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Treatment Work - Conditions

Trigger Points

A trigger point is simply a point on the body that, when pressed, refers pain elsewhere in the body. As an example, pressing a specific shoulder point refers pain down the arm. The “bible” on the subject is a two volume set by Travell and Simons. A more user friendly book is “The Trigger Point Therapy Workbook” by Clair Davies. Pain patterns are very, very specific and well documented. As information, the Travell mentioned is Dr. Janet Travell, who happened to have been John F. Kennedy’s personal physician while JFK was President.

Typical allopathic treatment involves an injection with Lidocaine, Botox or a Saline solution. Botox, as an example, works by paralyzing the surrounding muscle tissue, lasts about 3-4 months, is very painful to receive, and costs about $500 per injection. It does NOT, however, cure the problem. It merely masks it.

The typical bodywork treatment is called Direct Ischemic Pressure. It is the epitome of simplicity. Apply direct pressure into the trigger point until the maximum referral has been achieved as well as the maximum degree of pain. Then simply maintain that level of pressure. After a few seconds, the referral pattern will start shifting until it is only under the pressure point. After that has been achieved, the pain level will decrease to the point where it is merely pressure and no longer painful. Unlike injections, this DOES have the potential over time to cure the problem. And it need not cost anything because it is something that people can easily do for themselves and those around them.

But as a point of FACT (although disputed by most Western Medical folks), ALL trigger points are in reality acupoints. Because of this, I find it to be much quicker, easier, and less painful to receive if treated energetically by holding two acupoints simultaneously. Just a fraction of the pressure is required and the results are 3-4 times faster. Trigger Points

Trigger Points are no where near the irritant to me that my three Pet Peeves are. They are, however, what got me “actively involved” in the first place beyond just my immediate family.

As I was learning how to do things while in massage school, my daughter benefited from getting worked on at least every other week (She and her mother took turns while I was learning the Swedish relaxation fluff and buff stuff saying “It’s MY turn. No it’s not. He worked on you last week.” This switched to “It’s YOUR turn” once we got into learning treatment techniques. Don’t ever ask either one of them about cross fiber friction to treat shin splints <G>.)

I was not a member of any support groups at the time. My daughter, however, belonged to probably two dozen or more. Whenever I would learn something and practice it on her with good results, she would post the information to the various support groups. Before long, she was getting posts and emails saying “Barb – I know your Dad is in massage school. Has he learned anything about treating X, Y, or Z?” She would forward the question to me, I would reply to her, and she would then send the answer out to the groups.

About six months after I graduated, she forwarded a post to me from someone in Florida about a person who DIED from an allergic reaction to the Botox injection used to treat her trigger points. Specifically, she died from cardiac arrest while receiving Botox injections to treat trigger points stemming from her Fibromyalgia. . She was 43 years old. I went stark raving ballistic. I was so hot about it, I was over the moon. I also stopped sitting on the side-lines and got actively involved with the support groups.

Anyone with a reasonable knowledge about trigger points is probably already aware that the “bible” on trigger points is the two volume set “Myofascial Pain and Dysfunction” by Janet Travell and David Simons. At close to 1700 pages for the two volumes, it is very, very detailed. At $195 new and $161 used from Amazon, it is also very, very expensive. A much more reasonable alternative is “The Trigger Point Therapy Workbook” by Clair Davies. It is less than 300 pages but it is also less than $20 new and even less than that used.

Both sources COMPARE trigger points to acupoints. On page 2, Davies says “Why has the medical profession not embraced the idea of trigger points? Partly it’s because trigger points are commonly confused with acupressure points.” He goes on from there, perpetuating the myth and lie that has surrounded trigger points/acupoints for the last 50-60 years.

What most people don’t know is that Janet Travell was John F. Kennedy’s personal physician when Kennedy was President. This means that much of her formative period was BEFORE Nixon went to China. And it was not until the reporters who traveled to China with Nixon came home and wrote about the use of acupuncture in China in lieu of sedatives during surgery that there was even a glimmer of mainstream understanding about meridian theory, let alone acceptance. There is also that lovely thing called Prevailing Standard of Care, which meant that any mainstream “real” (as in card carrying AMA member) doctor who even considered something as outlandish as acupuncture risked losing their license to practice. Consequently, all of the early literature on trigger points was deliberately distanced from anything having to do with acupoints. There is some similarity, BUT they are NOT acupoints. That attitude is still prevalent in mainstream medical literature.

It was incorrect 60 years ago. It is incorrect today. They are not just “similar.” ALL trigger points are in fact acupoints.

There are many different ways to “treat” trigger points, ranging from very gentle to very invasive, from totally free to very expensive, from painless to excruciating, from what actually works to simply throwing your money away. The mainstream medical approach these days more often than not is an injection with Botox, Lidocaine, or a Saline Solution. Those who have gone through it that I have discussed it with tell me that the average is about $500 per injection and lasts on average of about three months. It in no way makes the problem go away. It merely masks it for from 2-4 months. And it does so by paralyzing the surrounding tissue and in essence deadening the trigger point. However, once the injection wears off, the point returns in all its painful glory. They also tell me the procedure itself is very painful to receive.

The standard bodywork treatment taught in any massage school in the country that gets into treatment techniques is direct ischemic pressure. This is just one of my fifty cent words that simply means applying direct pressure into the point and holding it until the pain stops.

Before getting into more detail, a bit more background about trigger points. Trigger points don’t just suddenly appear with no warning signs. They always start out first as tender points. If left untreated, tender points have the nasty habit of turning into trigger points. The distinction between the two and what defines a point as being either a tender point or a trigger point is whether pain is referred elsewhere in the body when pressure is applied. If the pain is local to the point, it is a tender point. If pain is referred elsewhere, to some location in the body other than the point being pressed, it is a trigger point. These referral patterns are very specific and very well documented in the literature.

To treat using direct pressure, use a fingertip, thumb or some blunt object to press into the point. On a scale of 0-10, press until the maximum pain level is reached AND the maximum referral distance from the point has been achieved. As an example, say the involved point is in the Infraspinatus on the scapula and the referral is in front on the biceps. Continue increasing the pressure until the maximum distance from the point itself is achieved, Then simply maintain that pressure. That’s it. As the point releases, the referral pattern will withdraw to being just local to the spot being pressed. The pain LEVEL usually doesn’t change during this withdrawing. If it was a 7 to start, it will stay at a 7 until the pain becomes localized. But once it is localized, the pain level itself will diminish. Just maintain the same amount of pressure, start to finish, until the pain is gone.

TheracaneWill one treatment be a permanent fix or cure? Probably not, if the problem has been chronic. But you CAN make the trigger point go away in time using this technique. More importantly, you can show your clients how they can treat themselves (I know, bad for repeat business but think of all the referrals they will hopefully send your way). If the point is difficult for them to reach, have them get a Theracane and show them how to use it. The technique is simple, easy to do, non-invasive, relatively painless (certainly compared to injections), and very, very inexpensive since they can treat themselves.

All of the above discusses the standard, manual, bodywork protocol. But knowing that trigger points are in fact acupoints puts things in an entirely different light. You can achieve identical results in a fraction of the time and with a fraction of the pressure (less painful for your client and easier on your own thumb and finger joints) if you treat the point energetically using a local and distal point simultaneously. One point is the trigger point. The point I generally use for the second point is Gall Bladder 20. (I tend to use Gall Bladder 20 as my second point for most things because it is a cross-over point with the meridians). Accessing the two points simultaneously and then simply holding for an energetic balance is all that is necessary.

Aside from the fact that my books on acupressure/acupuncture/meridian theory SAY that trigger points and acupoints are the same thing, I have other, empirical reasons for believing this to be true. One is that I have taken out literally hundreds of trigger points on dozens of bodies in the last couple of years by simply holding a local and distal point and waiting for the balance. After you get used to doing it that way, you will suddenly realize that you can actually tell by the changes in the sense of energy what is happening in the body; that the pain has become localized, and even where the pain is on the 0-10 scale. The other reason is because of what my knowledge of anatomy, muscle structure, nerve pathways, and fascia tell me. It doesn’t take much cross checking or comparison of these to pain referral patterns to realize that the pain referral patterns do not track with muscles and nerves. You can’t draw a direct line through a muscle or along a nerve to get from the trigger point to where it hurts. If there is no direct muscle/nerve link, what connects the two? There is only one thing that I can think of and that is fascia. And since I personally, absolutely do believe that the energy pathways are in fact physically embedded in the fascia, it makes perfect sense that the pain referral is traveling along the energy channels, through the fascia. Besides, the Eastern literature on meridian theory goes back at least 5000 years. The Western literature on trigger points only goes back 60. Until proven otherwise, I think I will stick with the longer track record.

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