camera. If you wish, you can download and print the photos later for the client’s file.

Anterior and posterior view photos can reveal a number of issues, including a high shoulder (Photo 3) or high hip, the space between the torso and the upper limb, the positions of the hands, an externally rotated lower limb, a fallen arch, or if the head and/or torso are held to the right or left of centerline, to name just a few. (Photo 1)

Lateral view photos make it easy to point out a forward head (Photo 6), rounded shoulders, and a slumped abdominal posture, as well as the angle of the innominate bones and the position of the knees; they are also helpful in identifying a twist or rotational pattern. (Photo 4)

Value

Just like chiropractors advertise free “spinal exams” to attract new patients, you could provide free “postural analysis” to attract new clients. Include the postural analysis as an added value during the initial visit; then include a second complimentary postural analysis once the client completes a series of treatments. This is not only a great way to sell packages, but it also demonstrates the client’s postural progress and shows the effectiveness of your treatments.

Additional Benefits

Everyone likes to be remembered. In addition to helping you ascertain the client’s structural issues, postural analysis photos can help you remember what your clients look like, so that you can greet them by first name. Clients often return months or years after receiving therapy; your photos can help you notice a new hairstyle or the weight the client lost, which makes them feel important and special.

Professional Image

You know what they say: A picture is worth a thousand words. Integrating postural analysis into your practice helps you stand out from other therapists in your area. The public will perceive your unique practice as a cut about the rest. Postural analysis raises your level of professionalism and credibility in the mind of your clients, while providing client education and building your practice at the same time. Postural analysis photos only take a moment to snap, but they are an invaluable resource to you and your clients.

 

SIDEBARS

 

Ten Advantages of Taking Postural Analysis Photos

1.     Educates clients about postural distortions

2.     Shows which muscles are stressed and over-lengthened

3.     Explains visually and logically the muscular causes of pain

4.     Helps clients decide to purchase a series treatments

5.     Documents posture before, during and after a series of treatments

6.     Shows clients, physicians and insurance companies treatment progress

7.     Presents clients with customized treatment plans

8.     Records and documents client’s postural changes

9.     Reflects the professionalism of your practice

10.  Helps build your practice

Postural Analysis Checklist

o      Obtain written permission to take photos.

o      Hang plumb line 3 feet in front of posture chart.

o      Hang Plumb Bob approximately ¼-inch off the floor.

o      Instruct client to remove shoes and jacket, and place hair behind the ears.

o      Have client stand between the postural chart and the plumb line.

o      Anterior view: Place heels an equal distance from the plumb line and posture chart.

o      Lateral view: Position client so that plumb line is immediately anterior to lateral malleolus.

o      Handle photos as confidential medical records.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic Muscular Pain Relief Center is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, Muscle Movement Chart, and DVD programs. Visit www.KentHealtht.com or call (888) 574-5600.

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Tools to Succeed for Massage Therapists to Build Your Practice

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By: David Kent, LMT, NCTMB

In these tough economic times, how can you stand out above the competition so that clients will continue to spend their time and money on treatments with you? Well, it often depends on your ability to determine the root of your clients’ complaints coupled with the effectiveness of your treatment and your ability to educate your clients about the muscular components of their pain.

This article will review effective, time-proven methods that work together to educate and empower your clients so that they’ll not only want to continue their treatments, but also play an active role in their own healing process. All massage modalities can be integrated with the tools discussed in this article in any type of setting, including spa, clinical or outcall practices.

Education is a necessary component of a client’s overall treatment plan. Although one treatment may be helpful, perhaps a series of four, six or more would provide greater benefit. But in order to communicate this to your clients and help them recognize why committing to follow-up treatments makes sense, it is necessary for them to understand the processes of their body.

Using Forms

A client’s initial visit should always include a detailed intake form that provides an overview of his/her current and past health conditions. Often this paperwork reveals clues by listing prior accidents, injuries, surgeries and chronic conditions. Additionally, maintaining written accounts of a client’s health history helps protect you in the unlikely and rare event of a client lawsuit. Professional liability insurance covers you as a therapist in case you are ever sued. Remember to always seek authorization from the client’s medical doctor if you are unsure about potential contraindications.

Visual Pain Scales allow clients to specify and document regions of discomfort, the type and intensity of the pain, and other complaints. I suggest you take the Visual Pain Scale into the treatment room, review it with your client, and place it on a stand so that you can reference it throughout the session. This also helps ensure that you remember to address all of your client’s complaints, which a key factor in retaining a steady flow of returning clientele. Without the aid of documentation, it can be easy to slip into a massage routine and forget to address the very reason the client sought treatment in the first place (Photo 1).

Taking Pictures

It is said, “A picture is worth a thousand words.” Postural analysis photos only take a moment to snap, but they can go a long way in helping you explain the stresses on various muscles and to show which muscles are shortened and over lengthened. Keep it simple, the camera and screen built into a cell phone would even allow you to show client’s their forward head or high shoulder posture. Remember to always get permission to take postural analysis photos and treat them confidentially—as you would any other medical records (Photo 2a and 2b).

Relying on Charts

Charts can help you explain to clients the function of muscles and demonstrate why some are stressed and painful. Portable flip charts provide a professional presentation in any environment and are easily moved from one location and/or treatment room to another. The best flip charts on the market are easy to use with logical formats and laminated pages to prevent oils and lotions from damaging them over time. (Photo 3)

Wall charts are also useful and easy to reference. If you are limited on wall space, you can invest in an inexpensive wall chart hanger system that allows you to hang and access up to 10 wall charts in a single space. Muscular and skeletal charts are useful in showing the symmetry that exists in the body. And a Postural Analysis Grid chart makes it easy—even for the layperson—to see the body’s asymmetries in postural photos. And a muscle movement chart also gives the degrees of normal range-of-motion for each joint, which aids with the assessment and development of a treatment and self-care routine.

Trigger point charts, depending on their design, can assist in developing a comprehensive treatment plan that is both based on medical research and specific to your client’s pain.  (Photo 4 ). If trigger points are identified during the treatment session, a trigger point flip chart can also help you show clients their trigger point patterns while they are still on the treatment table. The formation of trigger points is often the result and/or cause of postural distortions that can be identified in the postural analysis photos, as well.

Using and Selling Topical Analgesics

Topical analgesics can help generate additional income without spending extra hours in the treatment room. Many clients use topical analgesics between treatments. There are several types on the market. One company offers free samples attached to a flyer with your name and contact information printed on it. This is also beneficial in promoting your business. Integrate the use of topical analgesics into your treatment routine and give your clients a few sample packs to use at home. Free samples often lead to future sales. If your clients want to buy a topical analgesic, it’s better for you to make a few extra dollars selling it than sending them to the drugstore down the street.

Review

At the end of each treatment, take a minute to review your findings with the client. Use their pain scale, posture photos, skeletal, muscular and trigger point charts to create a treatment plan. This would also be an excellent time to offer your client a package of treatments that has a financial incentive for them to commit.

Remember, people will spend money on care they feel will make the difference in the quality of their lives. You just need to give them the knowledge and the reasons to make an educated decision. Using the tools and systems outlined in this article will enable you to revolutionize and protect your practice in these tough times.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic, Muscular Pain Relief Center, is in Deltona, Florida, where he receives referrals from various healthcare providers. David is President and Founder of Kent Health Systems which teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealth.com or call (888) 574-5600 for more information.

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Getting Comfortable with Postural Analysis Practice Building Tips

Download a printable version or this article with photos

By: David Kent, LMT, NCTMB

We all recognize the importance of getting our cars serviced regularly so that they run at their optimal level. Not surprisingly, the same is true of the human body. In fact, there is a very useful car-related analogy we can use when it comes to describing postural analysis: a front-end alignment and wheel balance.

The word “posture” is derived from the Latin verb “ponere,” meaning “to put or place.” The word “analysis” comes from the Greek word “analyein,” meaning “to break up.” Therefore, postural analysis is simply the process of “breaking up” the body to determine where it should be “put or placed.” This article will review the body positioning for the purpose of taking a standing (static) postural analysis so that you can custom design your clients’ therapy sessions.

When a vehicle’s alignment is off, it manifests as uneven tread wear and loss of tire life. Likewise, when a car’s tires are not properly balanced, ride quality is diminished, tire life is shortened, and bearings and shock-absorber performance suffers. When one’s posture is off, the human body also experiences a range of problems: restricted range of motion; pain; organ dysfunction; and joint, tendon, ligament and muscle stress, to name a few.

The body, like tires, has an ideal position. It, too, must be balanced to run smoothly and last a long time. For a mechanic to assess and adjust the front end of a vehicle, he must first check wheel positioning for deviations from the norm. To do this, he sets the wheels in a standard position and conducts an evaluation. In massage terms, this is the equivalent of taking a postural analysis. A mechanic’s objective findings are also reported in terms we can relate to the body. For example, the mechanical term “toe-in or toe-out” is what we would call “internal or external rotation.” And what a mechanic calls “camber,” we call “tilt.”

When we report to a mechanic that the tire tread on our vehicle is wearing unevenly and the steering wheel vibrates, we have given our subjective complaints. The mechanic hears this complaint frequently and knows exactly what needs to be done. Before he can conduct his evaluation, however, he needs to use the proper equipment to access and design a repair plan, according to the car model’s specifications.

In the same way, clients often make subjective complaints to us about headaches and neck and back pain. These are common complaints we hear frequently. Just like a mechanic, we need to use the proper equipment to access and design a customized therapy session to meet each individual client’s needs, focusing on both short- and long-term goals.

The “manufacturer specifications” for the human body include the anatomical planes that show us the ideal positioning of joints and bones. While individuals are not expected to be perfectly positioned, we want to facilitate the best posture possible through massage therapy. According to Muscles: Testing and Function” “Ideal skeletal alignment…involves a minimal amount of stress and strain, and is conducive to maximal efficiency of the body.” Moreover, “the intersection of the sagittal and coronal midplanes of the body forms a line that is analogous to the gravity line. Around this line, the body is hypothetically in a position of equilibrium. Such a position implies a balanced distribution of weight, and a stable position of each joint. When viewing a posture in a standing [position], a plumb line is used to represent a line of reference…Since the only fixed point in the standing posture is at the base where the feet are in contact with the floor, the point of reference must be at the base,” or the foundation of the body.[1]

Whether you work in spa, clinic, medical office, fitness center, or some other venue, there are certain things you must do to conduct an effective postural analysis.

Postural Analysis Checklist

[Graphic designer: please insert check boxes next to each entry]

o      Hang a plumb bob approximately 3 feet in front of a postural analysis grid chart. The plumb bob should be approximately a ¼ inch off the floor.

o      The client should be:

o       in bare feet

o      wear clothing that allows for visual observation of body contours.

o      Standing between the postural chart and the plumb line, but his/her body should not be touching the plumb line or chart.

o      Client should place the hair behind the ears as the external auditory meatus is an anatomical landmark that is used as a reference point.

o      Position the feet in relation to the plumb line:

o      For anterior and posterior views, the heels are equally spaced from the plumb line and posture chart. See images #1 and 2

o      For a lateral view, the plumb line is immediately anterior to lateral maleous. See images # 4 and 5

Now, stand a few feet back from the plumb line. Using a digital camera, move from side to side (right to left) until the plumb line is lined up with the center line of the grid chart. Take a photo of the client and make any necessary notes for your objective your findings.

We all know the saying “A picture is worth a thousand words”. In images #1 and 3 it is easy to see how the right shoulder is higher then the left. We see the torso and head are to right of the midsaggital plane. In images 4 and 6 it is easy to see the forward head posture and the right shoulder being posterior to the coronal plane. These “deviations” have numerous origins. A muscle movement chart will help quickly determine which muscles are shortened and which ones are lengthened helping you design a customized treatment plan.

There are many advantages of taking postural photos, including

• Documenting posture before and after a series of treatments;

• Educating clients about their postural distortions and demonstrating causes of pain, muscle weakness, etc;

• Showing clients, physicians, and other relevant parties a client’s treatment progress;

• Presenting clients with clear treatment solutions;

• Recording and documenting the client’s postural changes;

• Customizing treatment plans; and

• Confirming your objective findings via trigger point charts. (See my article, “Charting Progress: Visuals for Success” in the February issue of Massage Today for more about this.)
When you take the time to administer a precise posture evaluation for your clients and devise a customized treatment plan, you will gain their respect and earn a reputation as a top massage therapist. Your clients will also appreciate how you utilized the information to educate them.

Don’t let the idea of conducting a postural analysis intimidate you. There are many things we do every day that we needed to learn to do for the first time. Once you get comfortable with posture, it will be easier to think about each client as an individual and know how to develop special treatment plans for each person. Over time, posture analysis becomes easy—second nature. You just need to start doing it.

For more information about posture analysis, as well as several tools to get started, visit KentHealth.com.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic Muscular Pain Relief Center is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealtht.com or call (888) 574-5600.


[1] Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function, 4th ed. Williams & Wilkins, 1993: pg 71.

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BIOFREEZE: Massage Therapy Practice Building Tools

Watch two short video clips by David Kent on ways to build your massage practice with Biofreeze.

Biofreeze Locator – Where To Buy

The BioFreeze Educational Brochure is free to massage practitioners and a great way to promote your practice. One Biofreeze sample pack is attached to each brochure. Biofreeze will print three lines of customized information (Name, address, phone) on the brochure and ship them to you free.

The BioFreeze Countertop Display Case is also free and great way to build your massage practice

To order your FREE Personalized Biofreeze Educational Brochure with Sample Pack please click here.

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Comfort Craft Massage Table Model 800 Features & Benefits

David Kent uses Comfort Craft massage tables in each of his treatment rooms.

Take a video tour as David shows you the features and benefits of the Comfort Craft Model 800 Massage Table. Learn about the:

  • Comfort Conforming Face Cradle With Gliding Action prevents compression of the cervical spine. The face cradle can be set to any angle and when not in use can be quickly repositioned under the table.
  • Adjustable Arm Rest provides comfort at any angle. Multiple adjustments points gives you the ability to make the modifications for short or tall individuals .
  • Foot Controls allow you to easily adjust your table height and the angle of the mid-split table top throughout the treatment. There are two sets of foot controls, one set on each side of the table.
  • Treatment Stool with Large Wheels provides a solid base and lets the therapist position to the perfect angle throughout the treatment. Single hand lever allow for quick and easy height adjustment.
  • Side Lying Treatment Tips and Benefits
  • Prone Treatment Tips and Benefits

To receive additional information about the Comfort Craft Model 800 Click Here or call Jim Craft at 800-858-2838

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Biofreeze Locator – Where To Buy – Practice Building Tool

The Biofreeze Where to buy Locator is a free practice building tool. Consumers visit Biofreeze.com/WhereToBuy, enter their zip code and your location appears on a map. Watch as David Kent tells you about the Biofreeze Locator.

Healthcare care providers that would benefit include: Medical Doctors (MD), Chiropractors (DC), Physical Therapists (PT), Occupational Therapists (OT), Massage Therapists (MT)

Watch videos to learn more:
Biofreeze CounterTop Display Case – video 1
Biofreeze Counter Top Display Case – video 2
Customized Biofreeze Brochure with Sample Pack – video 1
Customized Biofreeze Brochure with Sample Pack – video 2
www.BIOFREEZE.com/WhereToBuy
www.BIOFREEZE.com

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Finding Employment as a Massage Therapist – Hire Me!

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By: David Kent LMT, NCTMB

At the end of my seminars, I ask attendees to fill out a brief performance-review survey. The final question asks what therapists believe is the biggest challenge facing the massage industry. The question usually elicits a wide range of responses; however, at a recent seminar, the response was overwhelmingly the same: “finding a job.”

This article will review some simple but proven techniques to help tilt the scales of successful employment in your favor. Remember: There is a difference between knowing what to do and doing what you know. Your time and energy are valuable and must be spent efficiently. So why not take the time to ensure that you stand out above the competition?

Have a plan. Before you do anything, create a written plan so that you will stay focused on your goal. Generate a list of the spas, clinics, and chiropractic and medical offices that you would like to visit. Contact them ahead of time to determine if they are hiring; then ask each prospective employer about the qualifications they seek in a therapist. This information will help you narrow your search.

Put yourself out there. There is a common saying: “You will miss every opportunity you don’t take.” This might seem obvious, but you need to hit the ground running and not stop until you find a job. You might have had a couple of great interviews; you might think you have the job “in the bag,” so to speak. But until you’ve been officially offered a position, nothing is certain. Continue to seize every opportunity until you’ve found the job you know is right for you. Additionally, contact local massage therapy schools, instructors and associations and ask to be added to their email blasts announcing new jobs in the area.

Get informed. Before meeting any potential employer, do your research. Read the company’s ad in the phone book and visit their Web site. Learn the company’s history, read the staff bios, learn what services are offered, and research any other information that you might need to know for an interview. A common interview question is: “Why do you want to work here?” Researching the company ahead of time will prevent you from being caught off guard, intimidated or unprepared, which will ultimately help you to market your skills, experience, strengths and interests more precisely during an interview.

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Back Pain Caused by Rectus Abdominis Trigger Points

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By: David Kent, LMT, NCTMB

When clients schedule a treatment session, they expect results and regardless of which massage modality or technique you’ve mastered, you want to deliver.

Back pain is a common complaint among massage clients, and symptoms such as pain across the mid back or low-back pain over the sacrum below the iliac crest in the gluteal region could be the result of myofascial trigger points in the rectus abdominis. (Photo 1) According to Simons & Travell, “An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level”1. The authors also state that “In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions”1 (Photos 1).

Although many trigger points have been identified in the rectus abdominis muscle, this article will cover two primary trigger-point patterns that cause back pain in these regions, as well as tips about how to treat them and how to educate your clients about the nature of their pain.

Clues:

Trigger points can form in the rectus abdominis muscle due to visceral disease, direct trauma, emotional stress, poor posture and over-exercise, to name a few. Examples of trauma include surgery in the area or injury to the muscle during a motor vehicle accident. These muscles can also become overstressed by everyday activities, including certain exercises or rigorous housework.

Before treating the rectus abdominis, however, it is important to rule out other muscular possibilities. Referred pain from myofascial trigger points into the lower thoracic region can also be produced by muscles in the back, such as the latissimus dorsi, serratus posterior inferior, illiostalis thoracis, multifidi, intercoastals and insterspinales.

Lower lumbar, sacral and gluteal pain often includes trigger points from the quadratus lumborum, gluteul muscles, piriformis and the hamstrings. In addition to the rectus abdominis, the iliopsoas is another muscle that refers pain into both of these regions.

Encourage clients to reveal important clues about their pain by having them complete a thorough health history and intake form. This useful tool also enables you to ask intelligent questions relevant to the possible causes of the client’s pain.

In addition to the health history and intake forms, have your clients complete a visual-pain chart to specify and document the regions of their discomfort; this tool will help you easily spot the trigger-point patterns and treat them accordingly. (Photo 2)

And before getting started, remember to communicate with the client to rule out potential contraindications, such as recent surgery, abdominal aortic aneurysms, or pregnancy, for example. This information should also be documented on the intake form.

Analogies:

Using analogies can help your client understand the cause and effect of trigger points and their pain. For example, some trigger points are similar to a gun and bullet. When pressure is applied to the “trigger” of a gun, it shoots a bullet, which produces an effect at the point of impact. Likewise, when a therapist applies pressure to a “trigger point” in myofascial tissue, it produces referred phenomena (shoots a bullet) to another area of the body; that effect is usually described as pain, numbness, tingling, weakness or other like complaints.

Communication:

Therapists and clients must communicate with each other to determine the presence of trigger points. Instruct your client to let you know if you reproduce the pain when you palpate a myofascial trigger point. Only the client can tell you if the region being palpated is tender and referring pain elsewhere. Once you have identified the culprit, you can treat the appropriate muscle.

Treatment:

Place the client in the supine position with support under the knees and the arms at the side to avoid tightening the skin over the abdomen. (Note: these same techniques can also be used with the client in a side-lying position).

Determine the borders of the rectus abdominis by asking the client to tense the muscle; he can do this by moving into a semi sit-up position as you palpate the region. Make sure that the client relaxes the muscle before you start treatment. Check for muscle sensitivity by palpating with your fingers using static compression.

Release the attachments around the xyphoid process (Photo 3) and costal margin (Photo 4) with your fingers or thumbs. The pubic attachments can be easily located by asking the client to place their thumb over their belly button and extend their middle finger down until they palpate the pubic symphysis. Use static pressure initially. If the area is not too sensitive, add a combination of friction movements in the direction of the muscle fiber (superior and inferior) and across the muscle fiber (medial and lateral). It will be more comfortable for the client if the intention of your pressure is more dominant in one direction.

Lubricate the muscle belly; then stabilize the skin with the non-treating hand. With the other hand, treat with the muscle fiber using a scooping movement with the fingers (Photo 5), followed by cross fiber (Photo 6).

Pressure:

Make sure to check in with the client frequently about the level of pressure. The body is reflexive, and it responds automatically to stimulation. For example, when you touch a hot surface with your hand, you automatically, or “reflexively,” pull away to avoid burning the skin.

This concept is also true in massage therapy. If the client is reflexively protecting him or herself by pulling away, tightening the muscle, holding his breath, squinting his eyes or clinching his teeth, then you are applying too much pressure. Additionally, if the tenderness in the area and/or the intensity of the referred pain does not ease up within 8 to 12 seconds of holding static pressure on the trigger point, again too much palpation pressure is being applied, leave the area and return later; and then use considerably less pressure.

Other Concerns:

Emotions and Sensitivity – The abdominal region can be a sensitive area for clients. Use good judgment and educate your clients to ensure that they are comfortable with having the abdomen treated.

Positioning and Draping – The client must be positioned comfortably on the treatment table in order for the muscle to fully relax. Additionally, your client’s privacy must always be protected and respected. There are a host of factors that determine the draping technique that you use. If the client is not comfortable with his/her abdomen exposed during treatment, you can still effectively treat the area through the draping itself.

Ice or Heat – If the injury or trauma is acute and/or swelling is present, avoid the injured area, and use ice when appropriate. Otherwise, a moist heat pack can be placed over the muscle prior to therapy.

Topicals – Topicals can help relieve the client’s pain between treatment sessions. You can earn additional income without being in the treatment room. One topical company offers free samples and will even print your contact information on the accompanying promotional materials.

Staying informed by reading articles, textbooks, watching DVDs and taking hands-on seminars to keep your knowledge and skills sharp while helping you perform at your best in the treatment room to meet your personal goals and your clients’ expectations. A percentage of the back pain you treat will be from myofascial trigger points in the rectus abdominis. Watch for the clues and patterns, educate your clients, and use all of the tools at your disposal. Wishing you much success.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic, Muscular Pain Relief Center, is in Deltona, Florida, where he receives referrals from various healthcare providers. David is President and Founder of Kent Health Systems which teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealth.com or call (888) 574-5600 for more information.

1      Simons DG, Travell JG. Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1, Upper Half of Body, Second Edition, Lippincott, Williams and Wilkins: 1999 Page 943

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