hello Mike..thank you much for your interest..what do you do about those stubborn TP's?

I have a client who presents with the same TP week after week, and though it is smaller than its original size, it's still there, still causing that nagging P! for the ct. Thoughts? Suggestions?

my experience working with those darn TP's has been..interesting..depending on the person..when the person does home care..such as tennis ball or avocado seed compression..definately helps and I have had some luck with stretch and release techniques & isometric contraction technique..I hold theTP until either ; patients's pain has diminishes massively , or, theTP softens or evaporates beneath my pressure.I have also changed my direction of the pressure itself..MFR has proven results as well..it helps when the person opens that space tho.. have you ever used the spray and stretch technique or dry needling?

My tie to TP's comes through Bonnie Prudden and Myotherapy. Bonnie was the first person I inducted into the Massage Therapy Hall of Fame in 2006. Since, we have become good friends. Her book will be coming out and I hope everyone reads about this fascinating woman. The phrase, "They don't make them like that anymore," applies to her more than anyone I know. She did so much for our profession. Read the book!

can you get rid of TP's?

I can!:)

how do you get rid of TP? I have several clients who have them all over their backs. I try a lot of compressions as well as longitudinal release and cross fiber but TPs are definitely still there at the end of the session. I would sometimes try holding the points until they melt away but the number of points is wo widespread, I was wondering if there's a more effective way to handle a large amount of TPs on one client.

Nuts it's not TP
Muscular pain or any kind nuts possible after injuries or bad postural habits, also possible secondary dysfunctions: like injury on one side and body trying protect and overuse muscles on other side, in time there developed nuts because muscles there never relaxed, tight muscles compromised lymphatic circulation and finaly build nuts.
With nuts good if you warming up area before work, increase circulation by deep massage area compression help to if applied not direct on nut, but on mayo fibers below or above to nut, so you pull mayo filaments away from nut, stretching muscles belly (not tendons!)

Hi all, my findings over last 10yrs = yes you will be able to eradicate 70 to 90%
of TPs depending on your methodology and the age of the TP. this is the most sucessfull and rewarding part of my massage practice.
The TPs that wont respond that drive me nuts I understand to be called myogelosis.This is the hardened dead nucleous of an aged TP. Please see Boris Prilutsky's article in arcticalbase.
Regards steve

anybody know of any good TP CEU classes in the midwest- Milwaukee, Chicago, Indianapolis? I know embarrassingly little about trigger points- how they originate in the body... is it more muscular overuse, improper posture, tension holding patterns, psychological stress manifest, all of the above??? And I'm really eager to learn more.
Oh! So, I had something kind of strange happen. I was working on a client- in the traps between spine and scap on her right side, when I guess I hit a trigger point, because she could feel the referred sensation on her left arm-hand. Any ideas what might have been going on?

also- what's the difference between a regular old knot and a trigger point- anything else besides referred pain?

http://www.articlesbase.com/alternative-medicine-articles/trigger-point-therapy-85527.html
This is the direct link to the article to which I refered earlier. I hope you find it as interesting as I did.
The age of the triggerpoint can directly relate to its release/referal potential.
New triggerpoints can melt away in one session. The older they get the more in crisis the muscle = the more fibrotic the fibers become, spreading along the length of the muscle. Cross fiber friction works well with this condition. Keep in mind you are treating a condition that may have taken years to build up and as Chris has already mentioned you wont see immediate results at the end of the session. This is because the theraputic inflamation induced by cross fiber friction takes time ( days sometimes weeks ) to remove the fibrotic condition, ( I allow at least a week between sessions) each session should see improvement that is easily palpated.
The treatment is safe and effective but be carefull not to overtreat the area (especially with new clients) as a certain level of soreness is to be expected. On occasion you may have a client who finds the crossfiber element nausiating or the site holds strong links to a emotional crisis to which they are not yet ready to release. In these cases a more gentle approach is more appropiate.
Regards steve

Hi Henry thats very interesting what you say about spray and stretch.To have that personel experience of treatment is vital.
Do you have any particular TP method you prefere?
Regards steve

Henry - it is vital that clients change their habits, though sometimes it is very difficult eg, perpetuating factors can be due occupation or sport.
What do people know about the nutritional component to Trigger Point Relief? I am doing some research and want to write more about it. I feel it is an often neglected topic.

I have know about trigger points for almost 10 years, but have only really begun to explore and learn more about them professionally in the last 2 years. Great to see all the different perspectives.

Hi Henry, have you got any research evidence re nutritional factors you can share with us?
I am only aware of the Ischemic and ADP crisis theorys.
Regards steve

Have you seen this article by J Muscolino.relating to deep stroking of TPs and the use/duration of Ishemic compression.
http://www.learnmuscles.com/mtj%20TrP%20article%20-%201-08.pdf
I do use deep stroking but after leaving the area for 5+ minutes will return to apply ishemic pressure to the TP up to 8, on a 1 to 10 scale as the muscle "melts" over a 5 to 25 second period. 90% of the time never needing to go above a 4 on a 1 to 10 scale.
The article sugguests as the TP is already ishemic, yet more ishemic pressure is not needed ?
What do you think? what is your method?
Regards steve

I am just starting to do more research on TrPs. Thanks for the article link. Yes, TrPs are already ischemic, you can make it more ischemic with the stroking, however you are also changing the neurological signal, to the contracted sacromere, which is is not relaxing. There has to be some other neurochemical, physiological component too.

Thanks Stephen for the link, great show there what happen in that kind knots. I do agree with time of application of the pressure, and return to area in some time (I never look on timer) but same concept.
In this cases I mostly use deep slow strokes with fixation of attachments (if can), then work on another side same, then return there again so its probably take 5+m, on second time I and clients often fill stretching "pups" in muscle belly, also clients tell me they fill numbness in area after return (body produce endorphin)

Hi Alex, Alfred and Henry, (and anybody else ) did you read Boris Prilutsks article, do you have an opinion ?
http://www.articlesbase.com/alternative-medicine-articles/trigger-point-therapy-85527.html#
I find to get the best release of TP you have to go through a range of strokes (taking several minutes) to prepare the TP for release. Can there ever be any shortcuts (less physical) in palpation/preparation in your view?
Alex , if I get a pop it tends to be the nearest vertebre adjusting ala osteo/chiro but without the high Velocity Thrust!
Regards steve

My thoughts are that as the tissue is already ischemic and may have been so for some time, days months even years, ischemic pressure for another 5 seconds or even up to 2 mins longer wont do any harm.( sometimes you do have to wait a long time for muscle melt) I agree with you Henry, preparation and pinpoint accuracy are so important.
Regards steve

A client recently brought an issue to my attention related to TMJ and tinnitus related to a trigger point in the sinus cavity. Has anyone heard of this situation, as I would like to gather some information to help my client with his condition. Thanks!

Dear Group
I have been listening to the verious discussions re Trpts and thought I would put my 2 cents woth in.. Firstly I believe in creative spelling :)
Although I agree with both Steven and Henry on the Prodrama to the actual trigger point release I have to differ on the general application. I think we have to alway start with a accurate assessment with a measurable base line, next clear for injury followed by application of corrective treatment (Fascial release, and Trpt release, plus breathing exercises and postural correction). I think it is easy to fall into the trap of specific treatment. It is to easy to loose sight of the overall effect. The qusstion is not how to treat the trpt but why is it there in the first place. Multisystem approach (like Osteopathy). We need to avoid recipe type approaches and, instead use assesment based and evidence based aproaches. Check out http://www.fasciacongress.org/2009/abstract_pdf/J_088R%20Vagedes%20Myofascial_Release_Triggerpoints_DeepBreathingTraining%5B1%5D.pdf
If the link does not work go to http://www.fasciacongress.org/2009/abstracts.htm then under section six click on •Myofascial Release in Combination with Trigger Point Therapy and Deep Breathing Training Improves Low Back Pain
I look forward to your thoughts.. Your,
Don Solomon, RMT (Vancouver BC, Canada)

I agree with Don Solomon. This is our approach to TrPs, Fascial Stretch Therapy and movement correction. Many chronic active TrPs are caused by muscles which are under eccentric load (locked long), the latent ones are locked short. Address both sides with patient movement education to get the muscles and joints into more optimal and efficient and operationl lengths (Thomas Myers, Anatomy Trains).
As Travell and Simmons say, some times there are factors such us Stress, increased cortisol and nutrition which affect muscle metabolism (not often addressed with patients/clients).Other times there are unchangeable factors like structure which affect biomechanical load (length length, scoliosis), so TrPs need to be addressed on a regular, long term basis - and will not ever fully "go away," but they can be diminished.

Don - really looking forward to speaking with you after the Fascial Conference. I am going back to Arizona for the Level II Upper Body Fascial Stretch Therapy

Hi Alfred that all sounds good to me.
What is your or the groups experience of rib elevation in the upper thoracic area, as a primary factor, in chronic TP formation in shoulder joint muscles.
Regards steve

Thank you for the great information Henry. I have been working with the TMJ muscles along with the masseter and scalenes on my client with some relief for the tinnitus. He had spoken with a chiropractor who mentioned the sinus issue, so I wanted to check it out. I will definitely consider your recommendations for the foot and leg trigger point work as well in my client's next session, as he does exhibit some signs of postural distortion in the neck shoulders and back. I appreciate your feedback and I will keep you posted on progress with this situation.

I am not sure how Clair is doing, but have heard he passed away. This is unconfirmed though.

Hi Alfred and all, I just came across his obituary .Dec 29th 2006
http://www.legacy.com/obituaries/kentucky/obituary.aspx?page=lifest...
I didn't even know till now !

Stephen, thanks for sending the obituary. I can't believe Clair has been gone since 2006, and we are only finding out about it now! Very sad...and a big lost to our profession.

I use Biofreeze to lower the pain during stretch and it reduces the pain after.

Clair did make very big contributions along with Amber who published several very good books for the general public to understand and use to help relieve their own trigger points. Thank you.

Clair Davies lives ! wonderfull reveiws on amazon.Is there any other self treatment book that comes close ?
http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Treatment...
Is this book the greatest mechanism in uniting public therapist/travel simons ?
As MTs should we be doing more to promote this unification?

Yes, Clair does live on through this wonderful book. I just recommended this self-help book to someone on facebook, who is experiencing back/leg pain and he wanted to be able to do self treatments (told him to get it on amazon!)...and recommend that most of my clients get this book after they have been under trigger point care with me for a while, so they will be able to help themselves at home in between sessions. We carry it in local book stores here. Clients really like it when you go that extra step to promote helping oneself...they refer other clients in to see you! Hope this book stays in print for a long time.

Hi everyone,

I invite you to read the article I wrote on TrPs for mtj. You can access it at my website, www.learnmuscles.com and click on the articles page. Specifically, I invite a discussion on the relative merit of deep stroking massage versus sustained compression as the treatment technique of choice for TrPs.
Joe

All research that I am aware of so far shows that a TrP is NOT mediated by the nervous system. It is due to local ischemia that results in a decrease of ATP molecules resulting in an inability to break the cross bridges and an inability to resorb the calcium ions that are already present. Given this, then what value would causing and "holding" further ischemia have?
The goal of the deep stroking (or the release perhaps of the sustained compression) is to decrease the ischemia, not to increase it.
See also pages 40 and 41 of the second edition of Travell and Simons.

Actually that is pages 140 and 141 of the second edition of Travell and Simons, to discuss Trigger Point Pressure Release versus Deep Stroking Massage. Great discussion! I'll get back later with further response on this subect...

i use muscle stripping frequently, but doesn't it depend upon the location & type of muscle? for instance, subscapularis, iliacus, psoas major, medial & lateral pterygoids, longus coli & capitis, etc. i use compression a lot. i use it as a warming technique and for releasing muscles like those listed above.

muscles that seem suited to "stroking" or muscle stripping: erector spinae, forearm flexors & extensors, quadriceps, hamstrings, with permission gluteus maximus, medius & minimus, anterior, lateral and posterior compartments of the leg, posterior cervicals, scalenes, SCM, pectoralis major.

Here's Clair's version of deep stroking over ishemic compression.

http://www.massagetherapy.com/articles/index.php/article_id/485/Tri...

Thanks for sending Clair's article, Steve...it helps to clarify. I tend to not hold TrPs very long, but do the 'repeated milking action' or kneading the TrPs, because holding compression can be painful for the patient and hard on the practitioner as Clair mentions. And I really do like the 'microstretch' involved with deep stroking massage...very efficient use of time and energy. Either method works...depends on what works best for that specific patient and the practitioner.

working within the pain threshold? Clair suggests:
"The level of pain caused by massage is a useful measure of safety and effectiveness. To gain maximum benefits, you should exert enough pressure to make it hurt a little, but it should feel like a good hurt. Aim at a pain level of seven on a scale of 1-10. Pressure greater than seven risks causing the muscles to tighten defensively. Self-applied massage is best done in very short sessions, 15 or 20 seconds per trigger point. Several brief sessions during the day do more good than intensive treatments once or twice a week. Keep in mind that massage only helps create conditions for healing, it's the body itself that does the real work."

Can I tell you about my Right Knee problems "healer heal thyself" and all that ?
I used to be a good 10k runner 34mins but a knee problem put me out and dispite the best efforts of myself and a glittering aray of fellow pros we could never sort it out (a huge amount of fibrosis in VM ) I had never really connected to much with Clairs multiple times a day approach of repeated compressions with a triggerpoint tool. I didn't follow his advice exactely but with repeatedly "digging out " the tissue 3/6 times a day with an NMT bar for 4 weeks, the tissue did recover, strenghthened in the gym with leg press I returned to running after a 5 yr lay off with a 45min 10k. So glad I can run again as I find it essential in battling bouts of deppression.

Yes, sorry for the typo in the page numbers of T&S, It is 140 and 141.

wishing you all a very happy TP eradicating new year !