Human Physiology versus Modern Living
Human bodies have not changed much in the past 10,000 years; however, duringthe last 150 years, we have greatly changed our lifestyles. Our bodies deal with newchemicals, sleep habits, physical tasks, indoor lighting, noise, and other unnaturalstimulation. The increase of psychological stress, repetitive tasks, and decrease ofphysical activity in modern lives has contributed to chronic pain.It is difficult to change a lifestyle, but trigger point therapy can be used to reduce or eliminate the source of various types of pain, without drugs or surgery.
Pain Can Be Tricky
The Centers for Disease Control and Prevention reported in 2006 that over 25percent of Americans aged twenty and older report pain lasting over twenty-fourhours. The Annals of Internal Medicine reported that twenty-five billion dollars per yearwas spent in search of low back pain relief in 2003.Typical allopathic treatments for pain are medications, cortisone, and surgery.For many patients, surgery provides welcome relief, at least temporarily, fromsciatica, carpal tunnel syndrome, and other mechanical and pathophysiologicproblems. However, symptoms mimicking such problems can be caused by triggerpoints, which surgery does not improve.In general, trigger points frequently remain overlooked, unrecognized, and untreated.After a back injury, medication was prescribed for me for a year with little relief. Then Ivisited another medical doctor who, in one session, removed my pain using manualtherapy. He explained that my pain was referred from the actual problem areas.
Referred Pain
Referred pain is sensed in an area away from the actual pain source. Examplesof referred pain are headaches, phantom limb pain in amputated limbs, pain downthe left arm during a heart attack, and the infamous so-called brain freeze caused bydrinking cold liquid, which cools the vagus nerve running along the throat. During abrain freeze, one may feel it in the head, when the cause may be down the throat.Pain referral is also common in myofascial pain syndromes, which are caused bytrigger points in muscle, fascia (fibrous tissue that connects, separates, and supportsmuscles, bones, skin, and other organs), tendon, and ligament tissue.These trigger points are among the most common causes of chronic pain.
Trigger Points
A trigger point can be thought of as a muscle protection mechanism, whichstiffens the muscle in order to limit range of motion, triggered by injury, overuse,and adrenaline—all phenomena in which modern humans excel. Resultant stiffeningor spasms of muscles cause blood stagnation, nutrient loss, and buildup of toxins.Such protection can become chronic and painful and can activate other triggerpoints, spreading pain and disability like an infection.Postural muscles, as in the neck, shoulders, back, and pelvic girdle, and others,such as forearms, hands, calves, and face, that are used in repetitive actions are mostvulnerable to trigger points. Trigger points may cause headaches (tension andmigraine), temporomandibular joint pain, sciatica, and apparent carpal tunnelsyndrome and can be associated with burning, numbness, weakness, temperature,sweating, dryness, dizziness, nausea, tinnitus, vision, decreased range of motion, andother problems. Since trigger point syndromes are unfamiliar to many physicians,these familiar symptoms can make diagnosis difficult.Sedentary people and those, such as computer operators, dentists, drivers, andspecialized athletes, who hold unnatural positions or perform repetitive tasks are athigh risk of developing active trigger points. After sitting at a desk, running or a gymworkout may seem to make up for the sedentary time, but it actually may promotethe pain and dysfunction. Rigid use then overuse is not the best.Most trigger points are reduced or deactivated by acupuncture, electric stimulation, orinjections. Fortunately, trigger points also respond to manual therapy.
Trigger Point History
Some researchers think that many trigger points and acupuncture pointsoverlap. Hence trigger point therapy was accomplished by acupuncture thousandsof years ago in China and other parts of the world. In the seventh-century book AThousand Golden Remedies, Sun Su-Miao (Si miao) described “ah-shi” tender points—most probably trigger points.In the 1940s, trigger points were first clearly described and mapped by Janet G.Travell, MD, who eased John F. Kennedy’s pain in 1955, allowing him to run forpresident. Dr. Travell then served as the personal physician for both presidentsKennedy and Johnson. Drs. Travell and David Simons later wrote the seminal texton Trigger Point Therapy: Myofascial Pain and Dysfunction: The Trigger Point Manual.Although sixty years of medical research has shown that trigger point therapyrelieves pain, the medical community has been slow to promote this therapy.Doctors who do treat trigger points inject steroids, local anesthetics, carbon dioxide,dextrose, Botox(R), MyoXTM, and even muscle relaxants to disarm trigger points, and such injections have been covered by U.S. medical insurance since 2005.
Manual Trigger Point Therapy
In Europe, manual approaches are used by myoskeletal medical doctors andpractitioners. In the United States, physical therapists use spray and stretchtechniques, which numb the skin, interfering with pain conduction, allowingstretching to release trigger points. Also, massage therapists use direct pressure byhand, foot, or tool.The simplest and least invasive method of trigger point therapy involvesmanually locating the trigger point, which may feel like a pea or knot, and pressingor holding firmly, using thumb and finger, for fifteen seconds or more. Elbows andfeet may also be used, as in barefoot deep tissue therapy. Best of all, this modalitycan be incorporated into a Swedish, barefoot, deep tissue, or other type of massage,whether the client is clothed or not.Trigger point referral patterns in muscles have been thoroughly mapped; forexample, temple headaches are most often caused by trigger points in the temporalisor upper trapezius. So when a patient complains of a temple headache, the therapistknows, or looks up, which points on which muscles harbor this referred pain. Whenmanual pressure is applied to the correct point, the pain will temporarily increase,and then fade.Many massage schools now teach manual trigger point therapy, and popular laybooks have been written that can prove extremely useful for self-help.
Self-Massage
For self-treatment, a tennis ball may be placed inside a sock and dropped overthe shoulder between the shoulder blades and pressed against a wall into tenderspots for fifteen seconds or so, whether or not “good” pain decreases. This can bedone several times a day. For more force, or for gluteal areas, one can lie on thefloor or use a harder ball. Several tools are available to aid self-treatment.Not all pain is caused by trigger points, so if one to three therapy visits do notproduce relief, then referral to a licensed health specialist is recommended.
Conclusion
Over the last hundred years, Western medicine has been straying from manualtherapies to drugs, surgery, and other invasive treatments.Manual trigger point therapy is a noninvasive method for relieving many typesof pain. It may be used by doctors as well as massage therapists, and even bypatients themselves, to help reach the goal of a pain-free body.To find a trigger point therapist near you, ask your doctor, physical therapist, orlocal massage school.
About the Author
Paul Svacina, BS, PE, LMT, has a BS in aerospace engineering from Texas A&MUniversity and learned bodywork and health sciences in Europe and the UnitedStates, most recently at the Santa Barbara Body Therapy Institute, and with JohnHarris, Olympic therapist and coauthor of Fix Pain – Bodywork Protocols for MyofascialPain Syndromes, explaining treatments for trigger points and sports injuries. Paulspecializes in trigger point therapy, barefoot deep tissue massage, and myofascialrelease. For more information and resources about trigger point therapy, visit PaulSvacina’s websites at http://trisoma.com or http://santabarbarabodytherapy.com.
Copyright © 2007, Paul Svacina