Article 2
Trigger Points, Hot Spots, Pain Centers and Fibromyalgia
By Allan Burke, LMP 6/1/2008
In the first article we talked about various circumstances that can bring on and set pain in different parts of our body. We identified two categories being sudden and ongoing. A third category we could put under Medical or musculoskeletal disorders. The pain may be mild or severe, local area or widespread. Although pain may be acute and short-lived, as with injuries, it can be ongoing with various chronic illnesses as muscle fatigue and fibromyalgia .
Fibro for short, causes pain in the muscles, tendons and ligaments and found in multiple locations of the body. Remember “Multiple Locations”. Some of the musculoskeletal disorders and taut muscles cause pain by compressing upon the nerves. This pain tends to “radiate or travel” along a path that could be a burning sensation, described as a “shooting” pain, “Referred Pain” and even a Local Tenderness. All of this in turn affects and reduces a person’s Range Of Motion (ROM), having difficulty moving all or part of the body and limbs. This is a partial description of what we call “Trigger Points” and they can be setup in a persons body by all three categories and not just from disorders, but amazingly respond the same way! These “Multiple Locations” I asked you to remember, get converted to Multiple Trigger Points that we also sometimes call Pain Centers or Hot Spots. These bands of muscle develop taut strands within the many strands that make up that muscle. This can be felt and found by palpating (cross-fiber) the muscle and is usually noticeable by the telltale “twang” and a small nodule that develops in that strand. This taut muscle is kind of like a big Charlie Horse in your leg. The muscle still pulls tight and you have to stand on your foot or bend it upwards to stretch it. Similarly, the Massage Therapist will do some stretching techniques of the muscle, along with muscle release movements. In addition, there are several pressure techniques that are used to release the trigger point.
Trigger Points can be confusing as well as deceptive. And trying to fully understand them would take a longer course than what is given here. A lot of the work being done with Trigger Point Therapy is still in its pioneering phase. More things are being discovered about them, how they work, what things they can cause in the body. This cause can be muscle weakness, sharp travelling pain, affect some of our organs, our lungs and breathing, causing us to “Favor” certain muscles due to pain and try not to use them and from that we create other painful spots or soreness due to this favoritism.
Pioneering
About 20 or so years ago, Dr’s Simon & Janet Travell started this trigger point pioneering. A few years ago Dr. Travell passed away but left a legacy behind in this research of Trigger Point Therapy. Through the use of Sodium Chloride injections into the muscle, they were able to force or duplicate these trigger points. By doing this, they were able to inject many different muscles and actually “Map Out” a chart of trigger point locations. So in a way, they were mapping the Results. So there are many, many different “Causes” that make these trigger points but they are trigger points none the less.
These charts may be purchased at massage stores and supplies for use by massage therapists, doctors, chiropractors, etc; These charts are not all inclusive. They are made up from only a few of the muscles of the body. Not all the muscles were injected during these tests. But they give a good reference point to point out where a person may be experiencing their pain or “PAIN PATERN”. So what we would be looking at is a series of pain patterns. One thing in particular to be noted is that a pain pattern for example may travel down the arm and exhibit a round radiating pattern and further down the arm have another red pain pattern with a little light trail of pain leading down the arm while the real trigger point is in the shoulder. This same trigger point can radiate in another direction from the shoulder and up the side of the neck, thus going in two different directions. So this trigger point in the shoulder may not have pain directly, but could, has pain at a distance from where it is located. There are patterns for the upper and lower body, that can be viewed and pointed out to what pattern is similar to which the client is expressing. The conclusion on the chart is a black X that will mark the nearby trigger points. Now is that confusing or what? And this is only ONE trigger point. Can you imagine many points just like this one covering one or two parts of the body and in severe cases, the entire body. Talk to a Fibro Patient and they will tell you. Here is a disorder rather than an injury or perpetuating factor causing this.
Doctors, researchers and many others are trying to understand Fibro, as to what causes it and why there are attacks and times it goes into remission. What we are left to deal with is the results. And for many years, doctors had to deal with it. Some may remember that many doctors would simply not believe what was going on because no cause could be found and no cure. Fact is, right now, no one really knows. But what we do know is that it is real and it attacks the muscles. Before, doctors prescribed various kinds of medicine and pain killers depending on the severity. I want to point out that what is being treated here are the symptoms and not the cause. We do not have a drug in a needle to kill some unknown virus that is causing it, or something in the DNA chain passed down for researchers.
Recent Discoveries in Fibromyalgia
When a person is in complete remission of Fibro and has no pain does not mean they do not have it. They have the capability of having an attack. I want to emphasize the word “Attack”. Because that is what is going on. Think also of hay fever for example. You get an “Attack” of Hay Fever. If you leave the source that caused it, you still have the symptoms until you take something to reduce the swelling and watery eyes and if you stay away from the source you won’t get it. Once you have an attack, you are left with the results of that attack. Fibro is much the same way. When the attacks are over, you are left with the results. In a way, at this time when the Fibro attack has stopped and you are not getting more painful areas we could say that it is in remission or has started remission. BUT, tell that to a Fibro patient lying in bed or sitting on a stack of pillows that and they will think you are ready for the nut house. Why, because they STILL HAVE THE RESULTS OF THEIR FIBRO ATTACK, PAIN ALL OVER. As long as they continue to have this pain, the patient is still going to believe they have active Fibro.
At this point in time, the person has Multiple Trigger Points all over the body or where ever it settled. It could be the upper body, lower body, along the left or right side, on one arm or both or All of the above. They cannot move or walk well and prefer to be sitting in a big chair with pillows or in bed. If it is worse, parts of their arms and legs and feet will go numb, their feet cannot feel the floor. Certain clothing, bed sheets are painful upon their skin.
Now we are at the point on “How do we get rid of the results of this Fibro Attack”. The concluding Article 3 will go into this and the aspects of Advanced Trigger Point Therapy dealing with Multiple upon multiple trigger points. Up until now, we have been dealing with a few major trigger points caused by an old injury or an injury that healed several weeks ago but I still have pain from it.
Massage Therapist,Trigger Point Theraphy, Deep Tissue, Myofascial Release. Neuromuscular St. John's, Swedish. Specialize working with Fibro clients
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