The Most Complete and In-Depth Anatomy App Available

Video on March 10th, 2011 2 Comments

MyoFinder™ is a new approach to teaching anatomy, using a media rich educational iPhone app.  This learning tool is designed to assist massage therapy, physical therapy, medical and chiropractic students and professionals .

Does Continued Focus and Tracking of Symptoms Actually Exacerbate A Clients Condition?

Pain & Injury on March 6th, 2011 No Comments

The desire to have clients record and track the location, intensity, frequency, duration, onset, triggers and medication use for specific conditions is common place in research as well as in clinical practice. Especially when studying and treating clients who suffer from conditions like Tension-type Headaches, Low Back Pain and other chronic pain syndromes. It is important to establish a baseline for these symptoms and have measurable’s defined to see if the treatment intervention is having a therapeutic effect. Can this daily focus and consistent reporting to various practitioners actually exacerbate symptoms through self awareness, not to mention the stress associated with having one more thing to do in the course of a busy day? The answer is most likely yes to this question. Does this persistent focus cause the client to become their symptoms and or condition therefore loosing sight of themselves? How best can we deal with this variable/problem and what can be done to minimize the impact that this factor has on a client, data collection and ability to accurately report and publish findings?

Low Back Pain: Goal Setting and Treatment Plan

Pain & Injury on February 11th, 2011 No Comments

The first step in treating low back pain (LBP) is to determine if the client has been given a specific diagnosis, this should be based upon both a thorough physical examination and  specialized diagnostic testing. The important thing here is to make sure that a serious disease entity has been ruled out and not the cause or mimicker of the (LBP). A common diagnosis often given to clients is called Non-specific (LBP) meaning there is no identified anatomical reason for your back pain. It is then important to conduct a comprehensive health history, postural assessment and range of motion evaluation to determine the mechanisms of injury, contributing factors and functional limitations. Health history, palpation examination, pain scale scores, and (LBP) disability indexes can help identify the level of severity, stage of inflammation and impact on the clients quality of life.  There are three recognized levels of (LBP): Acute, Recurrent and Chronic. The level of severity and stage of inflammation will direct and dictate the treatment techniques selection with the following goals in mind:

1)   Decrease swelling and inflammation

2)   Decrease muscle spasm, muscle contracture and muscle adaptation

3)   Decrease passive and active pain

4)   Restore range of motion and overall function

5)   Reduce scar tissue formation and help realign scar tissue

6)   Decrease depression, anxiety and somatization

7)   Improve core strength and muscle endurance

8) Correct postural dysfunction

Acute (LBP) treatment would include Lymphatic Drainage opening the main lymphatic ducts and lymph nodes then draining the low back region into the inguinal lymph nodes. Strain Counterstrain can be applied to the Quadratus Lumborum, Psoas, Iliacus, Erector Spinae, and the Gluteal muscles. Gentle circulatory massage can be applied to the entire back, gluteal muscles and hamstrings.

Recurrent (LBP) treatment would include Myofascial Release to the entire back, gluteal muscles, hamstrings and Iliopsoas. Cross fiber friction can be applied to the Erector Spinae, Quadratus Lumborum, Multifidi, Gluteals and Hamstrings. Strain Counterstrain can be applied to the Iliacus and Psoas.

Chronic (LBP) treatment would include Trigger Point Release Techniques, Cyriax Cross Fiber Friction and Post Isometric Relaxation directed at the Erector Spinae, Quadratus Lumborum, Gluteals, Hamstrings, Iliopsoas and Multifidi. In addition Cyriax Cross Fiber Friction can be applied to the following ligaments – Iliolumbar, Sacroiliac and Sacrotuberous.

The interesting aspect about setting goals and designing a treatment plan is that none of this really matters if you don’t know how to accurately locate and palpate all of these muscles and ligaments.

Shoulder Instability and Focal Strengthening

Pain & Injury on January 31st, 2011 No Comments

Dislocation Can Lead to Instability

Instability of the glenohumeral joint is typically caused by some type of traumatic event where over-stretching of the joint capsule, ligaments and supporting muscles occurs. The mechanism of injury is often from some type of fall onto the out reached arm and the forces translate through the long lever of the arm. Anatomically the glenohumeral joint has a very delicate balance between mobility and stability. Exhibiting the greatest range of motion in the body, yet the glenohumeral joint has limited ligamentous support and the joint capsule is very lax. Therefore the glenohumeral joint relies heavily upon the rotator cuff muscles to help stabilize the head of the humerus in the glenoid fossa. These same muscles along with other prime movers generate 9 different movement patterns at the glenohumeral joint. The typical strengthening program focuses on the the large and prime movers like the Latissimus Dorsi, Teres Major, Pectoralis Major, Deltoid, Trapezius, as well as the small rotator cuff muscles. Once again an overlooked muscle that can help bring the humerus head back up into appropriate alignment with glenoid fossa is the long head of the Triceps Brachii. Focal strengthening of the long head incorporates shoulder extension with elbow extension. I would love to hear success stories related to this approach, it is a recent discovery for me.

Triceps Brachii the Forgotten Warrior

Muscle Profile on January 22nd, 2011 No Comments

I can’t remember the last time someone came into my office and said my Triceps are killllling me. They do however report this phenomena/problem with their Trapezius, Deltoid, Rotator Cuff, Quadriceps and Hamstrings just to name a few common anatomical names that clients know and love to say. This three headed Warrior/Workhorse does not complain very much if at all and yet performs alot of hard work on a daily basis. The Triceps Brachii has a long head that attaches to the infraglenoid tubercle of the scapula, which makes it a multi-joint muscle acting upon both the shoulder and elbow joint. The medial head attaches to the distal and posterior surface of humerus and consists of more slow twitch fibers than fast twitch fibers and extends the elbow. The lateral head attaches to the proximal posterior surface of humerus just superior to the radial nerve and extends the elbow. All three heads share a common tendon that inserts into the olecranon process of the ulna. The long head is a synergist to the Lats, Teres Major and  Pectoralis Major in adducting the shoulder and acts synergistically with the Lats and Teres Major in extension of the shoulder joint. From a clinical standpoint the lateral head is also of great interest because it can entrap the radial nerve causing tingling and numbness in the dorsal aspect of the forearm and base of the third digit. The trigger points of the lateral head refer into the fourth and fifth digits, both the entrapment and trigger point referral patterns mimic a common condition called Thoracic Outlet Syndrome.        Don’t forget this silent Warrior!             (Travel & Simons 1999)

TRUST YOUR INSTINCTS!

Pain & Injury on January 18th, 2011 No Comments

Have you ever doubted your intuition and second -guessed your decision, even though you had an inner knowing to trust your gut?  In today’s litigious society most human beings, no matter how knowledgeable or skilled, sometimes question the validity of decisions they make. In my 22 years of practice as a massage therapist and teacher, there had never been a time when I encountered a circumstance that, in my mind, involved a life or death situation needing prompt action. But a recent incident woke me up and caused me to stop and reflect on the importance of acting on the knowledge and instincts possessed within us all.

My client Matt is an extremely athletic male of 36.  Over the last months, I had been treating specific areas of concern relating to a herniated disc issue, as well as concentrating on various chronically stressed musculature due to his active lifestyle.
On this particular day, Matt came to my office insisting that I look at his “gigantic swelled up calf,” which he described only as feeling “tight.”  He was not upset by this, but almost proud to exhibit this unusual phenomenon.   He couldn’t figure out why it was so uncomfortably swollen, though he did not complain of any discernible pain.  His right calf showed all the classic symptoms of severe inflammation.  When I questioned him about any apparent injury to that lower posterior leg in the last few days, he explained that he could not remember any assault that could account for this present condition.  I became suspicious.

Matt had a session with his trainer that day, who thought the symptoms might be related to an inflamed sciatic nerve as a result of the disc involvement.  The trainer instructed him to stretch the calf and use a styrofoam roller to try to “work out the tightness.”  Upon hearing this story, my mind raced with anxiety, as I had a gut feeling that what I was dealing with here was not what his trainer had indicated.  Though I didn’t want to sound alarmed, I relayed my concern that it might be something else.

When Matt requested that I work on his calf (to work out the tension), my voice became uncharacteristically stern and nervous, as I gave my emphatic negative response.  When he asked me what I thought it was, I explained to him, as diplomatically as I could, that it was not within my scope of practice to diagnose any pathology.  As a massage therapist, it is my obligation to assess the musculoskeletal condition and determine if massage is indicated or contraindicated.

I silently thought things through.  What I knew was that blood clots are often in the calf location and may appear to have redness, swelling, heat and pain, though I also understood that sometimes there are no symptoms.  I knew there had been no previously known injury to warrant the obvious signs of inflammation.  Also in my awareness was the fact that a lodged blood clot was a medical emergency and that one out of three embolisms (traveling blood clots) that are not diagnosed or treated will lead to death.   I weighed my next words with caution and told him the seriousness of the matter if, in fact, the problem was a blood clot.

The self-doubting began.  What if I am wrong about this, maybe hastily overreacting and upsetting my client needlessly?   Do I risk looking like a fool if the client goes to the hospital now, tells his doctor that his massage therapist suspects an embolism, and it turns out to be nothing at all?  On the other hand, if I withheld information from him, massaged the affected area, and something catastrophic were to happen to him afterward, how would I feel then (not to mention a possible lawsuit)? With so much at stake and acting on the courage of my convictions, I told him that if he were my family member, I would insist that he go to the hospital now to make sure that it wasn’t the worst- a blood clot.  Extremely shaken by my words yet trusting my judgment, he promised me that he would stop at the hospital on his way home and get it checked out.  I asked that he keep me informed.

That was a Friday, and my concern lasted through that day and the next.   With no word by Saturday evening, I made the assumption that my fears had been unwarranted, and reassured myself that it was better to be safe than sorry.   Returning home on Sunday evening, however, I found a message from Matt on my machine.  He reported that I had scared him into stopping in the emergency room after leaving my office.  He was diagnosed with a serious life-threatening pulmonary embolism condition, and had been hospitalized ever since that Friday afternoon.   He went on to say that his admitting physician had told him that the advice I had given him had saved his life.  His condition had been such that he might have died had he waited to seek timely emergency care.

We massage therapists at times don’t give ourselves credit for what we know about the body, both scientifically and intuitively.  We can sometimes see and palpate abnormalities that can be overlooked by other healthcare practitioners.  We can share beneficial information and suggestions, and provide a valuable service to our clients. As children we’re taught to STOP, LOOK, AND LISTEN before crossing a street.  As professional massage therapists we’re wise to heed the same advice when we recognize the signs and symptoms of various pathologies that may be contraindicated for massage, and need immediate attention. STOP to notice the warning signs, LOOK at the evidence presented, LISTEN closely to what has been said and, trust your insticts!

Gaye Franklin, NCBTMB, has been a massage therapist and instructor for over 20 years and continues her private practice in Boulder, Colorado.

MyoQuiz is Now Available

Why MyoFinder™ on January 18th, 2011 1 Comment

myoquiz1MyoQuiz is a FREE, Fun, Challenging and Interactive learning tool designed to enhance your ability to recognize 7 distinct anatomical regions and 78 individual muscles. MyoQuiz helps you prepare for an examination or for a challenging clinical situation- a great help for your studies and professional practice.

The ACL Deficient Knee

Pain & Injury on January 11th, 2011 No Comments

kneeThe Anterior Cruciate Ligament (ACL) of knee is a commonly injured structure and is not as strong as the Posterior Cruciate Ligament (PCL). This ligament attaches the femur to the tibia at the midline of the joint from the intercondylar area of the tibia to the lateral condyle of the femur. The important role that this ligament plays is to restrict excessive movement of the tibia in an anterior movement or translation, as well as posterior movement of the femur and medial rotation of the tibia.
My clinical and personal observation is that the Gastrocnemius and Popliteus are recruited to compensate and stabilize against the anterior shear forces of the (ACL) deficient knee. This translation without ligamentous restriction requires these muscles to play a different role, a paradox between prime movers to stabilizers of the knee joint. Palpation of these muscles would therefore lead the practitioner to probably identify these muscles as hypertonic and fibrotic. The typical approach would then be to try and loosen up these dense tight muscles. Caution should be taken, too much reduction in the muscles tonicity may result in additional translation of the tibia, increasing friction within the joint and  leading to greater inflammation. As we all known inflammation leads to swelling causing decreased range of motion at the largest synovial joint in the body and once again a loss of communication between the joint and surrounding musculature. Would love to hear other practitioners thoughts and observation of this common problem.

Long Term Consequences of Severe Ankle Injury Alters Balance & Proprioception

Pain & Injury on December 30th, 2010 No Comments

Balance and postural control training following a severe ankle sprain was not a part of my rehabilitation program back in the early 80′s. The emphasis in those days was to regain maximum strength especially after being in a mesh cast for 2 months.  The mechanism of my injury occurred during a pass rushing drill at Mesa State College as I stepped into an unseen sprinkler hole and severely twisted my ankle. I felt the familiar burning sensation of the blood rushing from the tissue tearing and the classic pop of the lateral ankle ligaments. I knew in that moment that I had suffered a severe injury, I laid on the ground gripping the grass with both hands, breaking out into a cold sweat and trying to hold back the pure agony of my situation. I was placed on a golf cart and whisked away to the orthopedic doctors office which was completely overbooked, so I sat in the back room with my leg up and an ice bag on my ankle. After hours of waiting the PA finally came into the room and saw that my shoe had been cut off of my foot because the swelling was so great. I was given two options schedule surgery immediately or cast the ankle, it was not a difficult decision at the time because I had just had knee surgery the year before. I opted to have the mesh cast applied complete with crutches, I wasn’t up for another joint venture. The long term consequences of this ankle injury has evolved into difficulty with balancing on one foot and my range of motion is definitely compromised, not to mention the intermittent arthritic pain that stiffens the joint and alters my gait pattern. In a recent massage I noticed that my Peroneous Longus and Brevis were really tender and tight – do these muscles hold the key to my balance and proprioceptive difficulties??

Cervical Spine Rotation and Resultant Hypertrophy of Sternoclediomastoid

Postural Dysfunction on December 19th, 2010 No Comments

Does sustained cervical rotation cause hypertrophy of the Sternoclediomastoid? Head and neck rotation to the left is performed by the right Sternoclediomastoid and vice versa for rotation to the right. Potential reasons for sustained cervical rotation can be attributed to better hearing and better eye sight on one side of the body or what is referred to as the tendency to maximize the position of the dominate ear and eye. Even slight cervical rotation can result in alterations in the alignment of the cervical vertebra, hence causing a reduction of active range of motion of all movement patterns. Common symptoms associated with this postural dysfunction include difficulty and painful swallowing.  In addition there are internal changes associated with the adaptive shortening of the Sternoclediomastoid and the formation of active Trigger Points. I have only witnessed this phenomena in clinical practice and have not found anything in the scientific literature related to this observation. Just another example of why it is so important to know the actions of the major muscles of the body. Would love to hear what other practitioners make of this observation and if there are any known references that would provide additional information.

Cervical Rotation

Cervical Rotation