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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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Posture Chart | Forward Head Posture

Where can I find a trigger point chart?

Forward head posture is the anterior positioning of the cervical spine. It is a posture problem that is caused by several factors including sleeping with the head elevated too high, extended use of computers and cell phones, lack of developed back muscle strength and lack of nutrients such as calcium. Forward head posture can cause issues throughout your body. Let’s take a look at a few of them that can be fixed with a posture chart.

Headaches TrP 1

Believe it or not, a headache can be directly caused by bad posture. Specifically, forward head posture places strain on your upper back and neck muscles. When this happens, those muscles must work as though they are supporting an additional ten pounds of weight for every inch your head moves forward. The added strain puts pressure on the nerves in your neck and keeps upper back and neck muscles in a constant state of contraction, causing headaches.

Who sells a posture chart?

Neck and Arm Pain

One of the most common things that cause neck pain is forward head posture. The forward pull of the weight of the head puts undue stress on the vertebrae of the lower neck, contributing to degenerative disc disease and other degenerative neck problems. It can also cause shoulder and arm pain since the position often goes hand-in-hand with forward shoulders and a rounded upper back.

Are You Interested in a Posture Chart?

If you have patients that come to you with these issues, a posture chart can be a great way to show them how a simple posture change can fix these issues. Contact us today to learn about the posture charts that we offer.

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Posture Charts | Importance of Good Posture

Who offers posture charts?

When you were a kid, chances are your mom told you to sit up straight or fix your posture. While you might have thought she was just nagging you, there was a real reason for it too. Having a good posture can prevent back and other medical issues later in life. Let’s take a look at just a few of the reason why a good posture on posture charts is important.

Eliminates Neck and Back Pain

When you have proper posture, your bones and spine can easily and efficiently balance and support your body’s weight. When you have improper posture, muscles, tendons, and ligaments have to constantly work to support that same weight. The extra strain that is put on your back from bad posture can lead to neck pain, back pain, and even headaches.

Improves Memory

Studies have shown that there may be a connection between good posture and memory retention when learning new things. That’s probably why your teacher in school would tell you to sit up straight at your desk. The theory is, good posture enhances your breathing. This allows you to take in more oxygen, and when you take in more oxygen, your cognition improves.

 Where can I find posture charts?

Makes You Look Slimmer

Poor posture can cause your stomach to protrude over your belt line, sometimes referred to as a “beer belly”. Standing up straight will make you look skinnier and taller.

Are You Looking for Posture Charts?

At Kent Health Systems we offer all sorts of charts and training aids for your practice, including posture charts. Contact us today to learn more.

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Trigger Point Chart | Pain Management Without Opioids

Where can I find a trigger point chart?

Trigger points are small areas of spasm inside your muscle. When “struck” trigger points can sometimes cause debilitating pain that can make it difficult or temporarily even impossible to move. For generations, the answer to pain caused by trigger points was opioids. However, with the use of a trigger point chart some hospitals have begun using alternative methods for pain management. Let’s take a look at one of those alternative methods.

Dry Needling

It’s no secret that the country is currently in the middle of an opioid epidemic. It’s also no secret that a hospital ER is the biggest prescriber of opioids in the United States. Some hospitals, like St. Joseph’s University Medical Center in Paterson, N.J. have begun using alternative methods though when treating patients for pain. In fact, the strategy has led to a 58% drop in the ER’s opioid prescriptions in just the first year that the program has been in place.

One of the methods that St. Joseph’s uses is dry needling the trigger point of the pain. Unlike opioids which are rarely actually able to penetrate the spasm and trigger point, a dry needle can break up the muscle tissue and mechanically stop the spasm and the pain. The dry needling is followed with a small injection of a local anesthetic for the soreness caused by the needle.

What is a trigger point chart?

Are You in Need of a Trigger Point Chart?

At Kent Health Systems we offer charts and training aids to better help you serve your patients. Contact us today to learn more about the products and services we offer.

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Getting Comfortable with Postural Analysis Practice Building Tips

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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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Back Pain from Gluteus Medius Trigger Points

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By: David Kent, LMT, NCTMB

Each week, I treat several clients who complain of “low back pain.” For many patients, however, the primary cause of pain is not the lower back but the gluteus medius muscle. No matter what kind of massage practice you have, a great deal of your success will depend on how quickly you are able to determine the origin of a patient’s complaint and your ability to produce measurable results. This article will review some ways to identify when the gluteus medius muscle is responsible for causing pain.

Anatomy:

The gluteus medius muscle lies superficial to the gluteus minimus muscle and deep to the gluteus maximus muscle. Proximally, it attaches along the external surface of the ilium between the anterior and posterior gluteal lines. Distally, it attaches to the lateral surface of the greater trochanter of the femur (See Photo 1).

The gluteus medius muscle “abducts the hip joint; the anterior fibers medially rotate and may assist in flexion of the hip joint; [and] the posterior fibers laterally rotate and may assist in extension.”1 It also helps to keep the pelvis level when the opposite leg is raised during activities such as walking, running, or standing on one leg.

Intake and History:

The first step to designing and implementing an effective treatment plan is to understand the client’s medical history and current circumstances. Utilizing health history intake forms will help you gather the appropriate information; they will also reveal important factors that could be relevant to a patient’s condition.

Using pain scales to document a client’s pain patterns are beneficial, as well. Ask the client to color the diagram form illustrating where on the body he/she experiences pain. Then ask the client to add modifiers that adequately describe the pain, followed by a number from 1-10 to rate its intensity (See Photo 2 ). This diagram provides a helpful visual tool that you can reference during the session. You will also see how pain patterns often match common trigger point patterns, which are discussed in more detail below.

Ask the client if any of his/her daily activities are affected by the pain. If the answer is yes, ask the client which muscles hurt, what movements aggravate the pain, and what he/she believes caused the pain. Ask if the client has recently started or modified an exercise program. Answers like walking, running, tennis, aerobics and other types of activities may indicate gluteus medius involvement. Has the client had any falls or sustained any hip injuries? What is the client’s occupation? Does the client place a wallet or tools in a back pocket? All of these questions will help you narrow down the origin of pain. (Read “Questions with Direction,”)

Gait & Postural Analysis:

Observe the client as he/she walks. A painful or “weak gluteus medius muscle forces the client to lurch toward the involved side to place the center of gravity over the hip; such movement is called an abduction, or gluteus medius lurch.”2

Show your client the relationship between posture and pain, and describe how you can help. Just like chiropractors advertise free “spinal exams” to attract new patients, you could provide free postural analysis to attract new clients. Market the postural analysis as a value that you include during the initial visit; then include a second postural analysis taken upon completing a series of treatments. This is a great way to sell packages, and it also demonstrates postural progress. (Read “Getting Comfortable with Postural Analysis,”) When conducting a postural analysis, look for signs of gluteus medius muscle involvement. Shortness of the gluteus medius muscle “may be seen as a lateral pelvic tilt, low on the side of tightness, along with some abduction of the extremity.”3

Trigger Points

“Myofascial trigger points (TrPs) in the gluteus medius are a commonly overlooked source of low back pain.”4 There are three trigger points frequently identified in the gluteus medius muscle. TrP1 (See Photo 1) is located lateral and superior to the posterior superior iliac spine (PSIS) just below the iliac crest. TrP1 refers pain and tenderness over the sacrum, above the iliac crest into the lumbar region, and throughout the gluteal region on the same side of the body as the trigger point.

TrP2 (See Photo 1) is positioned midway between the anterior superior iliac spine (ASIS) and the PSIS just below the iliac crest. “Pain referred from TrP2 is projected more laterally and to the midgluteal region; [and] may extend into the upper thigh posteriorly and laterally.”5

TrP3 (See Photo 1) is rarely present and can be located just posterior to the ASIS and just below the iliac crest. Referred pain is primarily produced over the sacrum bilaterally.

Educate your clients about trigger points. Use wall charts or flip charts to demonstrate their location on the body. Using charts and other aids will not only help the client, but it will also build your credibility with the client. This is also an excellent time to explain how the muscle affects posture.

Pain is a symptom. As massage therapists, our job is to address the cause of the pain and work to prevent its return. Educate your clients. Discuss proper ergonomics, stretching and strengthening. Identifying the gluteus medius as a source of back pain is easy once you have the knowledge.

David Kent, LMT, NCTMB

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, 3 Kendell FP, McCreary, et al. Muscle Testing and Function with Posture and Pain, 5th ed.  Lippincott, Williams and Wilkins: 2005.

2 Hoppenfeld S. Physical Examination of the Spine & Extremities. Appleton & Lange: 1976

4 Simons DG, Travell JG. “Myofascial Origins of Low Back Pain, 3: Pelvic and Lower Extremity Muscles,” Postgrad Med 73:99-108, 1983.

5 Simons DG, Travell JG. Myofascial Pain and Dysfunction, The Trigger Point Manual: The Lower Extremities, 2. Lippincott, Williams and Wilkins: 1992

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Simple Answer, Positive Results

Finding the source of your clients’ pain

By David Kent, LMT, NCTMB

Addressing the pain and discomfort associated with trigger points is one of the most common complaints massage therapists deal with in the treatment room. It’s not uncommon, for example, to palpate a trigger point in the upper trapezius, sternocleidomastoid or suboccipital muscles that produces a referred phenomenon to a completely different area of the body, such as the head. When trigger points refer into the head the phenomenon is often described as pain, a headache, pressure, tingling and/or numbness. Although clients are often surprised at this phenomenon, most are thrilled when I am able to isolate and treat the trigger point. Occasionally, however, a client might show distress at this discovery and say something like, “I’m all screwed up,” “I’m wired wrong‚” or “I’m weird.” In this article, I will share simple solutions for addressing these types of comments in ways that will help empower your clients to have a positive attitude and take a more proactive approach to their health care.

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David Kent – Massage Today: Simple Answers Create Results (05/08)

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Charting Success: Effectively Treating and Retaining Patients

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By David Kent, LMT, NCTMB

Whether you perform massage in a medical, clinical or spa setting, it is important for clients to feel they are benefitting from treatment. Using visual aids is an excellent way to chart and evaluate a client’s progress. Charting allows you to show a client his/her progress. It also helps you and the client stay focused on which course of treatment to pursue.

In my last article, “The Power of the List,” I presented my goal-setting questions and Power List to help you kick-start the process of identifying and achieving your goals for your practice and all areas of your life. In this article I will share tips for using visual aids for your client’s benefit, no matter what type of massage setting you work in. I also will describe how I use visual aids in my own practice. These tips will help you gain, maintain and increase the momentum you need to attain your professional goals while you subsequently help your clients.

Few goals are ever achieved in one step, and one massage therapy treatment is rarely going to resolve the core cause of a client’s stress, pain or dysfunction. Many clients want instant gratification—the “magic bullet” or the one-treatment fix that will immediately solve their problem; however, it is incumbent upon us to educate our clients about the accumulated benefits of a series of treatments versus a single treatment here and there. Clients who make a commitment to regular treatment often are quickly amazed at the positive impact it has on their quality of life.

Here’s a brief quiz. Imagine you are driving down the highway and the “low oil” warning signal displays on the dashboard. You take the next exit and drive to the nearest gas station where you check the oil level and see that the engine is low by two quarts. Should you:

  1. Buy just enough oil so that the warning light will turn off; then drive the car until the warning light comes on again, only to do the same thing again. This is the human equivalent of taking over-the-counter (OTC) medication.
  1. Pull the fuse so the warning light doesn’t annoy you. This is the equivalent of seeing a doctor for prescription medication that masks the pain.
  1. Locate the wire that connects the light to the dashboard and cut it so it can never send the warning signal again. This is the body’s equivalent to surgery.
  1. Add one quart of oil and drive until the warning display lights up again; then add one more quart of oil. This is the equivalent of a client with headaches, neck and shoulder pain scheduling an emergency massage therapy session. Upon completion of the session, you recommend follow-up sessions, simple stretching techniques, ergonomic changes, and other methods of self care; however, the client doesn’t follow any of your recommendations and the next time you hear from the client is when his/her pain is at the crisis level and he/she needs to “get in as soon as possible.”
  1. Immediately add two quarts of oil at the gas station and then schedule an appointment to have your car serviced as soon as possible. Think about it. Maybe there is an oil leak or maybe something is drastically wrong with the car. Over time, the oil in the car breaks down. This is what the experts call “loosing oil viscosity.” Could that be similar to loosing range-of-motion?

Obviously, the best answer to the question is “E”.  You need to schedule the car for service – not only for a filter and oil change, but for a complete checkup. You make this decision on simple information that would be obvious to any person. It’s not too hard to see that the car in this scenario is a stand-in for the human body. And this valuable machine needs attention and care to run correctly and last for the long run. Ultimately, it’s cheaper to maintain the body’s health than to “pay” for a complete “breakdown” in the long run in the way of lost work, doctor bills, medication, pain and a reduced quality of life.

The point of this exercise is to demonstrate the importance of gathering information the right way at the right time. For example, a client complains of headaches that occur three to four times a week and require prescription medication; however, even with increasing medication, the client frequently misses time off work. This client also has secondary complaints of neck, shoulder and upper back pain that disrupt sleeping patterns. In this example, my short-term goals are to reduce the headaches and the neck pain intensity, frequency and duration, as well as to improve sleeping patterns.

Here is where I start collecting my visuals to create my starting point of reference so that I can measure the client’s progress from this point forward. To begin, I have the client fill out intake forms, questionnaires and a pain-scale chart before and after treatment. Other aids I use to establish a baseline include documenting range-of-motion; conducting muscle and orthopedic assessments; using trigger point charts; taking postural analysis photos; and evaluating gait.

Depending on your massage therapy setting, you will probably adjust which visual aids you use in your practice; however, most clients, regardless of the setting, find it both useful and comforting when the therapist uses charts and models to describe their condition and note their progress.

Lastly, we all need a little encouragement to produce the results we want in our lives. Often, however, we have no one around to motivate us. Every day, I list the things I am grateful for, as well as the things I did to move myself closer to my goals. I also ask my clients to do the same. A client with chronic headaches might be grateful for finding you, the massage therapist, and—thanks to continued treatment—he/she might be grateful for missing less work and sleeping better at night. This client might be following your recommendations and stretching and exercising every day as a means of reducing the frequency of the headaches.

As for me, I am grateful for my health and my practice. And whether it’s learning a new skill, following innovative practice-management techniques or using visual aids, I make a point of doing something every single day that will help me reach my professional and personal goals.

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