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A typical experience
I had a new client the other day for an 80 minute massage. I asked him if there is anything that he wanted me to know. He told me that he suffers from a herniated disc that he has had for a few years. He has constant low back and right hip pain that at times radiates down the back of his leg to his knee. He told me that he has had two injections in his low back and has to stay on anit- inflamtory medication. Anything to avoid surgery. The pain is always there. I asked him if he ever saw a chiropractor for his pain. He said yes. But the adjustments hurt his hip so bad that he could not continiue. So here is a guy that thinks he is on the verge of surgery. I knew that there was a very strong probubllity that was not the case. The vast majority of pain people experience is nocioceptive pain( soft tissue- muscle, tendon, ligament, facia). MDs and Chiropractors see pain as neuropathic pain( nerve pain). With that asumption they give the wrong treatments and therapies. Now there is no denying that at times injections and surgery is needed. Not denying that. But most of the time - NOT. 70% to 85% of all pain comes directly from trigger points. Anyway I showed my client a testimonial from a client that I was able to help out of a very painful condition that she had delt with for a couple of years. I showed him that testimonial because all pain has a psychological eliment too it. I wanted him to start thinking maybe he is not on the edge of surgery. I palpated his entire back upper torso, both hips, and right leg. I found a very painful spot on his right L5 erectors. Another very painful spot on his right greater trochantor. A painful spot in the middle part of his lower right hamstrings. And also a tender spot on the right spinous of L3. I knew that if Iwas able to eliminate all those painful palaptory spots that I would most likely eliminate his pain problem. Because a healthy body had no painful spots even with deep massage. Ive been hunting and eliminateing trigger points for thirty years now. He walked out of the massage room pain free. He was pain free for the first time in years. All those other professional people misdiagnosed him because they assume neuropathic pain over nocioceptive pain. I assume the other way around. I'm a Massage Therapist.
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Permalink Reply by Gordon J. Wallis on
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This whole thread, if ya haven't noticed, is about the misdiagnosis of pain and the unknown factor of trigger points. Just today I saw this client for the second time, that was diagnosed with plantar fasciitis and heal Spurs in her left foot. It's been really bothering her for over a year now. The docs said they need to inject her foot with something, send her to a podiatrist and all this other stuff.. Now this has gone on for over a year.. She mentioned it to me, not thinking I could do anything for it. Well long story short.. Can you guess? She had a big bad trigger point just below the lateral malleosis( towards the heal ) of her left foot that made her flinch two days ago when I first touched it.. She told me when she woke up yesterday her ankle was really sore. But then after five minutes and ever sense, it has been totally pain free. She is freaked out happy. Today the trigger point was still there, however it did not make her wince when palpated, and was very much milder. I deactivated it again.. Maybe one more time or two and that's it for her plantar fasciitis and heal Spurs. We are talking five minute sessions here. Now here is the thing.. They found a heal spur on her right foot too. But there was never any pain in her right foot.. So even though there might be some kind of pathology, it does not me it's causing there pain. It's just like Travell said in the attachment bellow.
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I have several interesting trigger point clients that I'm working with. They are all unique in their problems, but this one is interesting because of the sheer number of trigger points. We both( the client and me )guesstimated that she had maybe 70 trigger points. Of course when she first came in the spa her intention was for a relaxation massage. But after talking with her for a minute or so, I began thinking that perhaps she needs trigger point work. She gets migraines, recently had a miscarriage, occasional low back pain, and calf cramps at night. After talking to her for another minute, she told me she wants the trigger point work. I won't list all the muscles and areas that were trigger pointed, there is just too many. She made an interesting comment about her migraine. She said sometimes when she rubs her neck, the migraine goes away. That's almost a sure sign of trigger points. People that really get migraines can't just rub their necks and the headache goes away. After working on her, I'm of the thought that her headaches are because of trigger points. She had several in her cervical muscles, mostly on the right. Occipital area trigger pointed. Right SCM trigger pointe. Temporal muscles on both sides. As well as Orbicularis Oculi on both eyes. And Occipitalis Frontalis above the eyebrow on the left. I don't know if I'm spelling these muscles correctly. But anyway.. Her sacrum was very tender to touch. That makes sense, sacrum, hips and low back are related to the neck, Occipitalis , and skull. She had upper T spine lateral spinous pain as well. The Latissimus Dorsi were it connects on both shoulder blades was very tender to touch.. And that makes sense too because that runs right down into the sacrum. She also had lateral spinous pain in the L4, and pain at the L5 sacrum junction. She had several pain points on the edge of her sacrum both sides, as well as Glute Med trigger points. She had a couple trigger points in each calf area. She had two pain points in her abdominal area where the ovaries might be. She had very painful Points on her Sternum. Three of them.. And painful points on each upper pecs near the deltoid pec junction.. Anyway,, no wonder she has headaches. I'm thinking they are not true migrains. But trigger point induced. Ive worked on true migrain people that don't have a trigger point on them. I usually can't stop their headaches. And they see lights, hearing intensities, and it's quite a different thing then trigger points( I think? ). Anyways, all her trigger points deactivated, and she is coming in for some follow up sessions. I should be able to help her quite a bit. I will throw in an attachment that you have seen before. But it relates to her headaches..
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Permalink Reply by Gary W Addis, LMT on
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sounds like fibromyalgia (an accumulation of long ignored trigger points, IMO).
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Yea well, she did not mention that diagnosis. But others I've worked on like her have. When I read up on fibromyalgia, it's discribed as something mysterious. They don't really know what it is. I just recently read, in a leading pain medical journal, that it's an auto immune syndrome disease. Anyway, there are 18 diagnostic points on the body, that if at least eleven of them are painful to touch, indicate the diagnosis of fibromyalgia. But what gets me is this..... When I palpate those pain points, I make them go away. http://www.nfra.net/Diagnost.htm
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Just to comment on this thread. This is interesting, at least to me. So I will comment on it. I've worked on this client twice. The first session was an hour. He was referred by another client that I had helped with a pain problem. The first session was an hour, because I need the time to do a full body scan for tender points. I don't think I'm going to call them trigger points anymore. The classic trigger point is in the belly of a muscle. I'm looking for pain points anywhere, not just in the bellies of muscles. They can be on boney prominences as well. Anyway the first session is an hour because I'm scanning the entire body for pain points.. He's second session was only 25 minutes. His complaint was left knee pain. He likes to hike and lift weights, and it's getting so painful that it's interfering with both of those two things. I found two very painful tender points, for location purposes, at ST35 and ST36 on and below his left knee. You can look it up on an acupuncture chart if you want. Those are pretty much the exact locations. I was able to deactivate those two painful spots the first session. I knew that the L4 spinal segment inervates the knee. So I wanted to check that area as well. Sense I'm going to do that I might as well check out his entire spine for pain points, which I did during that first initial scan session as well as the second session. This is where it was sort of weird. I figured the L4 lateral spinous could be tender to touch, and it was. And when I touched there, it also irritated his knee. I thought that made sense. But the weird part is. Several spots on his upper T spine when palpated( lateral spinous ) caused him discomfort in his knee as well. And that was on both sides of the upper T spine. And those spinous spots were not tender, they just caused his knee to ache and tingle when touched. I don't know what the relationship is between the upper T spine and his knee, but there obviously was one. I carried on like they were actually tender points and was able to eliminate those knee sensations. That was cool. The second time I saw him he was feeling much better. He said he was amazed. I kind of was too. The ST35 and ST36 pain points were still there, but at a much lower intensity. The weird upper T spinouses still reffered pain to his knee, and I eliminated those sensation a second time. When he got up off the table the second session he said that he felt even better. I'm guessing three more sessions and he should be doing good. So, any tender point needs to be eliminated or down graded as best you can. But also, any spot that causes pain or discomfort anywhere else in the body when palpated, also needs to be eliminated. I've been doing this for a long time.. It's advanced work. But, I first started palpating the lateral spinoouses gosh 20 years ago. I often times noticed they were tender and sore. Sometimes mildly, other times exquisitely so. I would go two or three or four times palpating each lateral spionous especially T1 to L5. Often after the fourth run, some if not all the spinoouses were no longer tender, and the client would feel better. Now, after thirty years, I eliminate those tender spots reall fast. But it's an area of the body that is rarely touched and is often a source of hidden pain. Chiropractors adjust the spine, why not massage the spine. Muscles move bones ya know..
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Vertebra don't slip out of position even from violent twisting movements: they have to be pulled. And muscles pull bones. If DCs accept that one piece of wisdom they would instantly become better chiropractors. Because they continuously deny that basic anatomical fact, they sometimes do far more harm than good.
FACT:every muscle can develop trigger points, for trigger points can form for a variety of reasons, inc including wrenching movements; to protect against extreme movements that endanger itself or other muscles; due to physical breakdown of an individual muscle cell or the body systems that keep it fed and oxygenated.
I understand where you're coming from, deciding to no longer refer to these tender spots as trigger points. Here's why I will continue to call them trigger points whether they exist in the belly of muscle or in its tendons. Doing otherwise, doesn't this give fuel to the "gurus" who have always denied the existence of trigger points? of ALL trigger points? If they mention them at all, they refer to them as "localized tender spots," which they claim to eliminate by rubbing and moving the limb this way or that.
Doesn't work that way, does it?-- Tender spots AKA trigger points have to be directly addressed using either the old tried and true hard ischemic compression or using the less painful, almost magical methods you have taught me and others.
Lastly, didn't Travell and Simons proclaim that the painful spots they christened "trigger points" can be found in both muscle bellies and in or near muscle attachment points? Dr. Devin Starlanyl in the book he co-authored with John Sharkey goes further than that, proclaiming that trigger points can form even in the skin and in ligaments and in fascia itself (I myself doubt that skin cells can develop trigger points-- although cells enervated by sensory nerves can certainly become "tender"). Clair Davies and my good friend and mentor Gordon Wallis (grinning) have taught us about the many types of trigger points and that not all trigger points refer pain elsewhere as Janet Travell erroneously believed.When cells in internal organs break down, in a natural reaction termed apoptosis, the dysfunctional cell divides into a sister cell then commits hari kari. Apoptosis occurs in all types of cells living within an organized colony of cells-- when an ailing cell "refuses" to die when it can no longer perform its cellular functions, it is said to become cancerous. Benign tumors called lipomas can form within the fatty tissue surrounding muscle cells, but they do no harm. A true cancer, but also benign, called rhabdomyomas can form due to long-ignored trigger points in striated skeletal muscles. But these rarely if ever transmogrify into aggressive, destructive cancers. I suspect that this is because no skeletal muscle is isolated from all other muscles...that every muscle interacts with myriad antagonist and agonist muscles. The work of a dysfunctional muscle cell is immediately taken up by its brethren. A pancreatic cell doesn't have that backup: if it can't function and for whatever reason cannot reproduce and surrender to apoptosis, the body will continue to make demands of it, which, severely damaged, it cannot fulfill. This breakdown will eventually lead to overwork and breakdown of other pancreatic cells, and far too often, eventually lead to complete organ failure, and death of the entire orgamism.
A trigger-pointed striated skeletal muscle won't directly lead to death of the entire life form: when it stops functioning, neighbor muscle cells take up its slack; or the pain on movement leads the sufferer to stop moving the painful joint, to find other ways of completing its tasks
Now, I realize that the above explanation isn't all that eloquent; is kinda fuzzy, actually. But, hopefully, the gist of my thinking is still understandable. If I've confused anyone, let me know, I'll try to elaborate.
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Hi Gary. To me it doesn't matter what they are called. Trigger points, tender points, pain points so on. By calling them Tender points I eliminate all the arguing about what a trigger point is or if they exist or not. Lol. And there are soft tissue systems out there that never mention the word trigger point, yet they eliminate trigger points when their procedures are followed. One of them is Soft Tissue Release, another is Muscle Release. They are both similar to Active Release, and I don't know if they mention Trigger Points or not? But the nature of their techniques destroy trigger points. As for Chiropractic. All I will say is that the best Chiroprators, in my opinion, are into soft tissue work. I like the way they think though. And I feel the right soft tissue work far better fits their line of thinking then their spinal manipulations ever do. But then I rarely have to think on things very much anyway. I simply palpate the entire body for Tender Points and eliminate them or down grade them as best I can. And when I'm able to do that( after a few sessions ), more often then not, what ever pain problem the client came in with is over.
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A new client came in the other day for a massage. When I asked him what he needed from the massage he said. Only here to relax. I told him that after 30 years I was an expert at taking pain out of the body. He then told me that he has a rotator cuff injury along with on and off low back pain sense his fall a couple months ago. But the pain is deep in my joint, so don't worry, you can't hurt me. He is telling me this as he is standing in his robe. I asked him if I could palpate his shoulder. When I palpated his shoulder muscles I found no tender points. I asked him where it hurt again. He indicated the top of his shoulder and deltoid.. It was his right shoulder. Then again he told me that the pain is in his joint, not in his muscles. I then had him abduct his arm.. When he did, he got it up to about 70 degrees before pain stopped him. I then had him hold his arm at the 70 degree painful level, and was able to palpate a very tender point on his middle deltoid where it connects to the Acromion. I then did a release for that tender point. And to his amazement he could abduct his arm full range of motion without pain. I then left the room as he got on the table. Now the guy wanted a massage.. I was pretty sure he didn't want me palpating his entire body for tender points. That's what he needed, but I'm sure not what he wanted.. But he seemed really happy about the shoulder work I did.. So I asked him if I could check a few other key areas related to his shoulder before I started the massage.. He said yes.. Now the deltoid is inervated by the 5th cervical segment. So I palpated along his left neck and found another tender point on the transverse process of his C5 vertebrae. I was able to deactivate that tender point as well. I then palpated his low back where he has pain on awaking in the mornings sense his fall. As I started palpateing he told me that his back is not sore now, and that it only is in the mornings. But on palpation he flinched at the L5 sacrum junction, on both sides. Two very tender points. I was able to deactivate those tender points as well. All those tender points are related. The deltoid is inervated by the C5 vertabrae. Now here is the cool part. The entire neck , including the C5 vertabrae is invervated pretty much by the C3 vertabrae. The C3 vertabrae is paired with the L3 lumbar which partially inervates the L5 vertabrae sacral junction. That's kind of advanced thinking. Do you really need to know that. No. Any area you find on the body that is painful , you wanna try to down grade or eliminate that pain as best you can reguardless, by whatever tools you have. All that took ten minutes. The rest of the time I massaged him avoiding deep pressure on his neck and low back. Didn't wanna activate those trigger points again. He left the spa happy and pain free. He lives to far away to come in for any follow up visits which is too bad but.. At least he knows it's not deep in his joint now.
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This is something new for me. Pretty freakin amazing actually. I got a referral from a chiropractor. I haven't gotten a refferal from a chiropractor , medical doctor, or a witch doctor for that matter, in over 20 years.. Haha! All the referals I get are from clients, people I've worked on. Anyway. This person has right side sciatica that radiated from her hip all the way down into her calf, and has also been suffering from headaches for literally years. Can't remember exact number. For a long time a way. Long story short.. She was full of trigger points. No surprise to me. She didn't really have sciatica. Oh she had pain for sure.. But it's the usual fake sciatica. Trigger points in the gluteus , back of the thigh, lateral thigh, inner thigh, knee, and calf. All on the right side. You can look up all the pain patterns those trigger points generate at www.triggerpoints.net if ya want.. Then you will get an idea of the discomfort this lady has been going through. I've seen her twice now. She did not need her meds in the morning as usual, and is sleeping better even after only one treatment ( session ). She had a second session today. I like to use the words treatment, procedures , and sessions.. They imply a more medical sounding approach, then the word massage( to most people ). But what I'm doing, and other massage therapists are doing, is medical.. It's manual medicine. At any rate, it's certainly more medical then what her medical docs were doing for her (as far as getting her out of pain goes ). Now for her headache part.. She actually came in with a headache when I last worked on her. She felt her headache mostly in her Occipital area and in her eyebrow. If you look on a muscle chart you will see that the Occipitalis frontalis connects those areas. She had trigger points in the Occipital area, as well as on her eyebrows( both sides). Painful ones too. She also has a painful point on the transverse process of C3 on the left side. As you've seen in the other charts that I've posted in the above comments, C3 has a relationship to L3. L3 inervated most of the area on her right hip that had the trigger points, as well as the knee. I was able to down grade or eliminate all those pain points, and she left the spa without her headache. So I'm pretty sure she is going to feel way better after maybe four more sessions. Travell and Simons were arguably the leading experts in the world on muscular pain. They are no longer with us. They both said that trigger points were responsible for 85% of all pain on the planet. Well here is what , who is arguably the worlds leading expert on all pain, not just muscular pain, says about trigger points( see attachment below ). Also, here is some info, if you are just starting out with deactivating trigger points that should help you. This is from one of Leon Chaitows ( another expert)books. He is an Osteopath from England.. He has some awesome books out on the subject. One easy way to down grade or eliminate a trigger point. Is.... 1. Apply firm digital compression to the trigger point sufficient to produce localized discomfort or pain, as well as symptoms in the target area ( reffered pain area). 2. Maintain this compression for 5 seconds. 3. Release for 2-3 seconds. 4. Reapply pressure ( same level) and keep repeating 5 seconds on, 2-3 seconds off until the patient reports a reduction in local or referred pain or an increase in pain ( which is rare) or until 2 minutes have passed with no change in the pain level.
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Ok, I forgot my attachment.. This is what arguably the worlds leading experts on all pain ( muscular as well as everything else )has to say about trigger points. When people say there are no such things as trigger points, or that trigger points don't cause as much pain as I think, or that fascia is the most important thing. Aren't argeing with me. They are arguing with some really smart people that study pain for a living.
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I've read a couple of Chaitow's books; one of my school textbooks was by him. But he's another Boris: his way is the only way! He needs a couple of sessions with a Trigger Point Whisperer. :)
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amen to that.
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