More On Myofascial Trigger Points (TrP’s)

Back in May of this year, I posted an article titled Trigger Points (TrP’s) In Detail and thought I would take it a step further by describing additional TrP’s that I learned about via the Precision Neural Mobilization seminar I attended. Before I list them however, please allow me to give you some other details.

1) TrP’s may be caused by several factors, including acute or chronic muscle overload, activation by other TrP’s, disease, psychological distress, homeostatic imbalances, direct trauma to the region, accident trauma, radiculopathy, and infections/health issues.

2) TrP’s form only in muscles—as a local contraction in a small number of muscle fibers located within in a larger muscle or muscle bundle. They can pull on tendons and ligaments associated with the muscle, which in turn, can cause pain deep within a joint where there are no muscles. They can also cause muscle weakness.

3) TrP referral patterns follow specific nerve pathways and have been readily mapped—thanks to Travell & Simons—to aid in the identification of pain. Many TrP’s have pain patterns that overlap, and some create reciprocal cyclic relationships.

4) A taut band in muscles containing TrP’s can feel like hard nodules. Upon palpation, a twitch response can often be felt; activateing the “all or nothing” response in a muscle that causes it to contract. Pressing on an affected muscle can often refer pain, and clusters of TrP’s are not uncommon in some in larger muscles (i.e. the gluteus group).

As promised, here is a list of TrP’s above and beyond what I gave you the last time; the first three being what was listed in my previous post…

  • Active – A TrP that causes a clinical pain complaint. It is always tender; prevents full lengthening of a muscle; weakens a muscle; activates a local twitch response when stimulated; direct compression refers patient-recognized pain that is generally in it’s pain reference zone. (Click here for a website that lists reference zones and pain referral patterns.)
  • Latent – A TrP that is clinically inactive with respect to spontaneous pain; painful only when palpated. It may have all other characteristics of an active TrP and always has a taut band that increases muscle tension and restricts range of motion (ROM).
  • Satellite – A TrP that is influenced neurogenically or mechanically by the activity of a key TrP.
  • Associated – A TrP in one muscle that develops in response to compensatory overload, a shortened position, or referred phenomena cause by TrP activity in another muscle. Satellite and secondary TrP’s are types of associated TrP’s.
  • Attachement – A TrP at the musculotendinous junction and/or at the osseous attachment of a muscle that identifies the enthesopathy caused by unrelieved tension, characteristic of the taut band that is produced by a central TrP.
  • Central – A TrP that is closely associated with dysfunctional end-plates and is located near the center of muscle fibers.
  • Key – A TrP responsible for activating one or more TrP’s.
  • Primary – A central TrP that is activated by acute or chronic overload, or repetitive overuse of a muscle in which it occurs, and was not activated as a result of TrP activity in another muscle.

The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies, but physicians, in weighing all the possible causes for a given condition, rarely consider a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.

The above quote comes from a workbook titled The Trigger Point Therapy Workbook. With this book, you will learn about TrP’s and how to treat them; however, it is important for you to keep in mind that if your muscular-skeletal system is misaligned, other muscles are affected, which in my opinion, makes it hard to self-treat in a way that is more than just temporary. Every little bit helps though!

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Some Info On Whiplash From Automobile Accidents

According to an estimate of the National Safety Council, there were 11,900,000 motor vehicle accidents in the United States in 1993. Of these, 2,750,000 were rear-end collisions. Although the precise number of whiplash injuries per year cannot be determined, a rather rough estimate is more than one million. Nearly one-third of all motor vehicle accidents are rear-end collisions, and it is this type of accident that is responsible for most whiplash injuries. — RW Evans

A couple of years ago, I completed a Distance Education course from “The Complete Guide to Whiplash” written by Michael R. Melton, owner of BodyMind Publications and founder of ChiroHosting, and learned what factors and variables—among many other things—are used when determining the difference between an accident with no injury and an accident with serious injury. They include…

  • The angle of the collision
  • The speed and size of the rear car
  • The speed and size of the front car
  • Road conditions
  • Occupant head position
  • Gender
  • Occupant awareness
  • Head restraints
  • Safety belts
  • Secondary collisions
  • Direct body impact
  • Loss of consciousness
  • Medical history
  • Pain onset

As you can see there are many variables involved, and believe it or not, each crash possesses its own characteristics.

According to an equation related to the physics of acceleration, the less a car is damaged or crushed in a collision, the higher the acceleration of the struck vehicle and the greater the risk of injury. — MC Robbins

That being said, it is crucial that a complete history be examined in order to help a whiplash patient recover quickly and easily. Following are some physical and psychological symptoms also found in The Complete Guide to Whiplash…

PHYSICAL

PSYCHOLOGICAL

  • Anxiety
  • Depression
  • Anger
  • Substance abuse

Per Michael’s book, one of the most common claims made by insurance companies is that whiplash injuries heal within six weeks and that care after that time is unnecessary. While many patients do recover within this six-week period, many studies show that between 20-30% have symptoms that last one year or more. In addition, studies also show that some symptoms may even take days or weeks to develop after an accident; however, insurance companies will often attempt to discredit a patient’s symptoms if they aren’t reported at the time of the accident; as if malingering.

It is very difficult for an ingenuine individual to fake a profile typical of a whiplash patient. — BJ Wallis

I wanted to write this post because I have had several clients over the years, whom suffered from whiplash as a result of an automobile accident, and eventually became pain-free using Precision Neuromuscular Therapy (PNMT) techniques. Although PNMT won’t necessarily treat every single symptom that was mentioned above, it can help with muscular-skeletal imbalances, which can cause many that were mentioned.

Here are some other great resources related to whiplash from automobile accidents:
The Neck Disability Index (NDI) Study
T
he NDI Questionnaire
The Crash Pulse in Rear-End Car Accidents
The National Crash Analysis Center
Motor Vehicle Accident Reconstruction and Biomechanical Physics

As always, I hope you found this information to be informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Self-Care (For Massage Therapists And Clients)

Copyright © 2009, by Doug Alexander

In my opinion, treating our own TrP’s is pretty difficult; however, it can offer some short-term relief until the issue of pain and dysfunction—caused by muscular-imbalances—is addressed as a whole, by a trained professional. I say this because I have my own issues and find it hard to help myself most of the time—and this is what I do for a living.

There are so many options out there on the World Wide Web… From stretching techniques to tools galore. But what works and what doesn’t? Unfortunately, I can not really answer that question, but I can offer up the following information based on my own experiences, and those of my clients after hearing their experience with the suggestions I have expressed over the years.

With that said, I would like to bring to your attention an Electronic Self Care Manual that was created by Doug Alexander and his team at TouchU, located in Ontario, Canada. I had the pleasure of somewhat-meeting Doug via e-mail a couple of years ago, and through corresponding with him, I luckily ended up with this awesome manual (the above image is just one page out of 73) at my finger tips; handing out particular portions to my clients as a professional courtesy. This manual happens to be full of great advice; including information on types of injuries, stretching exercises (yes, with pictures), breathing techniques, postural improvements, etc. This .pdf is available to both therapists and non-therapists. If you are not a client of mine, please contact TouchU directly for a copy. If you are a client of mine, there is no need to contact them directly as I have it readily available for you.

In regards to tools for self-care, one I highly recommend is the Original Backnobber II, made by The Pressure Positive Co. My husband, and every client I have recommended this to, loves it. I have several clients that even take it with them during business trips because it breaks down into two pieces, making it easy to put in their carry-on luggage. Another great tool from this company is the Knobble II. I have actually laid right on top of this as a way to address TrP’s that I have had in my back, shoulder blades, etc.

Well, folks… That’s all for now. This was a pretty short post, but I hope you still found the information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Supporting Those Whom Support Me

This post really has nothing to do with PNMT, but I have a client who supports me—I have treated all in his family but one—and I want to show him and his family my gratitude by supporting them as well.

His name is Paul Smith and he had a book published this year! The name of the book is Lead With A Story: A Guide To Crafting Business Narratives That Captivate, Convince, And Inspire. It shows the reader how to use the power of storytelling to navigate 21 of the most common challenges business leaders face, based on interviews with over 75 CEOs and executives at dozens of companies around the world.

Paul is about to embark on his first (and only) public book signing in Cincinnati, OH. If you are in the area and this subject matter is of interest to you, please support him as well by stopping by.

Cincinnati Barnes & Noble
7800 Montgomery Road
Thursday, August 9th
5-7pm

Congrats, Paul! 🙂

Barefoot Is Better

I am engrossed in an awesome book and thought I would share some information from it. The book is called Born To Run: A Hidden Tribe, Superathletes, And The Greatest Race The World Has Ever Seen; written by Christopher McDougall. I highly recommend you check it out if you are a runner—or just happen to be looking for a good read.

I’m not a runner myself, but my husband and so many of my clients are; most of them experiencing—or have experienced—one or more problems associated with the sport. Achilles tendonitis, plantar fasciitis, knee pain, hip pain, hamstring pulls, shin splints, etc. Does any of this sound familiar? If so, please keep reading this post!

Ever since I went to massage school in ’06, I have firmly believed that running shoes have way too much cushioning and are way too technical; all of this causing, in my opinion, compensation issues, in addition to weakening the muscles in our feet. While reading the book, I was pleased when I found out that Vin Lananna, Stanford University’s head running coach, basically felt the same way. In fact, he apparently had his track team run barefoot during their practices, despite the fact that Nike sponsored them. During practice in April of 2001, Nike reps asked why they were “bare-footing” and Coach Lananna’s response was (p. 169-170), “I can’t prove this, but I believe when my runners train barefoot, they run faster and suffer fewer injuries…. We’ve shielded our feet from their natural position by providing more and more support… People went thousands of years without shoes… I think you try to do all these corrective things with shoes and you overcompensate… You fix things that done’t need fixing… If you strengthen the foot by going barefoot, I think you reduce the risk of Achilles and knee and plantar fascia problems.” Interesting, huh?

Here are some links to research that was also quoted in the book…

British Journal of Sports Medicine – Dr. Craig Richards revealed that there are no evidence-based studies that demonstrate that running shoes make you less prone to injury.

The American Journal of Sports Medicine – Dr. Bernard Marti’s study found that runners in shoes that cost more than $95 were more than twice as likely to get hurt as runners in shoes that cost less that $40.

Journal of Orthopaedic & Sports Physcial Therapy – Dr. Barry Bates gathered data that suggested that beat-up running shoes are safer than newer ones. He and his colleagues reported that as shoes wore down and their cushioning thinned, runners gain more foot control.

Here are a few other links you might find interesting:

Barefoot Ted
Tarahumara people
Barefoot Ken Bob
Caballo Blanco
Scott Jurek

Well, I don’t want to give the whole book away, so why don’t you pick one up for yourself. If you’re a runner and suffer injuries as a result, I’m sure you’ll enjoy it as much as my husband and I did.

On a side note, we just got some VIBRAM Fivefinger shoes. My husband LOVES them and I can’t wait to try them out! Here is their step-by-step guide if you’re interested in having a look-see.

7/30/12 UPDATE: Sparing the details, I just wanted to quickly mention that since I wrote this post, we have had a bad, unfortunate, and unacceptable experience with VIBRAM’s customer service department… And would highly recommend that you not deal with this company. There are other brands of this type of shoe out there and hopefully I will finally get into a pair from one of them soon!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me