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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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Pretty much every day I meet people/clients that don't believe or realize that I can help them. I see and hear that in several different ways. I know there are all kinds of pain. But I also know a high percentage of it is trigger point pain. 80% of it anyway. People just don't know about trigger points. That includes a lot of massage therapists and other types of health care professionals. I was in a grocery store when I over heard a yong lady talking to her friend about the nerve pain in her shoulder. She said that she got bit by a spider years ago on the back of her shoulder, and has suffered a nagging kind of nerve pain ever sense. Been to doctors and all this other stuff. I interjected into their conversation and told them that I was a Massage Therapist with 30 years experience. And that I seriously doubted that it was nerve pain. Then she assured me that it was, and pulled part of her collar down to show me a small circular scare about half the size of a dime on the back of her shoulder blade where she got bit. It was on her infraspinatus muscle. I asked permission to touch her. She let me. I touched the scare. She gave a slight wince. I then did a release, and to her amazement , her nerve pain vanished. You should have seen her face. Now did I totally rid her of her pain once and for all? Probably not. But one thing is for sure. It's not nerve pain. If it was, it would not have vanished even for one second. When someone hurts, they often think nerve pain. Even when they get diagnosed by other healthcare professionals they often here the same thing. Nerve pain. Pinched nerve. Few here trigger points.
The other reason people stay hurting for years is this overwhelming emphasis on structure and posture. I hear it all the time. A client comes in and explains why they hurt because, for example( heard this the other day)...She has a reverse curve in their neck and hips are tilted out of balance ( her hips looked fine to me. Her neck did too). And the health care provider that she has been seeing for a year is trying to balance her posture out , but has not been successful at it yet. I'm thinking two things when I hear that. What good is that diagnosis if it leads to know results after a year? I hurt because I have too much or not enough curve here or there? Also, only 2% of the worlds population has perfect posture. There are all different kinds of postures and body types. Anyway this particular client was not interested in my trying to fix her low back pain. A band of pain in her very low back and upper hips. Evenly distributed on both sides. She wanted to relax. She had no idea that I could help her. So instead of arguing with her, I said that I would give her a good massage. But I wanted her to tell me if I touched or did anything to remind her of her pain. She said she would. So I carried on with the massage. I was surprised when she did not flinch or indicate any pain when I was working ,firmly sliding my elbow from her low back to her neck. I asked her if she felt her pain as I did that technique.? She said no. So I carried on with the massage with no further talking, all the while silently trying to find any sign of the pain she was talking about that made her see a chiropractor. Then when I got to her hips, she flinched. I asked her if that hurts or tickles. She said it hurts. I was halfway through the massage then. When I got to the other hip, same thing. She flinched. Travell calls that a jump sign. An indication of trigger points. So now I'm thinking.. Am I suppose to just ignore this and carry on with the massage, or address her pain and take care of it right now? After all she didn't want me to do that. She just wanted a relaxing massage. I desided to go against her wishes and address the trigger points. I told her, ok. You are hurting here. I'm going to palpate your hips. You tell me when I get to a tender point, a sore spot. She said ok. I palpated through a sheet. Here is what I found. A glute medius tender point on each hip. A PSIS tender point on each hip. And a Piriformis tender point on each hip. They were very noticeable to her on palpation. They all vanished. She was very surprised to feel pain free after the massage. If I really wanted to help her , for a more permanent effect. I would palpate the rest of her body for tender points,
Too much emphasis on structure. Way too much. And if it's not structure, it's gotta be nerve pain. Right? WRONG. All this is my opinion of course. In the attachment below is a gluteus medius trigger point and it's pain pattern. You can see how one would think low back pain. - Attachments:
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Permalink Reply by Gary W Addis, LMT on
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Good work, Gordon.
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What I did yesterday was pretty cool. Thirty years ago, and even ten years ago, I would have never thought it possible for a massage therapist to do what I did. Actually, I never thought it would have be possible for any type of healthcare provider to do what I did. I don't want to come off as bragging. I've failed many times in my life and career. And I'm on my third wife and I'm broke all the time. Anyway my whole reason for writing in here is to give testimony about the power of soft tissue work. Over the years I've worked with and observed acupuncturists, chiropractors, and physical therapists at their work. I know the kinds of patients they see, and the results they get. I know the kinds of clients/patients I see and the results I get. Soft tissue work is powerful and very clinically effective.
When I came into work yesterday one of my coworkers came up to me and asked my if I could do for her nausea. I said I don't know? Tell me what's wrong or where you hurt? She told me that she has pain in the occipital ( base of skull ) area of her neck, and the pain shoots up. And she is nauseated. When I got her on the table, to my surprise I found no trigger points in her neck at all. None in her hips and low back. However when I checked her abdominal area, it was a different story. She had two nauseating points in her upper left quadrant, one nauseous point in the lower left quadrant, one very nauseous point on the center line below the belly button just above the pubic bone, another nauseous point in the lower right quadrant, and the worst one of all just below her sternum where her stomach is. I was able to eliminate all those nauseous points, do a release for the occipital muscles and give her a foot massage all with in ten minutes. She got up off the table with no nausea or headache. That was amazing to me. That's cool. Really cool. - Attachments:
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A young lady came in for a massage not to long ago primarily because of low back pain along with tension and tightness in the shoulders. She was a nail tech, and figured that it had to do with her work. Now it always bothered her a little bit. But her discomfort had become worse then normal, so she decided to get a massage. It was an 80 minute massage, and I could tell that she wasn't hurt that bad, so there was plenty of time to find and eliminate trigger points. So she got one hour of massage and twenty minutes of finding and eliminating trigger points.
Here is what I found. A right Piriformis trigger point, a left PSIS trigger point, a very tender left paraspinal trigger point at the L4,5 level, another left paraspinal trigger point at the T4 level. She also had three trigger points on both the left and right sides of her neck, on the transverse processes. Oh also , at thr T3 level, she had a right lateral spinous trigger point. They all deactivated and she left the spa pain free. I instructed her not to stretch or test the areas in order to see if her pain was really gone. Because the cellular damage was still there. She needs at least a night to rest and heal. Now that the tissues have opened up, the blood can get in there and heal the cellular damage. It's always trigger points. That was cool. - Attachments:
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She was in an auto accident four days prior to seeing me. It was her fault and the car was totaled. She only had liability insurance and had to pay $600.00 for her totaled car to be towed away. Because it was her fault, insurance would not pay for any medical bills. She was afraid to go to the doctor because of the cost( She only makes a certain amount of money, lost her car plus another $600.00). She was afraid to see a doctor because of the cost, but at the same time she was in a great deal of pain and was afraid that she might have damaged her cervical vertebrae. The neck pain was so intense she couldn't sleep at night. In the mornings she could barely get out of bed. Rotation was severely limited both left and right. The interesting thing was that she felt the most pain on the right side of her neck regardless which way she tried to turn her head. Anyway she came to me hurting and very afraid that she had seriously hurt herself. I suggested that she see a doctor, but she knew me and wanted me to check her out first. And after that, she would see a doctor if I thought she should. Well she had pain on motion in her neck that only gave her a few degrees of rotation to either side, but I decided to check for palpatory pain (trigger point) first. Sometimes when you get rid of palpatory pain you get rid of pain on motion. I palpated almost her entire body and found no trigger points until I got to shoulder blade level. From her shoulder blades up to base of her skull she had a plethora of trigger points. One every half inch. She also had trigger points in her masseters and SCMs and on of her temples. All the trigger points deactivated. When she got up off the table she said she felt better, but when she tried to turn her head, it still hurt with a very limited range of motion. I could see the fear in her face. I then asked her to lay down on her back and for her to trust me. I told her to completely relax her neck, and that I would slowly turn her head in order to see how far it would go before it started hurting. I told her that I would go very slowly and stop at the first sign of pain. That I wasn't going to try and go through any barriers. To her surprise I was able to turn her head full range of motion to both the right and left with no pain what so ever. I explained to her that if there was anything wrong with her discs and skeleton that would have never been able to happen. The fact that it hurts when she turns her head proved that her pain problem was muscular. And although it hurt now, muscles heal in time. There was a sense of relaxation that came to her face after I told her that. Once fear is gone, healing is faster. I had her sit up again, manipulated the muscles in her L3 area and asked her to try and turn her head again. To her surprise there was a notible increase in her range of motion before the pain kicked in. The low back is related bio mechanically to the neck. Anyway, her first treatment was very successful. She came in the next day telling me she still hurt, but slept better through the night on less Advil then the other night. Again I eliminated triggger points in most of those same muscles. The next day( saw her three days in a row) she was 99% pain free , had full range of motion, and I only found two mild trigger points between her shoulders. So it was over.
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Connected to the above comment( Once fear is gone, healing is faster ). They call it catastrophizing. Check the attachment below.
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This maybe my last entry on this thread? I'm sure that I will still comment in here from time to time. But maybe not on this thread? . I've expressed my point of view that trigger points are the most important aspect of massage therapy, or any therapy, when it comes to helping people out of pain. And how trigger points are commonly never considered by any type of health care professional regardless of how much alphabet they have before or after their names.
We( massage therapists) could easily be the go to guys when it comes to palpatory pain and pain in general. But we aren't. Because of our education system. Very little time or energy is put into trigger point work if at all. When there is an emphasis on medical aspects of our profession, it seems to center around structure and fascia. Also what trigger point training that is out there seems to be overly complicated with too much emphasis on subjective palpatory skills and unnecessary time spent on needless analyses as to where the trigger points are.
All this is my opinion of course . I've tried to back up everything I've said on this thread with information and quotations from smart people that are experts in the pain field along with some of my personal experiences. My intention in here was not to teach techniques or tell anyone what to do. Im just expressing another direction that has virtually untapped potential for our profession that has ,for whatever reason, been ignored. And I know it has untapped potential.
A couple months ago I got a phone call from an anesthesiologist that runs a pain management clinic. He heard about my work and wanted me to come in and explain what I do to him and his staff. After a second interview and a live demonstration of my work he hired me. This medical doctor is a pain expert and knows the importance of trigger points, and the part they play in virtually all pain syndromes. He injects trigger points. With me in his clinic, it helps free him up to work on the more serious of his pain patients. It's a big fully staffed modern clinic, with more medical doctors coming on board.
I'm so excited to finally be working directly with a group of highly educated people that understand and recognize the importance of my work( trigger point work). As a side note....just the other day I met a massage therapist that told me there is really no proof that trigger points exist. Hmm? - Attachments:
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Apropos, isn't it, that MDs and DCs and PTs who lack the skillset to locate and release trigger points deny that trigger points exist. I am ashamed to say that a large percentage of our fellow massage therapists also look for excuses for their inability to treat trigger points.
About this thread, Gordon, please leave it open for others to post their own experiences. Or, maybe rename the thread? Instead of the current name, A Typical Experience, word it so that anyone who stumbles across the thread will recognize immediately that here they can discover the benefits of trigger point therapy for the therapist and especially for their clients., and through questions and answers learn trigger point treatment techniques.
I-- we, your followers-- have benefited greatly from the information you've shared. You will be busy in your well-earned new position. We hope that you will find time to continue to share your experiences with us.
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Gary, I don't think it's an inability to treat trigger points. They just don't know about them or if they do, the importance of them. As for the thread. Whoever wants to post on it can. And of course I will still check this site out and comment on things if I feel I have something important to say or contribute to.
Gary W Addis, LMT said:Apropos, isn't it, that MDs and DCs and PTs who lack the skillset to locate and release trigger points deny that trigger points exist. I am ashamed to say that a large percentage of our fellow massage therapists also look for excuses for their inability to treat trigger points.
About this thread, Gordon, please leave it open for others to post their own experiences. Or, maybe rename the thread? Instead of the current name, A Typical Experience, word it so that anyone who stumbles across the thread will recognize immediately that here they can discover the benefits of trigger point therapy for the therapist and especially for their clients., and through questions and answers learn trigger point treatment techniques.
I-- we, your followers-- have benefited greatly from the information you've shared. You will be busy in your well-earned new position. We hope that you will find time to continue to share your experiences with us.
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I found several articles online written by smart people that doubt the existence of trigger points. Here is one. I didn't read it all. Just skimmed it.
http://www.bodyinmind.org/trigger-point-evaluation/
All I know is that when I make the trigger points go away, the clients pain problem is gone or dramatically improved. That's real enough for me.
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If they can treat trigger points successfully, but choose not to in order to entice clients (patients?) to come in for appointments for months on end, then their ethics are questionable. BTW, I and everyone who has experienced the instant relief obtained with a skillful trigger point evaluation and treatment doubt the intellect of any "ethical" professional who denies the existence of trigger points.
As for that link and its author, I've had several arguments with him over on LinkedIn about the existence of trigger points. I've just read the entire article and all comments. My opinion remains that the "theory" advanced as it it were ironclad proof by Quntner doesn't even mention the trigger point therapies employed by massage therapists. The entire focus of Quintner's criticism are the methods used by physical therapists-- stretching, injecting, freezing spray coupled with minimal "milking" compression (i.e., light, intermittent compression of the TrP). Not one word about even the tried-and-true but needlessly painful hard compression of the tender spot currently being taught in a few massage schools..
No mention of, and certainly Quintner has zero knowledge of the advanced methods you and I (to a far lesser extent) employ that obtain trigger point release --painlessly-- in seconds.
But, trying to educate these willfully ignorant self-proclaimed gurus is akin to trying to inform a willfully ignorant fan of the true nature of the newly elected wannabe-- soon to become-- multibillionaire.
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Yea I'd love that guy to watch me work and see what he says? Lol. Anyway here is an article that argues the existence of trigger points.
https://www.nielasher.com/blogs/video-blog/72469509-trigger-point-t...
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