Trigger Points

Comment

Comment by Larry Warnock on August 29, 2011 at 9:08am

I don't feel the need to "extend" my statements.  Suffice it to say  that a trigger point therapist is a very advanced massage therapist who has studied the body far beyond the "storefront bodyworkers".  Like all my patients, I want to kinow something about lifestyle as I believe that stress, work, family, nutrition, etc. may be factors. for many of my patients, I am the first one who actually cared about them beyond prescribing pills. And, unlike many, I am still learning even with 40 years experience in trigger point therapy.

 

 

Comment by Boris Prilutsky on August 29, 2011 at 8:51am

Hi Larry .

Can you please extend  on following:Is  trigger point therapist represent separate ,individual fields and not belong to massage therapy fields /scope of practice? I mean if not difficult please define who is consider to be a trigger point therapist. What exactly one does and how ?

Please extend on what does it mean :”deep language of trigger points”?

you said:” once must have high level skills in palpation” Can you please to explain  what one have to feel under fingers?

 

You said:” a trigger point therapist must also be able to interpret lifestyles, the client's nutrition, etc. ? Can you please extend a bit what kind of consultant in this regards trigger point therapists should provide?

You said:” Trigger points do not just hide in a muscle.  There are multiple potential causes and we need to know them all in order to treat well and efficiently.” Can you please extend on causes that leading to trigger point developments?

Up front thank you.

Best wishes.

Boris

Comment by Larry Warnock on August 29, 2011 at 7:39am

Valerie:  I agree with your assessment.  You cannot become a trigger point therapist by attending seminars in lovely hotel ballrooms.  Most schools only touch on TPT and many people are trying to re-package the whole process in order to host seminars, etc.

Beside learning the deep language of trigger points, once must have high level skills in palpation..another "also-ran" subject in most schools.

coupled with the palpation and thorough knowledge of the body's sytems, including muscular, neuro, etc. a trigger point therapist must also be able to interpret lifestyles, the client's nutrition, etc.  Trigger points do not just hide in a muscle.  There are multiple potential causes and we need to know them all in order to treat well and efficiently.

Nice work on the books, etc. by the way.  It is good to know that there are several of us who know this field.  There is no one guru...they are both dead, unfortunately.

Comment by Boris Prilutsky on August 28, 2011 at 9:52pm

Hi Valerie.

Your original post was sound  like you looking for some answers, therefore I respected it  by extended post. If you would with no fear to appear  like an “saleswoman “start discussion then we would save some time. In any case I believe that my previous post/reply to you contained some information related to subject. In any case you did introduce your books, and I cannot see any wrongdoing. Most important is that during us discussing including agree and disagree, members will be able to learn some.

Phenomena of trigger points developments is presenting not only in cases of mechanical pains. For example motor trigger points, in most cases is a result of spinal nerves/roots irritation and/or compressions, but myofascial dysfunction could be developed because of spondylosis as well due to like you said:” one stress activates the [trigger point], then other factors perpetuate it.” Let's keep in mind that  constant physical overload of skeletal /muscular  system could trigger myofacial pain including trigger point developments. Therefore trigger point therapy is  not solo procedure but  the one equally important modality, additionally to must do, superficial and deep fascia mobilization that leading to fascia  tensions release , muscular mobilization as well post isometric relaxation techniques in order to balance an energy production within affected muscles.

This is like wishes cycle. Due to mention above factors, trigger points will be developed, and at the time of the treatment if trigger point will be not adequately treated, then only fascia /muscles release will be not successful effort to  treatment outcomes, because presence of trigger points will not allow successfully to treat muscular pathology, at the time only trigger point therapy, with no releasing tension within  fascia and muscles, never will allow to sustained results. Therefore I believe it is not really practical idea at seminars to teach trigger point therapy only, as well to address all possible muscles like temporalis, upper trapezius, posterior neck, and sternocleidomastoid muscles. Usually when teaching medical massage 8hrs,-16hrs  seminars we presenting only one subject. For example ASM syndrome. Where participants introduced to ASM syndrome pathogenesis,ASM origin and insertions, as well most of the time practicing all hands-on techniques that I mentioned above in relation to ASM. When focusing on one pathology for  each seminar, I believe it is enough 8 to 16 hours. Of course success of seminar depend in two parties. I mean instructor  have to be competent and desired as well students have to leave ego at home, to accept instructor’s authority to learn from, and to adjust  mind to learning “frequency”. In such a case we creating productive energy and during this not long seminar learning well.

BTW. Did you had an opportunity to read proposed at  this  discussion ,my and Dr.Ross article on subject? Would like to know if information with in is useful.

Best wishes.

Boris

www.medicalmassage-edu.com

 

Comment by Valerie DeLaune, LAc on August 28, 2011 at 8:46pm

Hi Boris - I guess I should have explained my background a little more, but I didn't want it to sound like I am on here to sell stuff.  I have written 5 books on trigger point techniques (the 5th comes out April 2012), I write articles for professional and lay publications, and I teach trigger point continuing education classes.  I think 15 hours of trigger point training barely scratches the surface (no pun intended!), and does not qualify someone to claim to be a trigger point therapist.  There are several good trigger point programs around the U.S. (sorry, don't know what is available elsewhere), and if someone is serious about becoming a trigger point therapist, they should enroll in one of those programs if at all possible.  Most are set up as a series of weekend courses.  The NAMTPT website lists some of those programs, but there are others. 

At the least, a therapist should read/study both of Travell & Simons books and have a very good understanding of muscular anatomy, including being able to locate muscles on the body (you'd be surprised how many people come out of MT school & can't do that).  They should be able to list which muscles they need to check for trigger points based on referral patterns (or at least know how to look it up)  i.e. if a patient has temple pain, they need to check the temporalis, upper trapezius, posterior neck, and sternocleidomastoid muscles for trigger points.  You'd be surprised how many people have a hard time "getting" that.  Some people understand that easily, but it is difficult for a lot of people. 

As for perpetuating factors, according to Doctors Janet Travell and David G. Simons, “If we treat myofascial pain syndromes without... correcting the multiple perpetuating factors, the patient is doomed to endless cycles of treatment and relapse....Usually, one stress activates the [trigger point], then other factors perpetuate it. In some patients, these perpetuating factors are so important that their elimina­tion results in complete relief of the pain without any local treatment” (1983, pg.103).

So that is why I think 15-30 hours isn't enough.

Best wishes,

Valerie

Comment by Boris Prilutsky on August 28, 2011 at 4:15pm

Hi Valerie.

Schools including professional and vocational, in my opinion cannot provide education in details, and for all subjects, that we are facing in treatment room. I believe that this is role of  CEs programs. 15 - 30 hours of training, if will be provided in productive way, and mostly hands-on in my opinion can allow one to learn subject to  the point of immediate implementation in treatment room.

Actually  how significant and complicated  trigger point therapy sounds , it is a bit simpler. At this discussion I offered links to trigger point therapy scientific review articles, that I believe containing  important and useful  information as well below you will find link to my short video clip where I am explaining ischemic compression as a techniques for trigger points therapy. please keep in mind, that by many means trigger points can be stimulated including using acupuncture needles that you using for  IMS . The mechanism is a bit different but leading to trigger point elimination, which means restoration of arterial blood supply. This nonsignificant hemorrhage that your needle will cause, will attract and trigger killer cells to the trigger points which can be delivered by increased blood supply only. With other  words, will restore the blood supply the" Demand and availability." As you can see, there is many different ways to address trigger points, but all treating the cause and not symptoms only. Please let me know if I was helpful and feel free to post any questions. Will try to answer to the best of my knowledge.

http://www.youtube.com/watch?v=PgisAtZJ7k4

Best wishes.

Boris

Comment by Valerie DeLaune, LAc on August 28, 2011 at 12:28pm

I started out as an MT and then went on to get my acupuncture degree.  With my acupuncture license, I am able to treat more perpetuating factors, but I still can't order lab tests.  I think it is far more important to understand which muscles need to be checked for trigger points and how to identify and eliminate perpetuating factors (or at least to recognize who to refer your patient to), than needling vs. manual therapy.  At this point, it is much easier for patients to find a massage therapist or physical therapist who knows about trigger points, than to find an acupuncturist or doctor who understands how to treat them (at least in the U.S.).  Though I think a lot of the schools aren't spending enough time on trigger points -- only 15-30 hours or so, which isn't near enough to get a firm grasp on the subject.

Comment by Boris Prilutsky on August 28, 2011 at 11:58am

Hello Jeff and Larry.

Thank you very much for replying. Jeff you absolutely right, addressing trigger points by hands and fingers was briefly mentioned in this two volumes manual  and only one time. And this is the reason why I always thought that Dr.Travell never did advocate hands-on approach.

But today and because Jeff was student of Dr. Travell, and claiming that she used to advocate our approach then I have no reason for a second thoughts in this regards. Thanks for information. As an professional  I grew up in the country where authority in the fields, like Dr. Travell  when advocating methodology, then most of the published  texts and papers used to dedicated to this methodology as well use to practice it. I spent considerable time to study Travell/Simons manual. Great work. Great presentation of pathology  and much more. The only problem that I personally see,is that a lot of massage therapists who may be possessing  Travell/Simons manual but never learn from it,or just know about this book and Dr.Travell famous name, and then using social media and even professional publications, spreading “nonsense”that in some cases as a professionals, we can adopt as an  correct information. We have tendency, and even on this site, to be polite and nice and not to confront in discussions this nonsenses. Simply speaking ,this is wrong. Because in the end it will harm our industry. We must sound, scientifically and professionally, otherwise doctors will not refer to us, but most important we must no harm to do, as well to achieve results. Using the opportunity, would like to call you to confront this kind of nonsenses using correct information. Otherwise I will have to stay lonely bad boy.LOL

Best wishes.

Boris

Comment by Jeff Sims on August 27, 2011 at 6:40pm

Yes Larry ~ Dr. Travell also focused on identifying & eliminating initiating & pertuating factors and avoiding the pain & dysfunction.

Comment by Larry Warnock on August 27, 2011 at 6:34pm

injection was one method of eradicating triggers but Dr. Travell was much more interested in eradicating them manually with finger pressure.

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