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A typical experience
I had a new client the other day for an 80 minute massage. I asked him if there is anything that he wanted me to know. He told me that he suffers from a herniated disc that he has had for a few years. He has constant low back and right hip pain that at times radiates down the back of his leg to his knee. He told me that he has had two injections in his low back and has to stay on anit- inflamtory medication. Anything to avoid surgery. The pain is always there. I asked him if he ever saw a chiropractor for his pain. He said yes. But the adjustments hurt his hip so bad that he could not continiue. So here is a guy that thinks he is on the verge of surgery. I knew that there was a very strong probubllity that was not the case. The vast majority of pain people experience is nocioceptive pain( soft tissue- muscle, tendon, ligament, facia). MDs and Chiropractors see pain as neuropathic pain( nerve pain). With that asumption they give the wrong treatments and therapies. Now there is no denying that at times injections and surgery is needed. Not denying that. But most of the time - NOT. 70% to 85% of all pain comes directly from trigger points. Anyway I showed my client a testimonial from a client that I was able to help out of a very painful condition that she had delt with for a couple of years. I showed him that testimonial because all pain has a psychological eliment too it. I wanted him to start thinking maybe he is not on the edge of surgery. I palpated his entire back upper torso, both hips, and right leg. I found a very painful spot on his right L5 erectors. Another very painful spot on his right greater trochantor. A painful spot in the middle part of his lower right hamstrings. And also a tender spot on the right spinous of L3. I knew that if Iwas able to eliminate all those painful palaptory spots that I would most likely eliminate his pain problem. Because a healthy body had no painful spots even with deep massage. Ive been hunting and eliminateing trigger points for thirty years now. He walked out of the massage room pain free. He was pain free for the first time in years. All those other professional people misdiagnosed him because they assume neuropathic pain over nocioceptive pain. I assume the other way around. I'm a Massage Therapist.
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Permalink Reply by Gary W Addis, LMT on
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I'm addressing this to you, Pueppi Texas, to Grodon Wallis and everyone else interested in this exchange.
Pueppi, you deigned yourself qualified to criticize comments made by my good friends and exceptionally skilled professionals Gordon Wallis and Therese Schwartz in separate threads; you lectured an LMT with six years experience and 1000+ hour MT education when she asked a simple rhetorical question, then went on the attack when another LMT (not me at this point) tried to explain what the poster was asking. So, yes, I then stepped in, prompting you to turn your ego loose on me.
My first comment in this thread was a discussion with Gordon. In it I said, "In my short career I have and continue to treat a lot of seniors suffering from sciatic nerve pain: the cause has [in my experience] ALWAYS been trigger points, in muscle, of course. Remember, the sciatic nerve doesn't become the sciatic nerve until the myriad nerve fibers that form it have left the spine and meld into the thickest nerve in the body. Those fibers originate from L4-S3. But other nerves, the pudendal for instance,also originate from the same section of the spine. Why, then, isn't there talk among MDs that the cause of this or that disorder-- pain in the anterior thigh, for instance-- isn't also caused by nerve pinch by one or more vertebrae? IMO, they've bought into chiropractic argument about sciatica, and just aren't analytically, scientifically, examining all the possible sources of that pain-- such as trigger points, which very few MDs accept as real.
"Therefore, I believe the Mayo Clinic and the medical profession are 100% wrong. To me, this is the deciding point: if the pain extends down only one leg, then the only logical treatment is what you and I and other skilled LMTs do-- seek and eliminate trigger points in piriformis and other muscles that can clamp down on the sciatic nerve."
In reply to another Wallis posting, I said: "So, even advanced trigger point therapy wouldn't have helped you. I believe that trigger point therapy would alleviate 99.9% of what Mayo Clinic and chiropractic profession falsely equate with vertebral problems. "
You read into my comments what you wanted to hear: something to attack me personally with. As I said without stuttering, I believe that 99.9% of all diagnosed sciatica cases can be cleared up with trigger point therapy. I stand by that figure, even though my close friend and mentor has said that approximately 15% of sciatica sufferers he has treated did have "some sort" of spinal issue.
Gordon, in the years I've known you, you've graciously shared details of scads of cases in which the complaint was sciatic pain in legs and hips-- and not one of those cases you've described had to be referred to another medical profession. You successfully treated the pain with...trigger point therapy.
To you both I point out that researcher-statisticians-journalists say that of the more than 500,000 spinal surgeries performed every year, more than 90% are unnecessary. (http://www.toyourhealth.com/mpacms/tyh/article.php?id=1447). Now, most surgeons are diligent and honest, no doubt, and take extraordinary efforts to avoid subjecting their patients to the trauma of the knife. True, it's unlikely that all 450,000 victims of unnecessary surgeries referenced on that website would have had their problems completely eliminated by a few sessions with a trigger point therapist, no matter how skilled the therapist. But, as the Mayo Clinic admits, almost all such cases clear up on their own if the body's own healing processes aren't interfered with too much. Hell, left alone, many probably not most trigger points eventually dissipate without the touch of a therapist.
Pueppi Texas said:Gary W Addis, LMT said:
Dear, my by saying "short career" I was speaking in comparison to Gordon's 34 years as a massage therapist.
Gary, I am not your “dear”. I have noticed that you deflect to sarcasm when you are angry. So, I see that you are getting frustrated. The only buttons that get pushed are the ones you let get pushed.
I don’t particularly like your style of communication either. You have a tendency to try to bully about and become nasty when you don’t like someone.
Believe it or not, I have read up on you and am aware of your prior career, but thanks for putting it out there again. Name dropping does nothing for me, by the way.
I wrote why I was disturbed by your comments. If you don’t find merit in that, I am sure you will continue to keep on doing what you are doing.
My best.
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Permalink Reply by Gordon J. Wallis on
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One of my clients had a breakthrough after her fourth trigger point session.. I comented about her on this thread somewhere. Anyway she has been diagnosed with fibromyalgia and in pain for years. She was noticibly depressed when I first met her. She pretty much, with the exception of her lumbar spine, had a trigger point every two inches.. After an hour,I didn't even get to her legs.. Today, her 5th session, I got through her entire body in 25 minutes.. Her spirit is back as well. She has been hurting for years. And she has been to other therapists as well as medical doctors.. No one addressed the trigger points. The simple reason she is getting better is because I am addressing trigger points. So a lot of pain on this planet, I know with all my heart and sole, is trigger point pain..My guess is about 85%. And a great percentage of that trigger point pain is not being diagnosed as such. The lady I just mentioned above was suffering from massive amounts of trigger points. At least 60 painful points that made her flinch and vocalize in pain when lightly to moderately touched.. She has maybe 20 trigger points now. So there is more trigger point pain out there then most people think, including professional healthcare providers. For me that's my truth. Anyway, as far as arguing and fighting in here, I don't feel angery or upset with anybody. I've got too many real worries to worry about like a disabled mentally ill wife. Pueppi, I have spoken ill of other types of health care providers in here. And I shouldn't. And I just want you to know that I have learned a lot from those very same types of health care providers as well. I owe my skill set , passion, and inspiration because of them. I've studied very little massage Continiuing education. I owe my success to Chiropractors , MDs, Osteopaths, Physical Theapists and especially Acupuncturists. And Gary I write in here as you know because trigger points, dispite the fact that they have been known about for years,are often never considered in any kind of pain diagnosis. And you are right. I have written about a lot of people that thought they had nerve pain, when it was trigger points. But 99.9% of all sciatic pain is not trigger point pain. I consider myself an expert on trigger points. But I'm also an expert on herniated discs. Not through formal schooling,but by being a herniated disc myself. I know a herniated disc intimately. Horrible burning pain with no palpatory trigger point involvement what so ever. And nothing can be done. I've Been in bed for a week with low back trigger point pain. Couldn't move without pain. But as long as I didn't move, I was pain free. That's not the case with a herniated disc. I was constantly rolling and dragging myself on the ground moaning. No sleep. Just drift off moments at a time. Not one position longer then a few moments at a time. Tons of Advil and Tylenol. I knew it would take a long time and did not want to become addicted to pain meds. Going to the bathroom was excruciating pain. But Gary you are right to say that surgery is not needed, unless things happen such as loss of bladder or bowel control. The only thing is that it's so excruciatingly painful and takes months to over a year to heal.. Most people can't take the pain and afforded to miss work. so they get the surgery. I'm fine now. So it does heal by itself. Took 14 months. People do get herniated discs. And I'm sure that the percentage of those kind of people are higher in big pain clinics compared to nice spas where I work. The herniated disc I knew intimately. I would not let any chiropractor ,physical therapist or massage therapist touch me. Trust me they all offered. If my lumbar spine was touched with any pressure over what is described as light. I would feel a nauseating burning pain in my back and into my groin and thigh all the way down to my foot. The patterns somewhat shifted at times. Anyway.. Not arguing, but I think the percentage of herniated disc and true sciatic pain is higher then you think. Just to qualify things more. By sciatic pain I mean nerve pain with no involvement of trigger points from the low back, into the hip and down the leg front back and or sides. But it's still rare compared to trigger points. Check the attachment below. Everyone has seen it before. But this lady suffered needlessly for ten years! She thought that she had perminent nerve pain. She saw medical professionals that knew nothing about trigger points. Just read what she says. But like I said in a couple paragraphs above , there are medical doctors that are very aware of trigger points and the pain they cause. Also Gary my friend. The Mayo clinic has actually proven the existence of trigger points. They have photographed them somehow with powerful imaging equipment. So I'm sure that the docs in their pain clinic check for the presence of trigger points. And if they say you have a herniated disc that's causing dibilitating pain down your leg. I'm sure You could count on that diagnosis. One more interesting thing. My herniated disc as bad as it was.. Was healed and gone in 14 months. Trigger points can stay for decades. The lady in the attachment had hers for ten years.
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http://www.arthritis-allergy.net/index.php/articles-and-publication... This fits into the above discussion. Real sciatica or what I call fake sciatica. I think this tells it as it is.
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The attachment below fits in as well. As Dr. Travell worried about. There really is a lot of misdiagnosis of pain because of the lack of knowledge about trigger points. I almost think I should end this thread again. But I probably won't.
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All true, Gordon. But there was no confusing your intense pain as mere trigger points. Discogenic pain is not remotely similar to trigger point pain, not gonna be confused with trigger points by me or anyone else. But the reverse is not true: many MDs and most chiropractors do mistakenly label myofascial trigger point pain as spinal problems needing time on a DC's adjustment table and/or a surgeon's operating table.
I know you realize that most vertebral subluxations begin with a single tiny, "inconsequential" trigger point that if not treated will recruit opposing muscles up and down the spine-- individual vertebrae will be pulled this way that way. In 1981 while preparing for a competition, I hyperextended my hips doing flat back leg presses with 500#, causing S-3 to slip out of position-- yes, the pain was excruciating-- which obviously caused postural distortions from top to bottom as the body adjusted spinal erectors tension in order to keep the eyes level. In Xrays my spine resembled a snake. A skilled DC needed six weeks to correct the problems. It was bad, Gordon, but not as severe as yours-- I continued to work my day job, train my clients, and train the unaffected parts of my body despite the pain, and later that year I won Mr. Georgia.
A grandson undergoing a teen years growth spurt, and taller than the other kids his age, slumped and slumped, exaggerating a genetic abnormality into severe kyphosis. His family lived hundreds of miles from me, but when apprised of the situation, my wife and I moved literally next door. I released tps up and down his spine, without making a bit of difference (except a very temporary pain relief). I urged his mother to take him to an orthopedic specialist, because as he grew I knew it was going to get worse. During a 12 hour surgery, he was cut open from C2 to sacrum, his spinal column pulled straight and then secured in place with titanium bridging-- his height instantly increased by seven inches! The pain during the year-long healing process was excruciating; his surgeon encouraged me to begin massage treatments (including TP releases) while he lay abed in the hospital.
The unfortunate truth, as you well know, Gordon, and as Pueppi ought to, that some well-intentioned and some unscrupulous chiropractors adjust clients three times a week for months or years without ever bringing about any improvement in the client's pain and movement restrictions. They may or may not be aware that the client would be helped -- cured even-- in one or two trigger point sessions with even a minimally skilled massage therapist.
Gordon, my expertise was unjustly criticized by Ms Pueppi. I spoke truth then as I do now. But, as you so often say, have been saying for years, "The truth remains hidden"...that 85-95% of myofascial pain (wherever it arises, in spine, in shoulders, arms and hands results from trigger points.
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https://www.painscience.com/articles/sciatica.php
This artcle points out why truth is often hidden.
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A client came in that recently had surgery on her right ankle do to a fall. She walked with a distinct limp do to the surgery and a removable cast on her right ankle. She wasn't using crutches. She told me that her back was killing her, as well as her hips and the sides of her legs. With the right hip and leg being the worst. She came in for an 80 minute massage and I figured that she didn't want me to go right into trigger point work. I had plenty of time anyway so I let my regular massage do some assessment for me. Her back and neck could take firm pressure. Her coment was that it was sore but felt good. However with her hips, there was a bit of flinching, although that felt good too. Same with her legs. I didn't massage the sides of her legs. I was able to massage her feet just fine, avoiding her injured ankle. The surgery was only two weeks ago. Anyway while she was prone the massage lasted about 45 minutes. Then I went into trigger point mode. Here is what I found. Several lateral spinous tender points on her neck, T spine , and lower lumbars. A TFL trigger point on her left hip. As well as a glute medius trigger point. On the right hip she had a glute medius, a SI joint trigger point as well as a piriformis trigger point. On her right leg she had a trigger point in one of her hamstrings and another on an inner thigh muscle. She had three Vastus lateralis trigger points on her right leg and only one Vastus lateralis trigger point on her left leg. When she turned over I found one trigger point in the middle of both left and right quad. I also found three trigger points in her right anterior Tibialis . I also found three very painful trigger points along her left sternum. All the trigger points deactivated. She felt really good after her massage. I told her, and she knows that I can help her. However, she has just started her physical therapy. And there was no use coming back for trigger point work until after her physical therapy is completed, if she is still hurting. Which would not surprise me do to the amount of trigger points she has. Anyway that was cool though.
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the smiles of relief from a client you've helped are worth triple the payment, aren't they. Good job.
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A client recently came in with chronic right hip pain. I explained to her that a massage could help and definitely would feel good. But if she really wanted help with her chronic hip pain, it would require trigger point work. And that I was sure other areas of her body were involved as well. She gave me permission to to my trigger point work. The sole cause of her hip pain was clearly from trigger points. The ususal glute muscles, sacroiliac joint L5,L4 trigger points, several other paraspinal trigger points, mostly on the right side. Four cervical trigger points. A few lateral spinous trigger points with a really bad one on the right spinous of L4, a milder one on the spinous of L3. She also had a right SCM trigger point. Last but not least she had three abdominal trigger points, two of which were on the right side. Now I could have just released her hip and low back trigger points and then carried on with a massage. Now some clients that's what I would have to do, because they demand a massage. But I know now that the body is more connected then most people think, and that it's much more clinically effective to eliminate all trigger points on the body..And I see a more global view of things a lot easier when I look at the body as having only eleven muscles( my eleven muscle method ). Her trigger pointed muscles were mostly her right back muscle and to a lesser degree her right front muscle. They harbored most of her trigger points. Anyway she felt better and understands that she will need a few more sessions before there is a resolution of her hip pain problem. I don't know the future of course, but there should be a resolution because it's trigger points all the way. Another reason is that she has very good muscle tone. She is healthy and fit. She also knows that she has to stop working out as well, If she decides to follow through with the trigger point therapy. I think she will. You can see her right front and right back muscle in the attachment below..
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As a side note to my entire thread. I just finished going through the latest of ABMP magazine. I didn't read every article in detail. I speed read. I am so different in how I think compared to what I saw in those articles.. I don't know. Maybe I will save them and re-read them ten years from now and see if I still fill the same. All this emphisis on fascia and structure makes me think of this really cool quotation. --- "In many schools, teachers and students alike are led away from the door which I believe they must enter. Consequently, they grow enamored with the landscape along their paths, and many stay there and consider it right. Thus, one sees them making a great uproar over the most insignificant educational theories and arguing among themselves over what is right and what is wrong. The landscapes along the way are merely appearances fashioned within the framework of the mind. As reguards to the landscape, details could be discussed without end."
CHOZAN SHISSAI, 17th-CENTURY SWORDMASTER
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The articles about fascia were informative about the anatomy; didn't try to instruct anyone on how to treat it.
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I know. And it is interesting. But when I work. I'm not thinking about fascia. Not that people have to think like me. But I find the importance of fascia, not that important when it comes to helping others out of pain. Just my opinion.
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