What I Treat here at Heart & Soul
What are Trigger Points chronic pain massage therapy Marble Falls Spicewood Burnet
By Steven Hefferon, PTA, CMT
Research by Drs. Janet Travell and David Simons, authors of “The Trigger Point Manual,” has shown that trigger points are the primary cause of pain at least 75 percent of the time and are a factor in nearly every painful condition. Learn more about trigger point therapy by this link: Trigger Point Therapy
Trigger points, a type of muscle stiffness, are the result of tiny contraction knots that develop in muscle and tissue when an area of the body is injured or overworked. Trigger points are something traditional doctors ignore, but they could be the one thing that has been overlooked in your case for years, if not decades.
A hallmark of trigger points is something called “referred” pain. This means that trigger points typically send their pain to some other place in the body, which is why conventional treatments for pain so often fail. Many health care practitioners wrongly assume that the problem is located where the pain is and therefore fail to assess the body correctly to find the cause of your pain.
I’m going to give you some valuable information about trigger points that I hope will encourage you to consider the possibility that trigger points may be the missing link in your quest for relief.
What triggers a trigger point
Trigger points can occur as a result of muscle trauma (from car accidents, falls, sports- and work-related injuries, etc.), muscle strain from repetitive movements at work or play, postural strain from standing or sitting improperly for long periods at the computer, emotional stress, anxiety, allergies, nutritional deficiencies, inflammation, and toxins in the environment. A single event can initiate a trigger point, and you can suffer the effects for the rest of your life if that trigger point is not addressed properly.
Why trigger points cause trouble
Your body’s instinctive reaction to a harmful “event” is to protect itself. It does that by altering the way you move, sit, or stand, which puts abnormal stress on your muscles, tendons, ligaments, and joints. This produces strength and flexibility imbalances in your muscles, as well as postural dysfunctions throughout your body.
If that were not bad enough, your blood flow can become restricted and when that happens both your peripheral and central nervous systems will start to send out those “referred” pain signals, making assessment and treatment even trickier. That’s why some experts believe that trigger points are the beginning stage of fibromyalgia. Can things get even worse? Keep reading.
Here’s why you may be suffering
To better illustrate the process, here’s an example of how one trigger point in one muscle can cause back pain, sciatica, or a herniated disc. The most common place for a trigger point is in the muscle of the lower back called the quadratus lumborum (QL), which is located just above your hips. Regardless of what kind of event sparks the trigger point, your QL will gradually become dysfunctional – that is, the QL will tighten and shorten. And as you limit its use, it will weaken.
As the QL becomes increasingly dysfunctional, it will alter the position of the pelvis. As the pelvis becomes dysfunctional, it will force the spine into an abnormal curvature that will put abnormal pressure on the disc. Over time, the disc will begin to bulge. This situation will get progressively worse, affecting your overall quality of life. Depression often follows. All of this from a single event that occurred in one moment in time.
How do you know if you have trigger points
Everyone has trigger points; the question is degree. If you have lingering pain, tightness, or restriction of certain movements, it is a good bet that you are experiencing the effects of a trigger point. Trigger points may produce symptoms as diverse as dizziness, earaches, sinusitis, nausea, heartburn, false heart pain, heart arrhythmia, genital pain, and numbness in the hands and feet.
Trigger points can bring on headaches, neck and jaw pain, low back pain, sciatica, tennis elbow, and carpal tunnel syndrome – you name it. They are the source of joint pain in the shoulder, wrist, hip, knee, and ankle that is often mistaken for arthritis, tendonitis, bursitis, or ligament injury. If you think this is overkill, I suggest you read the book “Why We Hurt: A Complete Physical & Spiritual Guide to Healing Your Chronic Pain,” by Dr. Greg Fors, in which he explains precisely why so many different conditions are rooted in trigger points.
Here are a few more symptoms you should know about: If you have restless leg syndrome, you have TPs; if your teeth hurt, you have TPs; if your workouts have plateaued, you have TPs; if you have painful menses or irritable bowel syndrome, you have TPs.
How does Trigger Point Therapy work
Simply rubbing the surface of the skin with a massage lotion, a vibrating massager – or using heat – will not change the tissue of a single trigger point. What it needs is sufficient deep sustained pressure to the “knotted-up area.” As you work the Trigger Point, your body will undergo soft tissue release, allowing for increased blood flow, a reduction in muscle spasm, and the break-up of scar tissue. It will also help remove any build-up of toxic metabolic waste.
Your body will also undergo a neurological release, reducing the pain signals to the brain and resetting your neuromuscular system to restore its proper function. In other words, everything will again work the way it should.
How long does it take to get relief
The length of time it takes to release a trigger point depends on several factors, one of which is how long you have had your trigger point. Other factors include the number of trigger points you have, how effective your current treatment is, and how consistently you can administer or receive treatment.
Even if you are lucky enough to find a clinician who can properly assess your condition – let alone treat trigger points – it can be time-consuming and costly to pay someone to completely release all the primary, latent, and myofascial trigger points you may have in your body. You can try going to a massage therapist, but trigger points are very fickle; they need to be addressed daily using a technique that will apply the pinpoint pressure that is needed. Most likely it will be impractical to see a massage therapist frequently enough to get a trigger point to release.
An approach that makes sense
The basic idea is simple. First of all, a trigger point is only about the size of a mustard seed, which is one of the tiniest of all seeds. The idea is to put sustained pressure on the area for a set period of time on a regular basis. There are a number of techniques out there that you can employ to do this. The bottom line is that you need to take the initiative.
“There is no substitute for learning to control your own musculoskeletal pain,” says Dr. Simons. “Treating myofascial trigger points yourself addresses the source of that kind of common pain and is not just a way of temporarily relieving it.” In other words, you can fix your own trigger points better than anyone else – once and for all. Dr. Simons has it exactly right: You must educate yourself about your condition and then apply what you’ve learned. This runs counter to today’s conventional wisdom, which says that whenever we have a health issue, we should find someone to take care of the problem for us.
What I’m saying here is that you need to take responsibility for managing your own care. From time to time, of course, you may find you need help from medical professionals. But even so, the more you know, the better care you’re going to receive. This is naturally going to require some time and effort on your part, but the payoff will be faster with far better results.
What is Ashiatsu massage?
Ashiatsu massage is a barefoot massage technique that has been performed for thousands of years, with roots in Asia and India. However, the type of ashiatsu massage commonly performed in clinics today is actually a Westernized adaptation of the massage style known as ashiatsu oriental bar therapy.
During ashiatsu massage, the therapist positions themselves above the client while holding onto parallel bars attached to the ceiling. Using the bars for balance, the therapist then uses their feet to combat deep tension in the client's muscles. Therapists are quick to point out that they're not stepping on people so much as using the bars overhead to vary the amount of pressure and weight they're putting on a client's body. It almost looks like they're dancing (while working out their biceps).
Ashiatsu massage vs shiatsu massage: what's the difference?
Though they have similar sounding names, ashiatsu massage and shiatsu massage are actually opposites by definition. The word ashiatsu literally translates to "foot pressure" (ashi = foot, atsu = pressure), while shiatsu means "finger pressure" (shi = finger). While both are forms of oriental massage therapy, ashiatsu is typically used to provide deep pressure, while shiatsu uses smaller, more focused movements to try to redirect energy flow or "chi" throughout the body.
What are the benefits of ashiatsu massage?
As hinted at above, the main benefit of ashiatsu massage is that it allows the therapist to apply more pressure than they would otherwise be able to if they only used their hands. This is especially helpful for clients dealing with chronic tension that can't be tamed with a traditional deep-tissue massage. By targeting specific pressure points, the massage therapist's dancing motions can help decompress the spine in a way that may help relieve pinched nerves and back spasms.
About Trigger Points and Referred Pain
It's Probably Not an Injury -- But it Hurts Like One
Trigger points are microscopic areas of stagnation in muscle fibers. They are very common, cause a mysterious and extensive array of pain and other symptoms, and are a mystery to most practitioners. Even though myofascial trigger points have been researched and documented by physicians since the 1940s, they still have not achieved wide acceptance or understanding in the health community. Unfortunately, they are also responsible for the vast majority of pain complaints that people experience.
There are multiple reasons for this lack of attention. In spite of the landmark publication of the 2-volume Trigger Point Manual by two MDs, Janet Travell and David Simons in the 80s and 90s, the science of pain referral is only beginning to be understood with modern advancements in neuroscience, and some medical people are uncomfortable with the "soft science" of pain referral. Recent advances, however have moved the science along dramatically. The clinical evidence is undeniable.
Sadly, trigger point therapy is given short shrift in schools where it should be taught as an important core discipline -- medical, dental, bodywork, massage, physical therapy schools may mention it briefly, but students are left with a feeling that it's just another minor modality.
And it's not a trivial matter to practice trigger point therapy competently. The practitioner needs a solid basis in functional anatomy, be very familiar with locating muscles very specifically and must be able to palpate them for tenderness, know their referral patterns, change the length of the muscle, have effective treatment techniques and have access to a range of reference materials. Many practitioners are poorly trained, incorporate "a little" trigger point therapy in their work, are ineffective, and never realize its full potential.
Basic Trigger Point Physiology
Physiologically, trigger points are very small, microscopic encapsulations within specific muscle fibers that develop when a muscle has been placed under chronic or acute stress that overloads the muscle. Toxic chemicals develop near the area where motor nerves join the muscle fiber, and local edema develops which then prevents the capillaries from providing some essential metabolic activity to the area. The result is that nociceptive, or noxious signals get sent back to the central nervous system, and the body doesn't know how to process this information. The area of the trigger point itself is tender to compression, but the patient wouldn't know this unless they happen to press on it.
Trigger points occur in single muscle fibers, and groups of them tend to cluster in bundles of fibers near the motor endplate, where the motor nerve connects with the muscle. The affected fiber bundle remains in an artificial condition of engagement due to the bio-electric effects of the sensitizing chemicals. These bundles are known as taut fibers and can be clearly palpated as hard, ropy tissues, which harbor tenderness near the center of the fiber.
Trigger point physiology can no longer be dismissed by the medical establishment as "soft science". Researchers are engaged in studies to understand the microcellular processes and compounds that go into trigger point pathophysiology. Of particular note is the work of Dr. Jay P. Shah of the National Institutes of Health, who has been engaged in microdialysis of the chemical environment in the immediate locale of trigger points and has greatly furthered our understanding of referral and the associated phenomena.
A common CNS response in the face of ongoing nociceptive input is for the CNS to up-regulate and get more sensitive - a process that can happen in 15-20 minutes. Soon the patient begins to feel pain in a completely different area, often over joints, sometimes when specific movements are made. This is known as pain referral, and is thought to occur when new synapses are turned on as a protective response. This is due to the CNS perception of potential danger or "injury".
To the patient, the pain is experienced very vividly and convincingly where it's felt, not where the trigger point is located - except in the minority of situations in which the trigger point refers more locally.
Perception Determines Treatment - The Illusion of Injury
Pain referral is very confusing to untrained practitioners. There is actually no tissue damage other than cellular level imbalances and stagnation - and these can easily be addressed without invasive procedures. However, most practitioners will automatically assume that the pain is due to an actual injury. Imaging results will often confirm that something is not normal in the area of the joint, which unfortunately often means very little. This misinterpretation of pain leads to the well-worn treatments that so often fail or make things worse -- icing the area, steroid injections, NSAIDs, and surgery.
Statistically, Drs. Travell & Simons cite several studies showing that the vast majority - in excess of 85% - of pain complaints presenting in pain clinics were due to myofascial trigger points and could easily have been addressed had the practitioners been competently trained in these techniques. This is consistent with the results we get in our clinic. There are very few people that we cannot help dramatically.
Trigger points can be resolved through a number of different approaches. Generally, the trigger point area has to be mechanically or electrically stimulated and proper metabolism restored, and then the muscle needs to be put through full ROM, eventually without pain. Doing this well is a craft and an art, and relatively few therapists are competent at it. It isn't enough to simply press on a tender point and move on, because the body's neurological adaptations over time tend to reduce movement. The system must be re-trained in the experience of pain-free movement, and the positive neuroplastic abilities of the nervous system must be engaged.
RebelThaiMassage - Treating Trigger Points with Compression and Movement
Brad has trained with some of the pioneers in trigger point therapy and has developed Thai Bodywork or Thai Assisted Stretching Sessions, now called RebelThaiMassage, as a way to use the efficient techniques of traditional Thai massage as tools to treat trigger points. Traditional Thai massage (Brad studied in Thailand and with many American teachers versed in Thai and other Asian studies. Additionally, Brad studied at the New Begginings School for Massage, Austin, TX. The Thai techniques within RebelThaiMassage are guided by in-depth knowledge of trigger point theory, working muscles into shortening and length, and restoration of conscious, pain-free movement. RebelThaiMassage uses treatment configurations in which the practitioner can easily manipulate muscle length, compress tender points and often work antagonist muscle groups as well.
Confusing Symptoms Lead to Ineffective Treatments for Pain
The world is slow to change. Pain is an area in which our western medical system doesn't have great success. Many aspects of trigger point-induced symptoms are very confusing for doctors, PTs, chiropractors, massage therapists and others:
Trigger points send their pain the vast majority of time away from the location of the trigger point itself. This means that it is generally useless to "rub it where it hurts". Referred pain frequently occurs over and in joints, setting medical personnel off on a wild goose chase to discover the source of the "injury". Shoulder and knee pain are very common examples of this. Trigger points cause not only pain but chronic muscle shortening, producing postural distortions which then set up secondary issues. Referred sensation is not restricted to pain, but can include tingling, coldness, numbness, weakness, lack of coordination, and jerky movement. It is tempting to explain these phenomena neurologically with theories of nerve impingement at the spine and other areas, but most often this is not the origin of the pain. Typical misdiagnoses might include carpal tunnel syndrome, sciatic nerve impingement, radiculopathy, disc degeneration, and the like. Trigger point referral comes and goes in a confusing manner due to the thresholding nature of referred pain. Satellite referral is a common occurrence in which muscles refer pain to other muscles, which then cause their own referral -- this can go through many levels and even experienced trigger point therapists miss these patterns. When a network of myofascial trigger points is left to develop over time, it generally gets worse and becomes a myofascial pain syndrome. This can mimic a host of systemic conditions, including fibromyalgia, auto-immune diseases, infectious diseases and the like. Over time, the consistent, ongoing nociceptive input from trigger points can cause the nervous system to enter a chronicity phase, in which pain becomes constant and highly resistant to even the most powerful opiate drugs. At this point, pain is a brain response and is unrelated to the original inputs. This can lead to overall decline in quality of life and eventually death.
Experience RebelThaiMassage at the Heart & Soul Bodywork Clinic
Studies have shown that over 85% of pain complaints presented at clinics are likely to be caused by myofascial trigger points rather than actual tissue damage. Unfortunately, most practitioners tend to interpret pain as a symptom of an injury, leading to ineffective, side-effect-laden treatment approaches like drugs, steroid injections and surgery.
Ashiatsu Massage, Thai Massage and Chronic Pain therapy Mobility Freedom Technique.
HEART AND SOUL YOGA & Ashiatsu Massage hot yoga • (830) 693.9355 • 707 3RD STREET, MARBLE FALLS, TX 78654 yoga studio Burnet Spicewood
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