Trigger Point Therapy And Referred Pain

Human bodies have not changed much in the past 10,000 years; however, during the last 150 years, we have greatly changed our lifestyles. Our bodies deal with new chemicals, sleep habits, physical tasks, indoor lighting, noise, and other unnatural stimulation. The increase of psychological stress, repetitive tasks, and decrease of physical 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 25 percent of Americans aged twenty and older report pain lasting over twenty-four hours. The Annals of Internal Medicine reported that twenty-five billion dollars per year was 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, from sciatica, carpal tunnel syndrome, and other mechanical and pathophysiologic problems. However, symptoms mimicking such problems can be caused by trigger points, 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 I visited another medical doctor who, in one session, removed my pain using manual therapy. 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. Examples of referred pain are headaches, phantom limb pain in amputated limbs, pain down the left arm during a heart attack, and the infamous so-called brain freeze caused by drinking cold liquid, which cools the vagus nerve running along the throat. During a brain 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 by trigger points in muscle, fascia (fibrous tissue that connects, separates, and supports muscles, 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, which stiffens the muscle in order to limit range of motion, triggered by injury, overuse, and adrenaline - all phenomena in which modern humans excel. Resultant stiffening or spasms of muscles cause blood stagnation, nutrient loss, and buildup of toxins. Such protection can become chronic and painful and can activate other trigger points, 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 most vulnerable to trigger points. Trigger points may cause headaches (tension and migraine), temporomandibular joint pain, sciatica, and apparent carpal tunnel syndrome and can be associated with burning, numbness, weakness, temperature, sweating, dryness, dizziness, nausea, tinnitus, vision, decreased range of motion, and other 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, and specialized athletes, who hold unnatural positions or perform repetitive tasks are at high risk of developing active trigger points. After sitting at a desk, running or a gym workout may seem to make up for the sedentary time, but it actually may promote the pain and dysfunction. Rigid use then overuse is not the best. Most trigger points are reduced or deactivated by acupuncture, electric stimulation, or injections. Fortunately, trigger points also respond to manual therapy.

Trigger Point History

Some researchers think that many trigger points and acupuncture points overlap. Hence trigger point therapy was accomplished by acupuncture thousands of years ago in China and other parts of the world. In the seventh-century book A Thousand 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 for president. Dr. Travell then served as the personal physician for both presidents Kennedy and Johnson. Drs. Travell and David Simons later wrote the seminal text on Trigger Point Therapy: Myofascial Pain and Dysfunction: The Trigger Point Manual. Although sixty years of medical research has shown that trigger point therapy relieves 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), MyoX(TM), 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 and practitioners. In the United States, physical therapists use spray and stretch techniques, which numb the skin, interfering with pain conduction, allowing stretching to release trigger points. Also, massage therapists use direct pressure by hand, foot, or tool. The simplest and least invasive method of trigger point therapy involves manually locating the trigger point, which may feel like a pea or knot, and pressing or holding firmly, using thumb and finger, for fifteen seconds or more. Elbows and feet may also be used, as in barefoot deep tissue therapy. Best of all, this modality can 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; for example, temple headaches are most often caused by trigger points in the temporalis or upper trapezius. So when a patient complains of a temple headache, the therapist knows, or looks up, which points on which muscles harbor this referred pain. When manual 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 over the shoulder between the shoulder blades and pressed against a wall into tender spots for fifteen seconds or so, whether or not "good" pain decreases. This can be done several times a day. For more force, or for gluteal areas, one can lie on the floor 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 not produce relief, then referral to a licensed health specialist is recommended.

Conclusion

Over the last hundred years, Western medicine has been straying from manual therapies to drugs, surgery, and other invasive treatments. Manual trigger point therapy is a noninvasive method for relieving many types of pain. It may be used by doctors as well as massage therapists, and even by patients themselves, to help reach the goal of a pain-free body. To find a trigger point therapist near you, ask your doctor, physical therapist, or local massage school.

Copyright © 2007, Paul Svacina