this message is for jaya jeff sims....I go with the clients reaction to the TP. If it is too intense I try to work around it .. letting it go for a while and come back to it.
Most of the time the TP are pretty centralized, as we work on the more intense TP first. Most of my clients come back every other week or once a month for treatment, so we have time to let things calm down before attempting more TP. I hope that answers your questions??
Martha
Very saddened to hear of the passing of Dr. David Simons, one of the pioneers of trigger points and myofascial pain. Right to the end of his life he was still researching and writing. He will be greatly missed. Lets all continue to honor him by keeping up the great work with MTPs.
I have a client with several Piriformis tps on her right lateral hip. When I place static pressure, or strip across its fibers she says she feels it in the front of her hip around the right AIIS. Has anyone experienced a pain referral zone like this? I can't find it on any of the charts.
Thanks
Sunrise Gervais
I am happy to invite you to join my group:” Medical and Sports Massage” including FREE Medical and Sports massage lessons. Not alot of practitioners in the US are familiar with Russian Medical and Sports massage as it was proposed by a Russian physician professor of medicine Anatoly Sherback . I'm happy to offer you information about this methodology as well as some additional information about me. I hope that our friendship will be pleasant and mutual beneficial. I believe in sharing knowledge. In such a case you will be able to learn from me as well as I can learn from you . If after reading information about medical and sports massage, or viewing lessons you will have any question I'm encouraging you to make comments or initiate discussion topic . In such a case my replies will be available for many to read, as well as your replies. Looking forward for great relationship.
i have seen more than a few clients complaining of tension and pain with trigger points in temporalis and the tissue anterior and superior to the ear that also have had cosmetic surgery (they call it a mini-lift) to reduce wrinkles around the eye. this procedure seems to be an initiating factor. anyone else see it?
my approach has been to release the related tissue, including auricularis anterior and superior, temporalis, and SCM. i feel what seems to be the scar and tissue that's been tucked under during the surgery.
Remember that the referral patterns that Travell & Simons mapped were only COMMON referral patterns (and trigger points). Your patient may have UNCOMMON trigger points and referral patterns, particularly if there are multiple perpetuating factors, and the problem has been going on for a long time.
following links is to scientific review of trigger points therapy,including definitions as well proposals for appropriate techniques. If you will have any questions please feel free to ask.
Actually respectfully I have to disagree with nursing class teaching.myogelosis is not really muscles anymore as well to apply pressure or otherwise to stimulate myogelosis is contraindicated.
Attempt to address myogelosis by any means will cause significant pain increase , more hypertonus developments within neighboring not affected muscles etc.in proposed articles we offered definition of TPs including morphology.
Nancy.this site is for professional massage therapist,and when we providing treatment we do not using injections but utilizing our hands and fingers.
Dr.Travell as well any other medical doctors never injected any substance into myogelosis.this ones who did so, caused a lot pain and aggravation to already painful myogelosis.BTW.Dr.Travell never ever did advocate ,addressing TPs by massage techniques.
I am a professional massage therapist and I am trained in NMT. I have Travell & Simon's Myofacial Pain and Dysfunction: The Trigger Point Manual volumes 1&2. I am going to school for my RN degree so I can work on scars, sprains, strains and everything else that other massage therapist can't work on. I am taking my education and professionalism to a new level. I won't get into any debates with you as to what Dr. Travell did or didn't do. The book speaks for itself.
I didn't question if you are professional massage therapist. Just did reply to what you have said:"We are learning to bust them with a syringe."(I am assuming that word" bust" means treating/to address)
I mean massage therapist do not addressing trigger points by injections.in some particular cases nurse practitioner can inject TPs but not RNs.. most of MD ,strained not to inject in cases of myogelosis,including Travell & Simon's Myofacial Pain and Dysfunction Manual ,do not proposing to inject in cases of myogelosis.I believe that any massage therapist, who trained in orthopedic massage can provide treatment in case of scar tissue management, sprains, strains,with out attending RN program.You are right, we shouldn't argue, but all of us on this site, must to try to provide information related to us. We can agree or disagree, but shouldn't argue.let's keep this site on good professional level. Good luck with school.
I never attended nursing school but am a pretty good therapist and can deal with scar tissue, etc. I learned a lot from Dr. Travell herself.. .and, yes, lets try to keep this forum professional...so many people join these sites just to sell stuff. We should keep that to a minimum.
Good to know that you are Dr. Travell's student.really regret that I never had an opportunity to meet this woman, but pretty familiar with her works,including Travell & Simon's Myofacial Pain and Dysfunction Manual.in my opinion it is great books,but Travell & Simon never advocate TPs therapy by hands/ fingers.am I right?if not please extend little bit on it. Thanks.
Actually I am going through nursing to work on the contradictions like sprains and such that they say we can't do. RN's are allowed under direct supervision of a doctor just like botox. I am learning much more to the human body by going to school. I am beginning to see why they complain and want us licensed. What you have to learn to do nursing in my opinion is harder than pre-med. Most hospitals won't allow a MT in the labor room to do pregnancy massage or allow us to work on an incision that isn't healed. As a nurse, I can. I am hoping to bring a better light on our profession by going to nursing school. I think we need bridges.
Second edition, volume 1, page 151, references manual vs. injection techniques. I don't have access to a first edition, but believe Dr. Travell advocated manual techniques and not just injection; she used spray and stretch as well Boris.
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
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.
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.
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).
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.
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.
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?
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.
Larry & Valerie: I would appreciate both of you providing your expert's working definition for the term; "trigger point", as well as providing a brief description of assessment protocols that a licensed/certified massage practitioner might legally use for locating one, identifying its most likely cause and then how to properly treat it.
My concern is the Travell & Simons books were written for M.D.s and published in 1983 & 1992. They present medical opinions & treatment methods that may well be considered by today's M.D.s to be outdated and for the most part are outside of a massage practitioner's scope of practice in the USA.
Of course you don't have to extent if you don't want or cannot to extent. Then why you would make all this 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".”
Larry, With no explaining what is the “advance body studies ”and why and how you “far beyond the "storefront bodyworkers”? This monologues just not useful. What we can learn from it? Or what we can learn from this:” 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.” Absolutely nothing possible to understand or learn from your sentences.
Doesn't matter what is trigger point therapist’s curriculum is, I am disagree with you in regards you being advance/superior. According to many surveys, 90% of Drs. visits are stress related, essential hypertension, anxieties, diabetes type II, clinical depression and more very difficult diseases. There is massage therapists, that specialize in providing full body medical stress management massage (not relaxation but stress management) which is most powerful methodology in stress management. From painful disorders, cases when we incorporating trigger points therapy, people suffering but from heart attacks and other stress related diseases people dying. Why would you feel advance to massage therapists who performing full body massage?
To feel “advance” it's wrong because it dividing our community , and we have to try to stay united, to respect each other, and to try to share knowledge in order to advance entire industry. This is important. More successful outcomes we all will deliver, more recognition of general public and medical society we will get. Second time you replying to me, and do not including my name. I suspect that you feel too advance to call me by name. Another example why it is not good to feel superior.BTW. To feel superior is a symptoms, of not tolerance, anger, bitterness, ego out of proportion, selfdistractions. Wouldn't recommend to feel superior and of course not in professional discussions, because feeling superior and advanced you actually delivered nothing to learn from your statements. Simply nothing.
On this one below I strongly disagree. One who feel superior having close mind and just cannot learn: You said“And, unlike many, I am still learning even with 40 years experience in trigger point therapy.”
Jef...I just finished providing a stress management workshop with about 40 athletes. It is called CHILL TIME. As a psychologist, I developed this because there is no one more stressed out than a student/athletes...except maybe some of our members.
Take a deep breath everyone...and then go back to work...whatever that is for you.
I have had the injection type and they don't hurt. They feel like getting a shot. I have had the spray as well. It has a numbing effect. There are contradiction we can't work on and nursing allows me to work on an actual incision before it becomes a scar and to work on it while it heals without waiting. In many states we are limited. I agree 15 hours to learn TPT is few. In just trigger point therapy alone I have 192 hours plus I have kinesiology, muscles, a&p, swedish, dt, and many more modalities. When I graduated I had about 1200 hours or so. I have an AOS in massage therapy. All the other classes where given for when that 192 hours came about, I wouldn't be lost. I had to learn nerves, ligaments, tendons, and every contradictions know to man. I have the best education possible in massage in my opinion. I had the best teachers. At the time, Colorado Springs law was we had to have 1050 hours to receive their licensure. Tack on a few hours and there is the associates degree. I am very grateful to my massage education, it has made nursing school much easier. I already have a great knowledge of medical terminology which made that class a breeze. I already knew how to write up SOAP notes which made the SOAP/CARE writing class much easier. My massage education has put me ahead in nursing classes. I have learned plenty because of nursing that I never understood as an MT especially with Dr. Travell. You are right she wrote those books for medical personnel and not MTs. Remember massage wasn't huge back when and most people didn't work on injuries. The only ones who did where PTs, nurses and doctors. We have come a very long way.
My feeling that we having some miss clarification in prospective of needed hrs. for training.
No doubt in my mind, if one will have to be trained in approximately 50 (full medical and sports massage scope of practice )different protocols, and in case if one already professional and taking CEs, then I agree with you, most likely for this type of training ,it will be needed in an average 500 hrs. This 50 case presentations is a typical subjects that all of us facing and no matter what methodology we are practicing. Therefore I do believe that for full scope of practice in cases of CEs 500 hours can be reasonable training time.Sorry I didn't have a chance to read from your books, but planning to purchase it. My feeling you are know what you are talking about. I don't know you but it's my pure intuition and therefore I'm looking forward to read from it. There is many different methodologies to address pathologies and all of them can be safe and effective. What I have learned, is that,there is no silver bullet and by sharing knowledge on this side, including respectfully agree and disagree every one can learn from each other. I hope you agree with me on this.
Look forward to hear from you and to continue productive discussion.
Hi all - I am traveling & don't have a lot of time right now. When I said "trigger point therapist" I was referring to anyone who has received advanced training in trigger points -- meaning beyond 15-30 hours, whether they got it in massage school, physical therapy school, acupuncture school, or doctor school. My original training was something like 72 hours (in addition to my massage training), and I went on to study Travell & Simons books from there. If you claim to specialize in trigger points, you should have at least somewhere around 100 hours of training just in this subject (whether you got it from a program or just studying books extensively.) I think trigger point treatment combines well with a number of other modalities - medical massage, physical therapy, chiropractic, Swedish massage, myofascial release, acupuncture…and there are others.
Here is a link to some schools the NAMTPT lists: http://myofascialtherapy.org/training/index.html. My classes are at http://triggerpointrelief.com/workshops.html (not trying to sell something, but the question got asked about hours, training, etc). There is no legal requirement to have a certain number of hours to be able to call yourself a trigger point therapist, other than whatever your State requires for whatever license you practice under. Here is the protocol the NAMTPT recommends: http://myofascialtherapy.org/myofascial-therapy/protocol.html. I would like to note that the first step, “Differential Diagnosis,” is only for within the scope of your practice. For example, I have a chiropractor and a naturopath to refer to for x-rays, MRI’s, blood work, treatment, etc. Since I can’t do all the diagnosis and treatments, I have a network of other professionals that I work with. But as a practitioner, you do have to become familiar with perpetuating factors so you know who to refer your patient to for whichever ones you can’t diagnose and treat yourself.
Though Travell & Simons was written for doctors who did injections, most of the text is still pertinent to anyone who treats trigger points. And they were updated -- Volume 1 was updated, and I know Simons was working on updated Volume 2 before he died (don't know what the status of that is). Noel, I’m going to refer you to http://triggerpointrelief.com/cdrom/triggerpts.html for more info on trigger point points. There is no brief answer to identifying causes and then treating them -- each muscle has its on set of perpetuating factors & treatments, in addition to systemic perpetuating factors. That’s why extensive training and/or reading is necessary to become proficient.
Thanks all for participating in this discussion, and glad the awareness is growing and trigger point knowledge/treatment is getting incorporated into your practice, whatever it is. That, to me, is by far the most important thing.
Thanks for posting. It looks like we will be able to clarify a lot of stuff on this subject. I mean maybe we will not agree on all, maybe we will ask questions each other, but it will be in professional and practical way.
you said and it makes sense :When I said "trigger point therapist" I was referring to anyone who has received advanced training in trigger points”
You said:” If you claim to specialize in trigger points, you should have at least somewhere around …….
Valerie. on this one I have a question. What does it mean:” to specialize in trigger points therapy,? Is it separate scope of practice?
Rules of this site allow you at the time of discussions to offer your site address. You not only advertising your class but participating in discussions, and this is what this site is about
You said:I would like to note that the first step, “Differential Diagnosis,” is only for within the scope of your practice.
I strongly know, not believing but know, that In regards of trigger points “Differential Diagnosis,” is not applicable, but contraindication are applicable. I mean pinpoint sharper/most intensive localization of pain is a trigger point, in case if one palpating all type of new formation, such as tumors, cysts, so-called muscle knots which is most likely is myogelosis, and even palpatable formation, will demonstrate localization of sharp level of pain, , it just prohibit to apply pressure, or any other techniques. You can feel /detect pathologically changed muscular tone but not trigger points. Trigger points detected as well reported by clients, by describing sensation only.
You said:” For example, I have a chiropractor and a naturopath to refer to for x-rays, MRI’s, blood work, treatment, etc. “
it is nice to have this data but not crucial. There is many people who suffering untolerant pains, and even will demonstrate difficult neurological picture, but MRI will be perfectly good /negative. Because MRI cannot reflect myofascial tensions . With our hands we can detect this tensions as well by special techniques to eliminate the causes of difficult symptoms.
At the time MRI of other person, can provide images of terrible changes, including disc herniations but one will not complain on significant pains or at all. We should be driving and directed accordingly to clinical symptoms.
You said: Though Travell & Simons was written for doctors who did injections, most of the text is still pertinent to anyone who treats trigger points.
Valerie., most of the text, is a great presentation of the pathology etc. and in my opinion can be used as an academic source including references, but not as a text book for massage therapists. I mean text that offering not only scientific review, but simply speaking what to do with hands. It doesn't offer it.
You said :”And they were updated -- Volume 1 was updated, and I know Simons was working on updated Volume 2 before he died (don't know what the status of that is).
I believe am possessing the first eddition , and it is clearly text writing for medical doctors. Maybe new updates adjusted to be more for us. Please be aware nor Dr. Travell as well Dr. Simmons did practice hands-on massage therapy.
You said :”There is no brief answer to identifying causes and then treating them -- each muscle has its on set of perpetuating factors & treatments, in addition to systemic perpetuating factors.
In my previous post I presented main causes that leading to trigger points developments and not only within muscles. No doubt autoimmune diseases as well including systemic diseases can lead to trigger points developments. In such a case only our treatment alone will not help, most likely rheumatologist’s involvement including medications will be needed. But trigger points is a trigger points with the same morphology as well different methodologies of trigger point therapy.
You said :”Thanks all for participating in this discussion, and glad the awareness is growing and trigger point knowledge/treatment is getting incorporated into your practice, whatever it is. That, to me, is by far the most important thing.
Agree with you, and hope to hear from you again. Most important , we should remember is, that out there , many methodologies that allow successfully treat conditions, as well we should remember that there is room for your skills improvement. I try to remember it, and it works for me, hopefully for others too.
Best wishes.
Boris
PS. I have tried to order your book:” self trigger point therapy for tension headaches.” It didn't allow me to get through . I have very bad skills to use all Internet services, but in any case doublechecking. This weekend my son will help me to order.
Well, just joined this group and reading discussions. You don't have to be a rocket scientist to do trigger point therapy! My it is easy! I've had one class in school and have Travell and Simons, which I refer back to ALL the time for specific muscles. I do it if I find one or some in every massage practically just out of habit. Once you know how, it is quite easy.
I know exactly what you mean Boris. There seems to be this you have to be "advanced" and have all this multitudes of special training under a specific person to be qualified to be in the field! What did MT's do before they could jet set all over the country or world to train under such and such guru's way back in the olden days?
First of all, welcome to the group . I personally love this site and believe it giving huge opportunity to change somewhat to better , learn ,to advance. Absolutely agree with you:” You don't have to be a rocket scientist to do trigger point therapy!” One just, have to learn and understand mechanism of trigger points therapy , must following contraindications, and most of all have to passionately love your craft. And then as you was saying :” Once you know how, it is quite easy.” At this discussion, I even offered video clip where it is obvious not complicated to provide trigger points therapy.
You said: “There seems to be this you have to be "advanced" and have all this multitudes of special training under a specific person to be qualified to be in the field!
I'm strongly believe that to be “advanced” means ,one have to be very good in what one does/ to deliver results. Many times capability to deliver results has nothing to do with how much one believe that “she/he” is “advanced”as well how many hours of education one got.
Personal talent, passion, dedication, exception of responsibilities and mission to heal, as well practical/real training can advance one. This time and because of time shortens cannot extend on” practical/real training” but will do it later on.
You said: What did MT's do before they could jet set all over the country or world to train under such and such guru's way back in the olden days?
On this one I can answer. In 80th, I was fortuned to read from Travell/Simmons manual. On the record ,22 years ago when I arrived to US, massage therapy community, didn't use Travell/Simmons text at all and I am suspecting that not a lot of our colleagues knew about this book but survived.
Really did appreciate your post. Will communicate soon.
You are right Boris. Yes, 20 or 30 years ago there wasn't much of anything and you came from Europe correct? There was much more of everything massage over there.
And yes the market will correct itself. If someone is good at what they do and delivers the positive outcome the client will come back and tell all their friends and relatives. If you don't deliver, they won't pay you again and all their friends and relatives will know of the inadequate treatment. You will soon be out of business. End of story. Simple.
Absolutely, market naturally will regulate, but meantime massage therapy industry not having sustained place in the healthcare “World”, and therefore I believe we should be united as much as possible. For example. A bit more than two years ago, at California licensing agency regulated us as a prostitutes, and we couldn't practice all over the state of California, and each year license renewal , included doctors clearance that we are not possessing sexual transmitting diseases. It was a horrible time.BTW. If you would work for chiropractor ,physical therapist, MD then you didn't need all this. Means if you are making money for them, then you are Not a prostitute. Thanks for mutual effort of ABMP and AMTA as well thanks to great individual leadership we have today state certification, and abuse and discrimination is over for us.
You can imagine, what all this “advance”guys demanded at a time low was conducted, but again thanks to great leadership we all very united and therefore got blessed. Traditionally, any soft tissue mobilization that executed by hands , we calling massage therapy .even nowadays still people teaching pure massage therapy techniques but trying to be ” different”and “advance” by“creating” different alternative names to massage therapy. Please by yourself tried to search massage therapy services, and you will get a lot of alternative names. What for? Is one ashamed to be massage therapist? I am extremely proud. Creation of all this names It is confusing, healthcare professionals as well general public. Doesn't help to support our goals to be recognized. But back to your post, you're right, if one calling her/himself “advance “ do not make one good therapist, who delivering sustained results. I believe around 7 years ago, when all this “advance”thiank God unsuccessfully tried to tear our industry a part, I proposed article link below. “Advanced”didn't like it, but thank God today we much more united than than. Of course not because my article, but I assuming maybe some I did contribute. Later on as I promised will continue sharing my views, on education.
That sounds crazy in California. Yeah, Montana just passed legislation to regulate and license last July. And some states don't have anything, and every state is so different that united doesn't sound like it will happen soon. And yes sometimes regulation is just sometimes people wanting control and to make money off of it. I've read your article but I went back and read it again. We can only hope that united will end up being better not worse. It is important though to seek to always keep a good reputation for the whole of massage therapy. Yes, look forward to reading anything you have on education.
Actually reviewing your site additional time,now I know why I have had positive intuition about your trigger points therapy teachings.I don't know if you are aware,but approximately 5 -7years ago Russian physician Dubrovsky performed tremendous amount of work, in comparising all body typical localizations of trigger points with acupoints maps.87% of this localizations is the same localizations. Being acupuncturist, I trust you teaching discovery well. Again my pure intuition.Maybe the only disagreement I am having with you.is, if only trigger points therapy applications is enough for sustain and adequate treatment. Also Dr.Dubrovsky helped us to understand mechanism of a acupuncture and acupressure.Which is stimulation/releasing of piezoelectrical streaming potentials, that secondary causing positive changes in functions of organs and systems .BTW.Dr.Ross Turchaninov in his texts "Medical massage"perfectly presented concept of piezoelectrical streaming potentials,as well teaching how to activate this potentials. I really have no financial interest in sales of his books, but in my opinion, there is no other work in English that was writing by MD , who spent considerable time providing surgeries,then come to conclusions that a lot of this diseases can be successfully treated as well prevented by medical massage protocols applications,dedicated PhD studies to the related subjects, as well by himself for many decades practicing medical massage. I mean, I know Dr. Ross , is his personal friend but this facts having nothing to do with my professional opinion on his textbooks.
I dont know?? Sometimes I feel like Im on another planet when I read about what you guys say about trigger points ? Gosh I have few if any problems eliminating trigger points..Thats where massage shines from my experience.. The few people that come back with the same trigger points usually create them themselves with their life style. But more often then not, they dont come back.. When someone comes in hurting....Im praying that I find trigger points.. Because then I know I can dramatically effect their lives, and more often then not eliminate whatever presenting symptom they came in with.. Its the ones that hurt or move in pain that dont have trigger points. Those are the ones I cant help. Those are the ones I stress and fret over.... Not the trigger point ones..
We observed so many misunderstanding in regard to trigger points and trigger point therapy that we decided to address them all at the same time in special article in the new issue of Journal of Massage Science: 'Ischemic Compression: To Be or Not To Be?' We hope that this article will explain a lot of misunderstandings.
Please go to www.scienceofmassage.com and click on the Journal Of Massage Science icon to get to the latest issue.
Jeff Sims
Jan 27, 2010
Martha C. Long
Most of the time the TP are pretty centralized, as we work on the more intense TP first. Most of my clients come back every other week or once a month for treatment, so we have time to let things calm down before attempting more TP. I hope that answers your questions??
Martha
Apr 3, 2010
Michelle Doyle, D.C., CNMT
Apr 6, 2010
Jeff Sims
Apr 6, 2010
Martha C. Long
Would like some input on this
Thanks
Martha Long
Apr 14, 2010
Sunrise Gervais
Thanks
Sunrise Gervais
Jul 31, 2010
Larry Warnock
It might be that there are triggers in the psoas and the referral pain could be in the TFL or near where the psoas inserts
Jul 31, 2010
Jeff Sims
Jul 31, 2010
Boris Prilutsky
I am happy to invite you to join my group:” Medical and Sports Massage” including FREE Medical and Sports massage lessons. Not alot of practitioners in the US are familiar with Russian Medical and Sports massage as it was proposed by a Russian physician professor of medicine Anatoly Sherback . I'm happy to offer you information about this methodology as well as some additional information about me. I hope that our friendship will be pleasant and mutual beneficial. I believe in sharing knowledge. In such a case you will be able to learn from me as well as I can learn from you . If after reading information about medical and sports massage, or viewing lessons you will have any question I'm encouraging you to make comments or initiate discussion topic . In such a case my replies will be available for many to read, as well as your replies. Looking forward for great relationship.
Best wishes.
Boris
Aug 1, 2010
Jeff Sims
i have seen more than a few clients complaining of tension and pain with trigger points in temporalis and the tissue anterior and superior to the ear that also have had cosmetic surgery (they call it a mini-lift) to reduce wrinkles around the eye. this procedure seems to be an initiating factor. anyone else see it?
my approach has been to release the related tissue, including auricularis anterior and superior, temporalis, and SCM. i feel what seems to be the scar and tissue that's been tucked under during the surgery.
anyone have any thoughts?
Aug 14, 2010
Valerie DeLaune, LAc
Jul 13, 2011
Frank Michel
Aug 19, 2011
Boris Prilutsky
Hi Frank.
following links is to scientific review of trigger points therapy,including definitions as well proposals for appropriate techniques. If you will have any questions please feel free to ask.
Best wishes.
Boris
http://scienceofmassage.com/dnn/som/journal/0903/medical.aspx
http://scienceofmassage.com/dnn/som/journal/0905/medical.aspx
http://scienceofmassage.com/dnn/som/journal/0907/medical.aspx
Aug 20, 2011
Nancy L. Ring
Aug 22, 2011
Boris Prilutsky
Hi Nancy.
Actually respectfully I have to disagree with nursing class teaching.myogelosis is not really muscles anymore as well to apply pressure or otherwise to stimulate myogelosis is contraindicated.
Attempt to address myogelosis by any means will cause significant pain increase , more hypertonus developments within neighboring not affected muscles etc.in proposed articles we offered definition of TPs including morphology.
Best wishes.
Boris
Aug 24, 2011
Nancy L. Ring
Aug 24, 2011
Boris Prilutsky
Nancy.this site is for professional massage therapist,and when we providing treatment we do not using injections but utilizing our hands and fingers.
Dr.Travell as well any other medical doctors never injected any substance into myogelosis.this ones who did so, caused a lot pain and aggravation to already painful myogelosis.BTW.Dr.Travell never ever did advocate ,addressing TPs by massage techniques.
Best wishes.
Boris
Aug 25, 2011
Nancy L. Ring
Aug 25, 2011
Boris Prilutsky
Hi Nancy.
I didn't question if you are professional massage therapist. Just did reply to what you have said:"We are learning to bust them with a syringe."(I am assuming that word" bust" means treating/to address)
I mean massage therapist do not addressing trigger points by injections.in some particular cases nurse practitioner can inject TPs but not RNs.. most of MD ,strained not to inject in cases of myogelosis,including Travell & Simon's Myofacial Pain and Dysfunction Manual ,do not proposing to inject in cases of myogelosis.I believe that any massage therapist, who trained in orthopedic massage can provide treatment in case of scar tissue management, sprains, strains,with out attending RN program.You are right, we shouldn't argue, but all of us on this site, must to try to provide information related to us. We can agree or disagree, but shouldn't argue.let's keep this site on good professional level. Good luck with school.
Boris
Aug 25, 2011
Larry Warnock
Aug 25, 2011
Boris Prilutsky
Hi Larry.
Good to know that you are Dr. Travell's student.really regret that I never had an opportunity to meet this woman, but pretty familiar with her works,including Travell & Simon's Myofacial Pain and Dysfunction Manual.in my opinion it is great books,but Travell & Simon never advocate TPs therapy by hands/ fingers.am I right?if not please extend little bit on it. Thanks.
Boris
Aug 25, 2011
Nancy L. Ring
Aug 25, 2011
Jeff Sims
Aug 27, 2011
Larry Warnock
Aug 27, 2011
Jeff Sims
Aug 27, 2011
Boris Prilutsky
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
Aug 28, 2011
Valerie DeLaune, LAc
Aug 28, 2011
Boris Prilutsky
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
Aug 28, 2011
Valerie DeLaune, LAc
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
Aug 28, 2011
Boris Prilutsky
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
Aug 28, 2011
Larry Warnock
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.
Aug 29, 2011
Boris Prilutsky
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
Aug 29, 2011
Larry Warnock
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.
Aug 29, 2011
Noel Norwick
Larry & Valerie: I would appreciate both of you providing your expert's working definition for the term; "trigger point", as well as providing a brief description of assessment protocols that a licensed/certified massage practitioner might legally use for locating one, identifying its most likely cause and then how to properly treat it.
My concern is the Travell & Simons books were written for M.D.s and published in 1983 & 1992. They present medical opinions & treatment methods that may well be considered by today's M.D.s to be outdated and for the most part are outside of a massage practitioner's scope of practice in the USA.
Aug 29, 2011
Boris Prilutsky
Hi Larry.
Of course you don't have to extent if you don't want or cannot to extent. Then why you would make all this 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".”
Larry, With no explaining what is the “advance body studies ”and why and how you “far beyond the "storefront bodyworkers”? This monologues just not useful. What we can learn from it? Or what we can learn from this:” 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.” Absolutely nothing possible to understand or learn from your sentences.
Doesn't matter what is trigger point therapist’s curriculum is, I am disagree with you in regards you being advance/superior. According to many surveys, 90% of Drs. visits are stress related, essential hypertension, anxieties, diabetes type II, clinical depression and more very difficult diseases. There is massage therapists, that specialize in providing full body medical stress management massage (not relaxation but stress management) which is most powerful methodology in stress management. From painful disorders, cases when we incorporating trigger points therapy, people suffering but from heart attacks and other stress related diseases people dying. Why would you feel advance to massage therapists who performing full body massage?
To feel “advance” it's wrong because it dividing our community , and we have to try to stay united, to respect each other, and to try to share knowledge in order to advance entire industry. This is important. More successful outcomes we all will deliver, more recognition of general public and medical society we will get. Second time you replying to me, and do not including my name. I suspect that you feel too advance to call me by name. Another example why it is not good to feel superior.BTW. To feel superior is a symptoms, of not tolerance, anger, bitterness, ego out of proportion, selfdistractions. Wouldn't recommend to feel superior and of course not in professional discussions, because feeling superior and advanced you actually delivered nothing to learn from your statements. Simply nothing.
On this one below I strongly disagree. One who feel superior having close mind and just cannot learn: You said“And, unlike many, I am still learning even with 40 years experience in trigger point therapy.”
Still wishing you the best.
Boris
Aug 29, 2011
Jeff Sims
Aug 29, 2011
Larry Warnock
Jef...I just finished providing a stress management workshop with about 40 athletes. It is called CHILL TIME. As a psychologist, I developed this because there is no one more stressed out than a student/athletes...except maybe some of our members.
Take a deep breath everyone...and then go back to work...whatever that is for you.
Aug 29, 2011
Nancy L. Ring
Aug 29, 2011
Boris Prilutsky
Hi Valerie .
My feeling that we having some miss clarification in prospective of needed hrs. for training.
No doubt in my mind, if one will have to be trained in approximately 50 (full medical and sports massage scope of practice )different protocols, and in case if one already professional and taking CEs, then I agree with you, most likely for this type of training ,it will be needed in an average 500 hrs. This 50 case presentations is a typical subjects that all of us facing and no matter what methodology we are practicing. Therefore I do believe that for full scope of practice in cases of CEs 500 hours can be reasonable training time.Sorry I didn't have a chance to read from your books, but planning to purchase it. My feeling you are know what you are talking about. I don't know you but it's my pure intuition and therefore I'm looking forward to read from it. There is many different methodologies to address pathologies and all of them can be safe and effective. What I have learned, is that,there is no silver bullet and by sharing knowledge on this side, including respectfully agree and disagree every one can learn from each other. I hope you agree with me on this.
Look forward to hear from you and to continue productive discussion.
Best wishes.
Boris
Aug 30, 2011
Valerie DeLaune, LAc
Hi all - I am traveling & don't have a lot of time right now. When I said "trigger point therapist" I was referring to anyone who has received advanced training in trigger points -- meaning beyond 15-30 hours, whether they got it in massage school, physical therapy school, acupuncture school, or doctor school. My original training was something like 72 hours (in addition to my massage training), and I went on to study Travell & Simons books from there. If you claim to specialize in trigger points, you should have at least somewhere around 100 hours of training just in this subject (whether you got it from a program or just studying books extensively.) I think trigger point treatment combines well with a number of other modalities - medical massage, physical therapy, chiropractic, Swedish massage, myofascial release, acupuncture…and there are others.
Here is a link to some schools the NAMTPT lists: http://myofascialtherapy.org/training/index.html. My classes are at http://triggerpointrelief.com/workshops.html (not trying to sell something, but the question got asked about hours, training, etc). There is no legal requirement to have a certain number of hours to be able to call yourself a trigger point therapist, other than whatever your State requires for whatever license you practice under. Here is the protocol the NAMTPT recommends: http://myofascialtherapy.org/myofascial-therapy/protocol.html. I would like to note that the first step, “Differential Diagnosis,” is only for within the scope of your practice. For example, I have a chiropractor and a naturopath to refer to for x-rays, MRI’s, blood work, treatment, etc. Since I can’t do all the diagnosis and treatments, I have a network of other professionals that I work with. But as a practitioner, you do have to become familiar with perpetuating factors so you know who to refer your patient to for whichever ones you can’t diagnose and treat yourself.
Though Travell & Simons was written for doctors who did injections, most of the text is still pertinent to anyone who treats trigger points. And they were updated -- Volume 1 was updated, and I know Simons was working on updated Volume 2 before he died (don't know what the status of that is). Noel, I’m going to refer you to http://triggerpointrelief.com/cdrom/triggerpts.html for more info on trigger point points. There is no brief answer to identifying causes and then treating them -- each muscle has its on set of perpetuating factors & treatments, in addition to systemic perpetuating factors. That’s why extensive training and/or reading is necessary to become proficient.
Thanks all for participating in this discussion, and glad the awareness is growing and trigger point knowledge/treatment is getting incorporated into your practice, whatever it is. That, to me, is by far the most important thing.
Valerie
Aug 31, 2011
Noel Norwick
Aug 31, 2011
Boris Prilutsky
Hi Valerie.
Thanks for posting. It looks like we will be able to clarify a lot of stuff on this subject. I mean maybe we will not agree on all, maybe we will ask questions each other, but it will be in professional and practical way.
you said and it makes sense :When I said "trigger point therapist" I was referring to anyone who has received advanced training in trigger points”
You said:” If you claim to specialize in trigger points, you should have at least somewhere around …….
Valerie. on this one I have a question. What does it mean:” to specialize in trigger points therapy,? Is it separate scope of practice?
You said :”My classes are at http://triggerpointrelief.com/workshops.html (not trying to sell something, but the question got asked about hours, training, etc).
Rules of this site allow you at the time of discussions to offer your site address. You not only advertising your class but participating in discussions, and this is what this site is about
You said:I would like to note that the first step, “Differential Diagnosis,” is only for within the scope of your practice.
I strongly know, not believing but know, that In regards of trigger points “Differential Diagnosis,” is not applicable, but contraindication are applicable. I mean pinpoint sharper/most intensive localization of pain is a trigger point, in case if one palpating all type of new formation, such as tumors, cysts, so-called muscle knots which is most likely is myogelosis, and even palpatable formation, will demonstrate localization of sharp level of pain, , it just prohibit to apply pressure, or any other techniques. You can feel /detect pathologically changed muscular tone but not trigger points. Trigger points detected as well reported by clients, by describing sensation only.
You said:” For example, I have a chiropractor and a naturopath to refer to for x-rays, MRI’s, blood work, treatment, etc. “
it is nice to have this data but not crucial. There is many people who suffering untolerant pains, and even will demonstrate difficult neurological picture, but MRI will be perfectly good /negative. Because MRI cannot reflect myofascial tensions . With our hands we can detect this tensions as well by special techniques to eliminate the causes of difficult symptoms.
At the time MRI of other person, can provide images of terrible changes, including disc herniations but one will not complain on significant pains or at all. We should be driving and directed accordingly to clinical symptoms.
You said: Though Travell & Simons was written for doctors who did injections, most of the text is still pertinent to anyone who treats trigger points.
Valerie., most of the text, is a great presentation of the pathology etc. and in my opinion can be used as an academic source including references, but not as a text book for massage therapists. I mean text that offering not only scientific review, but simply speaking what to do with hands. It doesn't offer it.
You said :”And they were updated -- Volume 1 was updated, and I know Simons was working on updated Volume 2 before he died (don't know what the status of that is).
I believe am possessing the first eddition , and it is clearly text writing for medical doctors. Maybe new updates adjusted to be more for us. Please be aware nor Dr. Travell as well Dr. Simmons did practice hands-on massage therapy.
You said :”There is no brief answer to identifying causes and then treating them -- each muscle has its on set of perpetuating factors & treatments, in addition to systemic perpetuating factors.
In my previous post I presented main causes that leading to trigger points developments and not only within muscles. No doubt autoimmune diseases as well including systemic diseases can lead to trigger points developments. In such a case only our treatment alone will not help, most likely rheumatologist’s involvement including medications will be needed. But trigger points is a trigger points with the same morphology as well different methodologies of trigger point therapy.
You said :”Thanks all for participating in this discussion, and glad the awareness is growing and trigger point knowledge/treatment is getting incorporated into your practice, whatever it is. That, to me, is by far the most important thing.
Agree with you, and hope to hear from you again. Most important , we should remember is, that out there , many methodologies that allow successfully treat conditions, as well we should remember that there is room for your skills improvement. I try to remember it, and it works for me, hopefully for others too.
Best wishes.
Boris
PS. I have tried to order your book:” self trigger point therapy for tension headaches.” It didn't allow me to get through . I have very bad skills to use all Internet services, but in any case doublechecking. This weekend my son will help me to order.
Aug 31, 2011
Brenda Rowell
Well, just joined this group and reading discussions. You don't have to be a rocket scientist to do trigger point therapy! My it is easy! I've had one class in school and have Travell and Simons, which I refer back to ALL the time for specific muscles. I do it if I find one or some in every massage practically just out of habit. Once you know how, it is quite easy.
I know exactly what you mean Boris. There seems to be this you have to be "advanced" and have all this multitudes of special training under a specific person to be qualified to be in the field! What did MT's do before they could jet set all over the country or world to train under such and such guru's way back in the olden days?
Sep 1, 2011
Boris Prilutsky
Hi Brenda.
First of all, welcome to the group . I personally love this site and believe it giving huge opportunity to change somewhat to better , learn ,to advance. Absolutely agree with you:” You don't have to be a rocket scientist to do trigger point therapy!” One just, have to learn and understand mechanism of trigger points therapy , must following contraindications, and most of all have to passionately love your craft. And then as you was saying :” Once you know how, it is quite easy.” At this discussion, I even offered video clip where it is obvious not complicated to provide trigger points therapy.
You said: “There seems to be this you have to be "advanced" and have all this multitudes of special training under a specific person to be qualified to be in the field!
I'm strongly believe that to be “advanced” means ,one have to be very good in what one does/ to deliver results. Many times capability to deliver results has nothing to do with how much one believe that “she/he” is “advanced”as well how many hours of education one got.
Personal talent, passion, dedication, exception of responsibilities and mission to heal, as well practical/real training can advance one. This time and because of time shortens cannot extend on” practical/real training” but will do it later on.
You said: What did MT's do before they could jet set all over the country or world to train under such and such guru's way back in the olden days?
On this one I can answer. In 80th, I was fortuned to read from Travell/Simmons manual. On the record ,22 years ago when I arrived to US, massage therapy community, didn't use Travell/Simmons text at all and I am suspecting that not a lot of our colleagues knew about this book but survived.
Really did appreciate your post. Will communicate soon.
Best wishes.
Boris
Sep 1, 2011
Brenda Rowell
You are right Boris. Yes, 20 or 30 years ago there wasn't much of anything and you came from Europe correct? There was much more of everything massage over there.
And yes the market will correct itself. If someone is good at what they do and delivers the positive outcome the client will come back and tell all their friends and relatives. If you don't deliver, they won't pay you again and all their friends and relatives will know of the inadequate treatment. You will soon be out of business. End of story. Simple.
Sep 1, 2011
Boris Prilutsky
Dear Brenda.
Absolutely, market naturally will regulate, but meantime massage therapy industry not having sustained place in the healthcare “World”, and therefore I believe we should be united as much as possible. For example. A bit more than two years ago, at California licensing agency regulated us as a prostitutes, and we couldn't practice all over the state of California, and each year license renewal , included doctors clearance that we are not possessing sexual transmitting diseases. It was a horrible time.BTW. If you would work for chiropractor ,physical therapist, MD then you didn't need all this. Means if you are making money for them, then you are Not a prostitute. Thanks for mutual effort of ABMP and AMTA as well thanks to great individual leadership we have today state certification, and abuse and discrimination is over for us.
You can imagine, what all this “advance”guys demanded at a time low was conducted, but again thanks to great leadership we all very united and therefore got blessed. Traditionally, any soft tissue mobilization that executed by hands , we calling massage therapy .even nowadays still people teaching pure massage therapy techniques but trying to be ” different”and “advance” by“creating” different alternative names to massage therapy. Please by yourself tried to search massage therapy services, and you will get a lot of alternative names. What for? Is one ashamed to be massage therapist? I am extremely proud. Creation of all this names It is confusing, healthcare professionals as well general public. Doesn't help to support our goals to be recognized. But back to your post, you're right, if one calling her/himself “advance “ do not make one good therapist, who delivering sustained results. I believe around 7 years ago, when all this “advance”thiank God unsuccessfully tried to tear our industry a part, I proposed article link below. “Advanced”didn't like it, but thank God today we much more united than than. Of course not because my article, but I assuming maybe some I did contribute. Later on as I promised will continue sharing my views, on education.
Best wishes.
Boris
http://www.massagetoday.com/archives/2005/08/11.html
Sep 2, 2011
Brenda Rowell
Boris,
That sounds crazy in California. Yeah, Montana just passed legislation to regulate and license last July. And some states don't have anything, and every state is so different that united doesn't sound like it will happen soon. And yes sometimes regulation is just sometimes people wanting control and to make money off of it. I've read your article but I went back and read it again. We can only hope that united will end up being better not worse. It is important though to seek to always keep a good reputation for the whole of massage therapy. Yes, look forward to reading anything you have on education.
Sep 2, 2011
Boris Prilutsky
Hi Valerie.
Actually reviewing your site additional time,now I know why I have had positive intuition about your trigger points therapy teachings.I don't know if you are aware,but approximately 5 -7years ago Russian physician Dubrovsky performed tremendous amount of work, in comparising all body typical localizations of trigger points with acupoints maps.87% of this localizations is the same localizations. Being acupuncturist, I trust you teaching discovery well. Again my pure intuition.Maybe the only disagreement I am having with you.is, if only trigger points therapy applications is enough for sustain and adequate treatment. Also Dr.Dubrovsky helped us to understand mechanism of a acupuncture and acupressure.Which is stimulation/releasing of piezoelectrical streaming potentials, that secondary causing positive changes in functions of organs and systems .BTW.Dr.Ross Turchaninov in his texts "Medical massage"perfectly presented concept of piezoelectrical streaming potentials,as well teaching how to activate this potentials. I really have no financial interest in sales of his books, but in my opinion, there is no other work in English that was writing by MD , who spent considerable time providing surgeries,then come to conclusions that a lot of this diseases can be successfully treated as well prevented by medical massage protocols applications,dedicated PhD studies to the related subjects, as well by himself for many decades practicing medical massage. I mean, I know Dr. Ross , is his personal friend but this facts having nothing to do with my professional opinion on his textbooks.
Best wishes.
Boris
Sep 5, 2011
Gordon J. Wallis
Sep 15, 2011
Dr. Ross Turchaninov
We observed so many misunderstanding in regard to trigger points and trigger point therapy that we decided to address them all at the same time in special article in the new issue of Journal of Massage Science: 'Ischemic Compression: To Be or Not To Be?' We hope that this article will explain a lot of misunderstandings.
Please go to www.scienceofmassage.com and click on the Journal Of Massage Science icon to get to the latest issue.
Dr. Ross Turchaninov
Oct 26, 2011