Information from the Trigger Point Therapy Workbook
The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, 2nd Edition, by Clair Davies, NCTMB with Amber Davies, NCTMB
“The daily clinical experience of thousands of massage therapists, physical therapists, and physicians strongly indicates that most of our common aches and pains – and many other puzzling physical complaints – are actually caused by trigger points, or small contraction knots, in the muscles of the body. Pain clinic doctors skilled at detecting and treating trigger points have found that they’re the primary cause of pain roughly 75 percent of the time and are at least a part of virtually every pain problem.” (p. 2)
“Trigger points are known to cause headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis [my emphasis], tendinitis, bursitis, or ligament injury. Trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow, and genital pain. Trigger points can also cause colic in babies and bed-wetting in older children, and may be a contributing cause of scoliosis. They are a cause of sinus pain and congestion. They may play a part in chronic fatigue and lowered resistance to infection. And because trigger points can be responsible for long-term pain and disability that seem to have no means of relief, they can cause depression.” (p. 2)
“The problems trigger points cause can be surprisingly easy to fix; in fact most people can do it themselves if they have the right information. That’s good because the time has come for ordinary people to take things into their own hands. The reason for this is that an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points, despite their having been written about in medical journals for over sixty years. There has been, and continues to be, great resistance to the whole idea that trigger points are real and should be taken seriously.” (p. 2)
“Our knowledge of trigger points, however, comes right out of Western medical research. Trigger points are real. They can be felt with the fingers. They emit distinctive electrical signals that can be measured by sensitive electronic equipment. Trigger points have also been photographed in muscle tissue with the aid of the electron microscope.” (p. 2)
“Most of what is known about trigger points is very well documented in the two-volume medial text Myofascial Pain and Dysfunction: The Trigger Point Manual, by Janet Travell and David Simons [both M.D.’s]. These books tell virtually all that is known about trigger points, and the prospects for pain relief are very exciting.” (pp. 2 and 3)
“Travell and Simons describe a trigger point as simply a small contraction knot in muscle tissue. It often feels like a partly cooked piece of macaroni, or like a pea buried deep in the muscle. A trigger point affects muscle by keeping it both tight and weak. At the same time, a trigger point maintains a hard contraction on the muscle fibers that it is a part of. In turn, these taut bands of muscle fiber keep constant tension on the muscle’s attachments, often producing symptoms in adjacent joints. The constant tension in the fibers of the trigger point itself restricts circulation in its immediate area. The resulting accumulation of the by-products of metabolism, as well as deprivation of the oxygen and nutrients needed for metabolism, can perpetuate trigger points for months or even years unless some intervention occurs. It’s this self-sustaining vicious cycle that needs to be broken.” (p.3)
“The difficulty in treating trigger points is that they typically send pain to some other site. Most conventional treatment of pain is based on the assumption that the cause of pain will be found at the site of the pain. But trigger points almost always send their pain elsewhere. This referred pain is what has always thrown everybody off, including most doctors and much of the rest of the health-care community. According to Travell and Simons, conventional treatments for pain so often fail because they focus on the pain itself, treating the site of the pain while overlooking and failing to treat the cause, which may be some distance away.” (p.3)
I have found trigger point therapy to be an extremely important part of my practice as a physical therapist, often resulting in significant relief of pain and dysfunction. I am forever grateful to Janet Travell, MD and David Simons, MD for their pioneering work and for their comprehensive two-volumes detailing all aspects of this field. The Trigger Point Therapy Workbook puts the massive research and knowledge of Travell and Simons into a framework that can be used by practitioners, and individuals themselves, to track down and treat trigger points. Every time working with trigger points brings pain relief to one of my patients, I am grateful to Clair Davies and Amber Davies for their dedication to this work and their true desire to eliminate as much pain as possible.
Here are some facts that are helpful to know:
Sometimes acute pain can respond very quickly with trigger point treatment, often in one or two sessions. But some pain requires patiently continuing treatment for many weeks. Some patients become discouraged and give up if progress is not fast enough. I have had cases, that were ultimately successful, where progress was not evident in the early stages. But, over several weeks, the trigger points became fewer in number and less sensitive and the problem slowly resolved. We are a society geared toward instant results. But healing, as opposed to merely masking the symptoms, may require time and patience.
If trigger points appear to be a part of a pain problem, but adequate trigger point treatment is not bringing the anticipated relief, it may be necessary to look for perpetuating factors that are keeping the trigger points active. Such factors can include:
- abnormal bone structure (including unequal leg length, an asymmetric pelvis, etc.)
- stress from poor posture
- repetitive movement stress
- vitamin and mineral deficiencies (including B1, B6, B12, vitamin C, folate, calcium, iron, magnesium, and potassium)
- metabolic disorders (such as thyroid inadequacy, hypoglycemia, anemia, high uric acid levels, and metabolic irregularities caused by nicotine, caffeine, and alcohol)
- psychological factors (such as tension and anxiety)
- other factors, such as chronic lack of sleep, diseases of internal organs, chronic infections, allergies, infestations of the intestinal tract.
The Trigger Point Therapy Workbook is designed to be a self-treatment manual and includes all the information necessary for success. However, I find that many of my patients, especially in the early stages, become overwhelmed and need treatment by a professional. Once they become familiar with the technique and its results, they may learn to feel comfortable with self-treatment. Indeed, self-treatment is what Clair Davies intended when he wrote The Trigger Point Therapy Workbook. If someone wakes up in the middle of the night with pain from trigger points or does not have access to a qualified professional for treatment, it was his desire that that individual could take immediate action to resolve the pain problem.
Pain can be caused by many factors. Don’t overlook the possibility that trigger points can definitely be one of those factors.
Information from Myofascial Stretching: A Guide to Self-Treatment by Jill Stedronsky, MS, OTR and Brenda Pardy, OTR
“A fascial restriction is a thickening, shortening or tightening in the connective tissue caused by injury, trauma, inflammation or poor posture. Restrictions can adhere to and put abnormal pressure on nerves, muscles, blood vessels, bones, organs and the brain, resulting in inefficient function of these structures. Pain, limitation of motion and structural misalignment are some of the consequences.” (p. 3)
“Myofascial Release, as developed and taught by John F. Barnes, PT, is a gentle, hands on approach used to free up fascial restrictions throughout the body. The therapist releases the tight fascia by applying sustained pressure into the fascial barrier or restriction, allowing permanent elongation of the tissues. As fascial layers are released, the client gains greater flexibility. This results in decreased pain, enhanced daily functional abilities, refined athlete performance, increased ease of movement and improved structural balance and integrity.” (p. 3)
As with trigger points, John Barnes, PT, would often say,”Find the pain; look elsewhere for the cause.” In addition to medical evaluation and treatment, trigger point therapy and myofascial release are valuable tools in the fight against pain.
Deficiencies of Vitamin D have been associated with pain syndromes. Check back – More to come!