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Practice Building with Postural Analysis

Postural analysis photos can be utilized like X-rays, CAT scans and MRIs to evaluate, educate, design customized treatment plans and document progress. They are a great tool for attracting new clients and selling treatment packages and can help you build your practice by taking a quick postural analysis and delivering your objective findings using the technology carried with you daily.

Pictures

Keep the process simple by using the camera and screen built into smart phones, iPhones, tablets and iPads, as they are powerful assessment and educational tools. They allow you to instantly take and review a series of photos. Showing patients pictures of their posture adds a whole new meaning to the saying “a picture is worth a thousand words” (Photo 1). The impact of patients seeing a picture of their high shoulder or forward head posture is very powerful. A lasting impression is made on the patients of your ability to quickly identify the musculoskeletal cause of their pain, provide visual evidence (objective findings) and provide a logical treatment plan.

Having photos taken can be stressful to anyone, so make patients more comfortable by letting them wear their regular clothing. To show the postural changes caused by wearing high heels, it is sometimes helpful to take postural analysis photos with the patient wearing and not wearing their shoes.

Prior to taking postural photos have the patient complete a health intake form that gives you permission. Photos should be treated as confidential medical records.

Reference Lines

Viewing the mid sagital, coronal and transverse horizontal planes against the body makes it easy to spot asymmetries and a logical reason to use a postural analysis chart during assessments. The chart is most effective when used in conjunction with a weight or plumb bob suspended from a line. Hang the plumb line from the ceiling, approximately three feet in front of the Postural Analysis Grid 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” from the floor (Photo 2a & 2b). To get the plumb line out of the way and conserve space when not in use, simply hook it over one of the pins holding the chart on the wall. If your chart hangs on the back of a door, hook the plumb line on a hook next to the door frame (Photo 2c).
Front & Back

Position the patient’s heels approximately shoulder width apart and equally spaced from the plumb line (center line). The plumb line will indicate the position of the midsagittal plane in the photos. Also be sure the client’s heels are the same distance away from the posture chart to avoid creating 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 rotate the lower extremities. Step back, align the plumb line with the centerline of the posture chart and take the photo (Photos 2a).

Side Views

Position the client so that the plumb line is immediately anterior to the lateral malleolus. This position allows the plumb line to represent the coronal plane to the body. Ask the client to place their 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 to the coronal plane. Step back, align the plumb line with the centerline of the posture chart and take the photo (Photos 2b).

Findings

One front and side view photo, in many cases, is all that is needed to give a quick overview of your postural analysis findings. Photos make it easy for patients to understand the stresses their musculoskeletal system is enduring as you zoom-in on different postural analysis views and explain how your treatments can help. Reference the tables labeled Anterior View and Lateral View for the relationship of surface anatomy to anatomical structures (photo 4).
Support

Have all the answers at your fingertips with trigger point, joint range of motion and muscle movement charts to explain the myofascial components of the patient’s pain. Explain the relationship of your postural analysis and other objective findings to their pain (Photos 3).

Market

Stand out from your competition and market how your assessments and treatments are special. Provide postural analysis as part of a package or to attract new patients. Build your practice by taking a quick postural analysis and delivering your objective findings.

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Dissection is the Ultimate Learning Experience

Dissection is the Ultimate Learning Experience

By: David Kent, LMT, NCTMB

There is nothing like a full-body dissection seminar to alter and improve one’s understanding and appreciation of the human body. A dissection seminar offers a unique opportunity to learn about the intricacies of the human body and its various structural relationships in a three-dimensional way. During the seminar, students become familiar with a range of pathologies; they also observe how the normal aging process affects the body.  This article will discuss just some of the benefits of participating in a dissection seminar.

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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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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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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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Practice Building For Massage Therapists: Consistency Breeds Success

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By: David Kent, LMT, NCTMB

The current economic slowdown is stressful to everyone. Business is slow, treatments are down, and both are affecting the bottom line. During these challenging times, however, there are things you can do to consistently to breed your success. Instead of getting frustrated and discouraged, use this extra downtime to your advantage. Following the tips in this article will help you achieve ongoing success in your practice, whether you are in a clinical, spa or outcall setting.

Getting Out There

Marketing professionals know how important repetition is to “imprint” a product in the mind of the consumer. This same concept applies to massage therapy and your ability to imprint your services on potential referral sources. Each week, I visit specific locations that have become my best referral sources. If you aren’t getting the number of referrals you would like, it’s time to get out there and introduce yourself. Here are just a few places to start:
o      Medical and chiropractic clinics

o      Acupuncturists and homeopaths

o      Hotels and salons

o      Personal training centers and gyms

o      Tennis and golf courses

o      Yoga studios

o      Health food stores

o      Gymnastic and dance studios

o      Business centers

Talk it Up

You took the time to get out there; now you need to make it count! Your goal is to attract business by educating your referral sources about the importance of massage therapy.  Advertisers use test markets and focus groups to refine their messages. But before you begin pitching your services, you will need to practice and refine your “commercial” with your “test market,” which is located in the next community over.

That’s right. You need to practice your selling skills before you officially launch your marketing campaign with your “real” audience in your own community. Practicing gives you the opportunity to build your confidence while simultaneously getting comfortable with introducing yourself to strangers, telling them what you do, and answering commonly asked questions. But don’t let yourself off the hook with your practice sessions. Make sure that you are as professional and courteous with your test audience as you plan to be with your “real” audience. The following tips will help you get comfortable in this newfound role as salesperson.
o      Introduce yourself. Let people know who you are, what you do, and where you practice.

o      Talk to everyone you come into contact with—everyone! From waiters and waitresses to the FedEx delivery person to your mechanic, dentist, or insurance agent.

o      Never assume that people know what massage is or how it can help them.

o      Following each encounter, reevaluate your performance and ask yourself the following questions: What did I learn?  What will I do different next time? What other strategies could I try in the future? Answering these questions will help you do a better job each time.

o      Finally, ask your clients and referral sources what they think is important for you to tell others when marketing your services. You’ll be surprised at how helpful their feedback will be.

Show and Tell

Explaining the basics helps others understand how massage therapy can help with headaches, sciatica, neck and back pain, and more. Additionally, using “props” can help educate your clients.
o      Carry a trigger point flip chart with you. Explain how trigger point patterns are often the cause of severe pain.
o      Take a moment to examine the posture of the person you are speaking with. Educate your contact about how each individual’s unique postural pattern can be treated with massage therapy. Then describe your ability to custom tailor your treatments accordingly.

Mutual Benefits

Discuss how you can be of mutual benefit to each other.
o      Can you send them business?

o      Take some of their business cards to pass out, and ask them to do the same.

Leave Treasures

Do something unique so that your referral sources remember you.

o      Give a helpful tip. If you are talking with a secretary who complains of neck pain, suggest that he/she try a telephone headset, or adjust the height and angle of the computer monitor or chair.

o      Teach simple stretching techniques.

o      Leave healthy snacks. I know people who are always on the run and rarely stop to eat. Sometimes, I’ll drop off an apple, nuts, and a bottle of water, along with my business card.

o      Leave samples of topical pain relievers.  

Contact Information
You’ve invested your time and energy marketing your practice. Now make sure that your referral sources can find your name and number when it counts. Be sure to leave
o      Business cards

o      Magnets

o      Flyers

o      Pens

o      Notepads

o      Any other tool you think will leave an impression.

Education
Clients often want to understand and learn more about their condition, so put your education to good use.
o      Continually educate and re-educate your clients.

o      Show them how to stretch and maintain themselves between sessions.

o      Explain the importance and benefits of regular exercise.

o      Use visuals, such as anatomical models, textbooks, trigger point charts or other charts to show the musculoskeletal origins of their condition.

o      Review the effects of poor posture and explain how it contributes to pain. Since a picture is worth a thousand words and many cell phones have cameras, taking postural analysis photos on the road is easier than ever. Read “Getting Comfortable with Postural Analysis” (Massage Today, July 2008) for more tips on using postural analysis photos.

o      Discuss the uses of ice, heat, and topical analgesics for pain.

Say “Thank You”

o      Place follow-up calls to new clients.

o      Send thank you notes to clients and referral sources.

We typically avoid the things that we are uncomfortable doing; however, with practice, you will quickly realize that certain thoughts and actions consistently focused in positive directions will ensure your success. And if you practice your selling skills consistently, you will improve each time you sell your services to somebody new. Remember: practice makes perfect! Hang in there and don’t get frustrated. Results don’t always happen overnight. Just invest the time and keep a positive attitude. You’ll be amazed with the results!

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.

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Tax Tips Save Massage Therapists Money

David Kent interviews Jennifer Grant, CPA, LMT; take a few minutes to listen as they discuss the three ways a massage therapist can save money at tax time. Learn how you can take or increase your work related milage deductions. They discuss how to Keep it, Document it and Store it. David and Jennifer use everyday examples therapist encounter.

Click play ↓ to listen.
[audio:http://www.kenthealth.com/wp-content/uploads/KentHealthCast-012-JenniferGrant.mp3]

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Subscapularis: Overlooked and Under Treated

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By: David Kent, LMT, NCTMB

The subscapularis is often neglected and/or undertreated as a cause of posterior shoulder pain with restricted range of motion (ROM). According to Travell and Simons, “differential diagnosis of subscapularis TrPs includes C7 radiculopathy, thoracic outlet syndrome, adhesive capsulitis and ‘impingement’ syndrome.”[1]In this article, I will review how to determine when the subscapularis muscle is responsible for causing shoulder pain and restricted ROM, as well as review its anatomy, function, trigger-point patterns and treatment options.

Intake and health history forms will help you identify some common factors that may contribute to the formation and perpetuation of trigger points, as well as the shortening of the subscapularis muscle. According to Travell and Simons, some of these factors include the following:

  • Repetitive movements that involve medial rotation, such as swimming the overhead stroke, playing tennis or pitching a baseball;
  • Repeatedly lifting boxes or other objects overhead with both arms extended;
  • Reaching backward to break a fall;
  • Soft-tissue stress when the shoulder joint is dislocated;
  • A fracture to the proximal humerus or trauma to the shoulder joint capsule;
  • The immobilization of the shoulder in an adducted and medially rotated position over a long period of time, such as when the arm is in a sling; and
  • Prior surgeries and procedures.[2]

Taking a photo of your client in front of a postural analysis grid chart is an effective method of evaluating, documenting, educating and ultimately showing a client his or her postural progress over a series of treatments. For example, a constant slumped, forward-head, adducted-scapulae posture will perpetuate trigger points and the shortening of muscles, like the subscapularis, by continually keeping the humerus in a position of medial rotation.3 [Photo 1]

 

 

Symptoms

 

Trigger Points: When trigger points are present in the subscapularis muscle, they produce referred pain “in the posterior deltoid area…down the posterior aspect of the arm, and then skip to a band around the wrist.”4 [Photo 2] Remember that referred pain is a symptom; we want to address the cause. So intake forms, postural analysis evaluations, range-of-motion and orthopedic assessments, and being familiar with trigger point patterns are all helpful to designing and implementing a customized therapy plan. But treating a trigger point is only part of the solution. We need to avoid a recurrence in the future. It is therefore necessary to demonstrate to your client which muscles need more lengthening and which ones need more strengthening so that all of the joints are properly aligned and moving through their full range of motion.

Anatomy: The subscapularis is one of four muscles that make up the rotator cuff, along with the supraspinatus, infraspinatous and the teres minor muscles. In my dissection seminars, I always highlight the subscapularis, which is the most anterior of the rotator cuff muscles. [Photo 2] It is a thick triangular muscle that attaches medially on the anterior or costal surface of the scapula on the subscapular fossa; it forms part of posterior wall of the axialla. Laterally it attaches on the lesser tubercle of the humerus and the lower half of the shoulder joint capsule.

Actions: The subscapularis is primarily responsible for medially rotating and adducting the arm. It also helps to hold the humeral head in the glenoid cavity. To check for shortening in the subscapularis it is necessary to evaluate both abduction and external rotation.

Abduction: According to Travell and Simons, when evaluating a shoulder with restricted abduction, it is first necessary to determine if the restriction is being caused by the inability of the scapula to move on the rib cage, the humerus to properly articulate in the shoulder (glenohumeral) joint, or a combination of the two. The difference can be easily determined by placing your hands on the client’s scapula to prevent its movement while asking the client to abduct his/her humerus. [Photo 3] When the subscapularis is involved, it restricts glenohumeral movements like abduction and lateral rotation, but it does not restrict scapular movements on the rib cage. If scapular movements are restricted, it is necessary to evaluate muscles that run from the torso to the scapulae like the pectoralis minor, serratus anterior, trapezius and the rhomboids.5

Lateral Rotation: When checking lateral rotation at the shoulder, adduct the arm by placing the elbow at the side. Bend the elbow 90 degrees to show the amount of rotation at the shoulder joint. [Photo 4] The arm should be able to laterally rotate 90 degrees. In addition to the subscapularis, other synergistic muscles like the teres major, latismus dossi and pectoralis major also adduct and medially rotate the arm. These muscles must also be evaluated and treated. Keep in mind that the antagonistic muscles are weak and over lengthened, so they need strengthening. Muscle movement charts can aid in quickly identifying the muscles involved and show the normal range of motion for the muscles and joints being evaluated. [Photo 5]

Treating the subscapularis: While there are many different approaches to treating the belly of the subscapularis muscle, I find one particularly effective; however, with this method some clients may only be able to tolerate static pressure versus movements, such as with-fiber or cross-fiber techniques.

  1. Place the client in a supine position.
  2. Stand facing the client at level of client’s shoulder.
  3. In the palm of your non-treating hand, cradle the scapula while using your fingertips to secure the vertebral border of the scapula; abduct the scapula.[Photo 6]
  4. Position the fingers of the treating hand against the belly of the subscapularis muscle. [Photo 7]

NOTE: Some clients may be ticklish, but this is easily overcome by using the client’s hand during the treatment. Have the client place his/her hand on the ticklish region while you treat the area between his/her fingers. [Photo 8]

  1. Drape the client’s arm across his/her chest (adduction) to shorten the muscle. [Photo 9]
  2. Press the fingers of your treating hand down toward the table and into the subscapular fossa.

Before the session ends, advise your client that he/she will receive the most benefit from your therapy session by actively engaging in self-care stretching techniques, such as the doorway stretch, which will further help improve muscle length, and create and maintain balance in the shoulder. [Photo 10]

You have now identified several factors associated with subscapularis pain and discomfort with the help of assessment aids and tools like intake forms, charts and postural analysis photos. Continue to study and broaden your skills with hands-on seminars and DVD programs. And to share your tips and experiences in the treatment room, please drop me a line at [email protected]

For more information related to this month’s topic, check out “Charting Your Progress: Visuals for Success” (February 2008) and “Getting Comfortable with Postural Analysis” (July 2008) online at www.massagetoday.com.

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 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.


1-5 Simons DG, Travell JG, et al. Myofascial Pain and Dysfunction: The Trigger Point Manual, volume 1, 2nd ed. Williams and Wilkins: 1999.

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Taking Action to Improve Your Massage Practice

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BY: David Kent, LMT, NCTMB

In my May column, I talked about how to empower your clients using simple communication skills. It doesn’t matter whether you work in a clinic, a spa, or as an outcall massage therapist; chances are, you have encountered one or more clients who experience feelings of hopelessness and depression because of their physical pain. Keeping an open dialogue and educating your clients about their bodies, as well as maintaining a positive attitude in the treatment room, is as essential to a client’s well-being as the bodywork itself. Sometimes, however, this is easier said than done—especially when you are in the midst of your own challenges.

As massage therapists, we are often so focused on helping our clients that we neglect our own professional, financial, personal and spiritual lives. So how does one go about creating balance in all of these areas? In this article, I will walk you through five steps that can help you balance and produce positive changes in any area of your life.

If you’ve listened to the news in the last couple of months, chances are you’ve heard the buzz about the economy. Prices for basic goods, services and gas continue to rise, and many of the experts are predicting some tough times ahead. Obviously, some things—like the economy—are outside of our control. And it’s not healthy to expend large amounts of energy over the things that we can’t control. Rather, what we need to do is to focus our efforts on those things in our immediate lives that we can control; then evaluate the challenges and take steps to overcome them.

In addition to running a massage practice, we all perform various juggling acts. I am on the road several weeks a year teaching seminars, as well as running a clinic and continually working to develop new and improve existing products. This doesn’t take into account trying to maintain a social life and my relationships with friends and family. Perhaps you are dealing with similar issues: running a massage practice, trying to devote more time to yourself and your family, and a host of other personal and professional obligations. So, here is rule number one: It’s easier to deal with the stresses of life when you are flexible. There is no doubt that challenges will be constantly thrown your way. Maintaining flexibility and a willingness to adjust your plans will make dealing with these challenges much easier. You can start with the following five steps.

Five Steps to Positive Change

1. Acknowledge that something is out of balance and needs your attention. No one ever improved a situation by looking the other way. No matter how painful, scary or unpleasant the circumstances, it is generally best to face it squarely. 

 

Professional Challenges. Are you worried about increasing volume or just maintaining your massage practice in this unsettling economy? Try one or more of the following:

  • Visit businesses, gyms, and other health care professionals in your area to establish new referral sources.
  • Offer discounts and incentives for regular and repeat clients.
  • Educate your clients so that they will continue therapy and refer friends, coworkers and family.
  • Learn new treatment techniques so that you can specialize in a particular area of bodywork.
  • Sell products to generate additional income.
  • Check out my article, “Building Raving Fans,” in the April issue of Massage Today for a host of additional practice-building tips.

Financial Challenges. Are you making a decent living or barely making enough money to get by? Hire a financial planner who specializes in small business money management. A financial planner can help you create a reasonable budget that you can stick to; help you plan for retirement and unexpected financial emergencies; and help you get organized so that you can see the bigger financial picture down the line. Can’t afford to pay a financial planner? Consider trading services with one. Or check out your local bookstore—there are plenty of great books that specialize in financial planning and small businesses.

Personal and Spiritual Challenges. You won’t be much good to your clients unless you are taking care of your mental and physical health. Exercise, eat healthier, and take time out to recharge your brain and do the things you enjoy.

2. Ask empowering questions that include a specific positive outcome. Ask yourself what you can do right now to immediately improve your situation.
Professional Challenges. Empowering questions would include:

  • Are there mentors or other professionals that I can turn to for advice?
  • Are there sources of information online or elsewhere where you I can learn more about how to handle this problem?
  • Should I take some educational seminars?

Financial Challenges. Empowering questions would include:

  • Do I have a functional accounting system?
  • Do I understand the finances of my business? If not, you may need specialized computer software or other practice-management options, such as customized business forms.
  • Should I take a financial class or tutorial?
  • Should I update my business tools? Perhaps you own charts and tools, but they are outdated. For the price of one or two treatments, you could pay for updated materials that increase your volume. That’s an investment in your business (and a tax write-off).

 

Personal and Spiritual Challenges. Empowering questions would include:

  • What do I need to do to stay personally and spiritually balanced?
  • What physical activities do I enjoy doing that work with my schedule?
  • What can I do for myself that has a positive influence on all the areas of my life?

3. Implement change by taking action. The empowering questions you asked in step two will help determine the actions you need to take. There is a saying that goes, “The journey of a thousand miles begins with the first step.” The key is to start and then constantly move in the direction of the outcome. Don’t get frustrated if things don’t happen right away. Most things take time to come to fruition—and patience is a virtue.

4. Assess and modify your plan to achieve your outcome. This is where flexibility comes into play. Always prepare for unexpected challenges and try not to get overwhelmed when things don’t go exactly right. Instead, ask yourself, “What did I learn today?” When you hit a wall, start at step one above, and repeat the cycle. Realize that there will be occasional bumps in the road. For more about achieving your desired outcomes, check out my article, “The Power of the List,” in the January 2007 issue of Massage Today.

5. Maintain a positive outlook. It is important to see the silver lining with everything we do. Most people will never completely understand the challenges we face as massages therapists, but you chose this profession because you wanted to help people. No matter what challenges you are facing, there is always a light at the end of the tunnel. Stay positive. Take the lemons in your very capable hands, and make lemonade.

Join me again next month for more valuable information, until then stay focused, be positive and enjoy the process.

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