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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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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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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

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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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Head, Neck and Shoulder Pain: How Trapezius Plays a Roll

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By: David Kent, LMT, NCTMB

When clients enter complaining of headaches, neck and shoulder pain it is easy to show them that their pain is a “symptom” of a bigger problem. Educating clients about the muscular components of their pain, often determines if they reschedule and refer their family, friends and coworkers. This article will review a few of the trigger point (TrP) patterns of the trapezius muscle and its involvement in various postural patterns.

Trigger Points:

Trigger points form in muscles for a reason and are often a result of trauma or stress. Poor posture can place a great deal of structural stress on the trapezius muscle. The human head is heavy and designed to be support by the bones of the cervical spine. Remember, muscles determine where bones are held in space. So a client with a forward head and rounded shoulder posture, has shortened muscles on the front of the body with over lengthened muscles on the back. The pains or “symptoms” are their headaches, neck and shoulder pain and we want to educate our clients on how we can address the cause.

When clients report that they have a headache that starts in their temple, deep in the head or behind the eye that continues behind their ear and into the back and side of their neck, they are describing TrP # 1 pattern of the trapezius muscle, which is one of the most common TrPs in the body (See Photo 1). Showing clients this pattern on a trigger point chart lets them know you understand the pain they are reporting and have a plan to help. This TrP forms from acute trauma from a whiplash, sustained shoulder elevation from holding a telephone to the ear, working on a keyboard that is too high, compression on the muscle from the shoulder strap of a heavy back pack or the pressure of a bra strap. Skeletal anomalies like a short lower limb or a hemipelvis should also be ruled out.

Commonly overlooked, is TrP 3 in the lower trapezius that refers a deep aching tenderness above the scapula that causes clients to report a “soreness” in the region of the upper trapezius. The pattern typically runs from the base of the occiput out laterally to the acromial process (See Photo 2). TrP1 and TrP 2 in the upper trapezius often develop as satellites within this zone of pain and tenderness that is usually referred from the lower trapezius TrP 3”1

Trigger points in middle and lower trapezius are often a result of tight pectoral muscles that should be released.

Posture:

The human body is designed with a great deal of symmetry or balance and has the same bones and muscles on both sides. Muscles on the front and back of the body counter balance each other. Addressing the cause of your client’s pain requires a whole body approach. Postural analysis is a great tool to document and educate your clients.

Muscles are like guide wires and determine where the bones are moved or held in space. When the bones and joints are properly aligned on the coronal, midsaggital and transverse horizontal planes the muscles are under minimal stress. To demonstrate this to your clients, first use muscular and skeletal charts to show the proper postural alignment of the body. Then review photos taken of your client in front of a postural analysis chart to show them which muscles are shortened, which are over lengthened and the unnecessary stresses being placed on their body causing pain. (see Photo 3)

Let your client’s know you will design a treatment plan to address their pain. Educate them on postural distortions like: forward head, high shoulder, forward rounded shoulders, collapsed abdominal posture, the position of the pelvis, anatomical deviations and more are not an isolated phenomena and cause the formation of trigger points and pain throughout the body.

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, et al. Myofascial Pain and Dysfunction: The Trigger Point Manual, volume 1, 2nd ed. Williams and Wilkins: 1999.

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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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