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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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Replies to This Discussion
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Permalink Reply by Gary W Addis, LMT on
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The Gate Theory I think is relied on by TENS units-- create a wee tingle along the nerve path to distract / overload the nerve, preventing in some cases and certainly modulating the amount of the acute pain signal getting through. One of my daughters has an implant along her spine that she can control with remote control (and even charge through the skin). She is pretty much pain free most of the time, and before the implant she was confined to bed for hours every week. Massages did help, but the spinal damage (from an accident, then multiple surgeries) always roared back an hour after she got off my table.Great testimony, Gordon.
Gordon J. Wallis said:The people that make up the patients in this clinic are not the typical cross cection of the community. These patients are the hurt of the hurt. That being said, I think I'm going to be able to help more people then I first thought?
Like I said, there are a lot patients with horrible pain issues that are not musculoskeletal. However, like I've said throughout this entire thread, trigger points are responsible for 85% of all pain on the planet, and involved in almost everyl pain syndromes. So I'm finding that there are patients here that have nerve pain along with a fair amount of musculoskeletal ( trigger points ) pain. So for those people, I will be able to work on the more superficial musculoskeletal side of things while the the doc (anesthesiologist ) will be able to work on the deeper level nerve pain side of things. I can also , to a limited degree, offer some pain relief to those suffering primarily from nerve pain by taking advantage of the Gate Theory of Pain. Light tactile touch stimulating the various skin mechanoreceptors will modulate ( dissipate/downgrade ) the intense pain signals reaching the brain. You can google the Gate Theory of Pain and read up on it. It's interesting. I learned a type of bodywork ( Associative Awaeness Technique) that is totally based on the Gate Theory of Pain. In the spa, I never really had a need to use those procedures, but I do now.
But the real good thing is , there are patients in that clinic suffering solely from trigger points. And they were getting trigger point injections, until now. Most of those patients I will be able to help( dramatically). Because as you know, I'm the trigger point guy. In the attachments below there is a diagram explaining the Gate Theory of Pain, the fluoroscopy room( where the anesthesiologist does his thing) , and a testimonial from one of the patients that I saw the other day.
This is an intense cool job.
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Permalink Reply by Gordon J. Wallis on
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I have a couple of times utilized the Gate Theory of Pain while in the spa. The one I remember the most was a fibromyalgia client. I comented about her case somewhere on this thread. She was so hyper reactive to touch, there was no way I could do my trigger point therapy. Her nervous system was so hyperactive that she started flinching even before I touched her.
I turned the lights down, got her to relax a little bit. And started lightly caressing her body, through the sheet, from her hip to her shoulder , for about a half hour. It desensitized her pain just enough for me to begin my trigger point work. After several sessions. I think about six sessions, her seven years of fibromyalgia was gone. That was cool.
I don't think it will work on everybody, but working in this pain management clinic, I may find out? Now the lady with the seven years of fibromyalgia believed in me, and generally had a positive attitude. Attitude plays a big part as well. There are a lot of factors involved in pain perception, and anything a massage therapist can do is limited for sure. But as massage therapists, it's helpful to aware about the Gate Theory of Pain. After all, what profession is in a better position to lightly stimulate skin mechanoreceptors for an hour then us? Anyway in the attachments below are some diagrams that represent the Gate Theory of Pain.
Something else to realize. General massage, deep tissue work and so on, as helpful as that is...Will not close the Gate as effectively as very light caressing will. We are talking the softest of touch. - Attachments:
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In a continuation on the Gate Theory of Pain and skin mechanoreceptors. It's important to know that there are several different kinds of mechanoreceptors. Some respond to pressure, others to vibrations, just to give two examples. If you really want to get into the pain eliminating effect, you will want to stimulate all those various mechanoreceptors in order to most effectively suppress pain signals to the brain.
Examples would be light caressing, light tapping, light steady pressure. These mechanoreceptors are very sensitive. Who hasn't felt a mosquito land on their body?
Anyway I'm not writing in here as an expert on the subject, but in the case of my seven year fibromyalgia client, I know there is something to it.
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Permalink Reply by Therese Schwartz on
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Gordon, it seems that the gate theory of pain has evolved. It evolved first into the neuromatrix theory, and now we have the biopsychosocial model. It's not that the gate theory is wrong, it has just been expanded. The link you sent me the other day has as the basis of that modality the new biopsychosocial model of pain. You might be interested in reading a bit about it. I haven't read much of this, but it describes the evolution and some of the new thinking about pain. It might be helpful in your new clinic.
https://www.practicalpainmanagement.com/treatments/psychological/bi...
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Oh yeah, there is more to it then light touch. One of the reasons I was able to help that fibromyalgia client was because I got her somehow to believed in me. Like your above information indicates, pain perception depends a lot on what's in the mind. And that depends on a lot of things( culture, experience, beliefs, family support, and so on). Also there is that placebo effect, which is real.
In the beginning, before I even touch the person, I spend a fair amount of time convincing them that I know what I'm doing, and that I can help them. Its not that I want to give false hopes. But their belief in me is important. It makes a difference. It's part of that biosychosocial model of pain.
The other thing is... I don't rip anybody off. If I fail, I fail fast. Usually within four short sessions. But dispite my confidence and experience. The whole thing is difficult. Therese, thanks for the input.
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I recently had a patient, a middle aged man, that was scheduled for trigger point injections. For some people that can be a painful experience, and it didn't seem , in his case, to be very effective for him. So the medical doctor asked me to see if I could help him.
He had right shoulder pain that radiated from his neck to the top of his shoulder and down to about the T2 level , all on the same side. He also had pain on right rotation.
I found two upper trapezius trigger points, one posterior neck trigger point at about the C3 level, a right lateral spinous trigger point at T1, and a really painful lavator scapulae trigger point. All deactivated with only a slight soreness left in the levator. He could turn his head to the right without pain. He will need follow ups, but it's the beginning of the end of his pain problem( at least that part of it). That was cool.
Often times,, not being able to turn your head one way or the other... its a trigger pointed Upper Trapezius and a trigger pointed levator scapulae both on the same side.
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Gordon, I'm sorry I didn't reply to this. It's been a challenging couple of weeks. The placebo effect is certainly real, as is the nocebo effect! Much of what is said to people actually helps perpetuate their pain cycle. Giving them hope that it can get better goes a long way toward breaking that cycle. Yes, it is very difficult. I'm glad to have some useful input!
Gordon J. Wallis said:Oh yeah, there is more to it then light touch. One of the reasons I was able to help that fibromyalgia client was because I got her somehow to believed in me. Like your above information indicates, pain perception depends a lot on what's in the mind. And that depends on a lot of things( culture, experience, beliefs, family support, and so on). Also there is that placebo effect, which is real.
In the beginning, before I even touch the person, I spend a fair amount of time convincing them that I know what I'm doing, and that I can help them. Its not that I want to give false hopes. But their belief in me is important. It makes a difference. It's part of that biosychosocial model of pain.
The other thing is... I don't rip anybody off. If I fail, I fail fast. Usually within four short sessions. But dispite my confidence and experience. The whole thing is difficult. Therese, thanks for the input.
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Sounds like more good work!!
Gordon J. Wallis said:I recently had a patient, a middle aged man, that was scheduled for trigger point injections. For some people that can be a painful experience, and it didn't seem , in his case, to be very effective for him. So the medical doctor asked me to see if I could help him.
He had right shoulder pain that radiated from his neck to the top of his shoulder and down to about the T2 level , all on the same side. He also had pain on right rotation.
I found two upper trapezius trigger points, one posterior neck trigger point at about the C3 level, a right lateral spinous trigger point at T1, and a really painful lavator scapulae trigger point. All deactivated with only a slight soreness left in the levator. He could turn his head to the right without pain. He will need follow ups, but it's the beginning of the end of his pain problem( at least that part of it). That was cool.
Often times,, not being able to turn your head one way or the other... its a trigger pointed Upper Trapezius and a trigger pointed levator scapulae both on the same side.
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Challenging. Working in the spa, I felt like I could help pretty much everybody that was in pain reguardless. Of course I could not help everybody. But a high percentage, yes. And I've filled this thread with a lot of testimonials saying so. But after working in this pain management clinic for a few weeks now, I've never felt so helpless or insignificant in my life. There are those with significant Myofascial pain that I can help for sure. But the percentage of those kind of patients is small, compared to the general population. A lot of trigger point activity in the clinic is superficial and secondary compared to their neuropathic pain( nerve pain). The worst thing I've seen is this Complex Regional Pain Syndrome. You might want to read up on that. I've never really seen it until working in this clinic. It can happen to any of us, from a minor injury or surgery. But anyway here is an interesting patient I saw recently.
His symptoms was a burning pain between his shoulder on the right side, along with complete numbness in his right arm. And it also hurt in certain positions. I found and eliminated trigger points in his infraspinatus, Upper Trapezius, Paraspinals and Rhomboids, Pectorals Major, Caracoid Process, and Deltoid. After the session his burning pain was gone, along with his numbness. Amazing. But he came back the next day in pain and numbness . It only lasted for 45 minutes after he left the clinic. He ended up getting some kind of nerve block from the doc. It lasts him a month. It's intense work. It's where I need to be though.
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I think the clinic may get a lot of diabetic patients. My wife is on two types of insulin, and a couple of pills all to control her blood glucose. She too experiences a lot of nerve pain; some of it I can temporarily relieve with TrP work, and some of it the best I can do is a brisk, light, circulation massage. She is on a nerve med too, and it helps. Eventually a nerve block may be required. You can be sure that the people in such chronic pain are appreciative of even an hour of relief.
You're right: it is where you need to be in order to do the most good.
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This is interesting. I continue to be humbled by my inability to help so many of the patients that come to our clinic for pain relief. At the same time, I am on occasion, able to help those in pain that other highly educated dedicated providers have not.
Recently a patient that is being treated for severe neuropathic lower limb pain. Totally out of my ball park. However she has also been suffering from upper right abdominal pain that nobody has been able to figure out or resolve for over two years. It began for her during pregnancy, and has never gone away sense, dispite medical care.
I got her on my table, and in twenty seconds, her abdominal pain was gone. It obviously was a trigger point. And that's my thing.
In Chinese medicine there is the concept of the front treating the back, and the back treating the front. In the attachments below, you will see me releasing an abdominal trigger point, along with some supporting diagrams. The videos and diagrams are not meant to teach specifics, but you guys should find it interesting?
https://www.youtube.com/watch?v=O2kpk4QfwbE&sns=em - Attachments:
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After 30 years, I pretty much know, with a high degree of accuracy, if I can help somebody or not. I'm talking about helping somebody out of pain. But every once in a while, there is somebody that I feel confident about helping, but disputes my confidence, im unable too? Then at other times ,there are those patients/ clients that I don't think I can help, and I end up dramatically helping them. That happened recently.
This patient had chronic low back and hip pain. But her worst discomfort is her knee. All kind s of pathology and history. Her pain wakes her up at night. When I worked on her I found a few very minor trigger points in the low back hips quads as well as around her knee. On palpation they did not elicit very much pain at all. Nothing to justify the pain level she was experiencing. She was noticeably limping. But anyway I deactivated those minor trigger points as I came across them. And at the end of the session, when she got off the table, her low back hurt worse then ever! And her knee still hurt. I was still very positive with her in my speech and told her everything went perfect from my perspective. The trigger points vanished, even if only temporarily . And that was enough reason for her to try a couple more sessions. But when I said that, I had real doubts ,in my mind ,about helping her. And I figured after the next session I'd tell her that I couldn't help her. Well she came in three days later very happy. She still limped, but not as much. And she told me that sense I worked on her she has been sleeping all through the night with no pain. She is telling her friends about it and all that stuff.
Anyway, I don't have any fantasies about totally curing her, but I can help her. And that's cool. I think a big part of it was my positive attitude. That's a major part of my tool kit. Them mind is powerful.
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