This Page Last Updated: Sat Feb 11 2006:

Trigger Points

Update:
	The book "Pain Erasure: The Bonnie Prudden Way" by
Boinnie Prudden is a $12.95 Do It At Home Book on trigger
point removal.  I got mine at the local book store.
ISBN 0-345-33102-8

End Update.

	These messages where originally to Darlen Strand, about my
wife, in the FidoNet Chronic_Pain Echo.

DS> My neck stays tense constantly.  I am forever with a headache.

DS>     It got better at times but as soon as I do work like cut the
DS> lawn or trim a tree or anything a little strenuous, it starts all
DS> over again.

        When I meet Karen she walked around like she had a board strapped
to her back and she would never turn her head, she turned her whole
body.

        This is one of the other things that we have found that did
relieve some of Karen's pain, at least a little.

        Some thing called Myotherapy or the treatment of "Trigger
Points":

        Here is a quick introduction from The Trigger Point Manual, this
is !!THE BOOK!! that Myotherapy is based on:

                Myofascial Pain and Dysfunction: The Trigger Point
Manual by Janet G. Travell, M.D. and David G. Simons, M.D.,
Illustrations by Barbara D. Cummings.  Published by Williams & Wilkins
428 E. Perston Street, Baltimore, MD 21202, U.S.A.  ISBN 0-683-083366-X.

        Volume One covers The Upper Extremities (Waist and above), Volume
Two covers The Lower Extremities (Waist and below).  You must have the
introductory information from Volume One to use Volume Two.

        From the Foreword:  "At last a text is presented about the pain
and dysfunction of myofascial tissues (Muscles), a condition that
confronts the medical practitioner daily, but remains poorly understood
and frequently overlooked by the medical profession.  Yet, patients
continue to present themselves with symptoms that are attributable to
myofascial trigger-point pathophsiology.  These patients often fail to
receive proper evaluation and, therefore, appropriate treatment.

        "'Trigger points' have been inadvertently discovered by
patients, their spouses, therapists, non-medical practitioners; yet,
many of their physicians who have examined them, have attributed their
condition to various etiologies, and treated them with ineffectual
methods.  Failure to achieve success has resulted in the assumption [By
the Doctors] that patients in their noncompliance are the cause of
failure, rather than therapeutic misguidance [Doctor being wrong
{Doctors are never, ever wrong, even if they are}].

        "For decades, Janet Travell has labored to document the
scientific basis of myofascial pain and dysfunction.  Her clinical
reports have been ridiculed and ignored by some, but believed and
confirmed by many."

        The Myotherapits that we have meet have made believers out of
us.  Remember I said Karen would not turn her head because of her tight
muscles?  Karen was setting on the therapy table with the therapies
behind her.  After the therapits treated her the first time, for about a
hour, the therapits asked her a question.  She turned her head to look
behind her to answer him.  She didn't even realize that she did it.  I
almost cried.  After the first treatment she said she had noticeably less
pain.  Gone by no means, but that was the first thing that even made a
dent in her neck tenseness.

        From the Glossary:  "Active Myofascial Trigger Point:  A focus
of hyperirritability in a muscle or its fascia [the bag like stuff that
covers muscles] that is symptomatic with respect to pain; it refers a
pattern of pain at rest and/or on motion that is specific for the
muscle.  An active trigger point is always tender, prevents full
lengthening of the muscle, weakens the muscle, usually refers pain on
direct compression, dediates a local twitch response of muscle fibers
when adequately stimulated, and often produces specific referred
autonomic phenomena, generally in its pain reference zone.  [For example
a trigger point below your ear will give you a headache behind your
eyes.]  TO BE DISTINGUISHED FROM A LATENT MYOFASCIAL TRIGGER POINT.

        "Latent Myofascial Trigger Point:  A focus of hyperirritability
in muscle or its fascia that is clinically quiescent with respect to
spontaneous point; it is painful only when palpated.  A LATENT TRIGGER
POINT MAY HAVE ALL THE OTHER CLINICAL CHARACTERISTICS OF AN ACTIVE
TRIGGER POINT, FROM WHICH IT IS TO BE DISTINGUISHED.

        "Referred (Trigger-Point) Pain:  Pain that arises in a trigger
point, but is felt at a distance, often entirely remote from its source.
The pattern of referred pain is reproducibly related to its site of
origin [You press on the Trigger-Point and it makes your pain feel
worse, usually some placed remove from where you are pressing].   THE
DISTRIBUTION OF REFERRED TRIGGER-POINT PAIN RARELY COINCIDES WITH THE
ENTIRE DISTRIBUTION OF A PERIPHERAL NERVE OR DERMATOMAL SEGMENT.

        "Referred (Trigger-Point) Phenomena:  Sensory and motor
phenomena, such as, pain, tenderness, increased motor until activity
(spasm), vasoconstriction [Preventing proper blood flow; for example a
trigger-point on the back of the neck can cut down blood flow to the
eyes], vasodilation [To much blood flow], and hypersercretion caused by
a trigger point, which usually occur at a distance from the trigger
point."

        We got our copy of this book from B.Daltons Book store, each
volume cost about $80.  [I hope you didn't fall over, please stick with
me for a bit.]  Check your area libraries.

        Ok so much for a basic introduction why are we telling you this?

DS> No pain at the time. Really, I can say I didn't feel any pain at all.  I
DS> don't know if I mentioned to you about one morning waking up to my being
DS> stuck sideways in between my water bed mattress and the bed wood frame.
DS> I'm separated now, but at the time I do believe it was because being
DS> that my husband is a very big man and when he lays on the water bed my
DS> side goes up and I tend to roll.  This time I guess being asleep I
DS> rolled the other way and fell in between the mattress and the frame. Well,
DS> when I woke up I was in the position of like doing a side stroke of
DS> swimming with my arm straight up over my head and my neck totally stiff
DS> and terribly sore.  Well after that my neck has never been ok.  It got
DS> better at times but as soon as I do work like cut the lawn or trim a
DS> tree or anything a little strenuous, it starts all over again.

        Keep in mind I'm not a doctor and I can only speculate what has
helped Karen might help you.  This is my speculation:

        Your accident gave you a Latent Trigger Point [every one as a at
least a few, but the may never become active, where they cause pain].
Then your sleeping wrong gave you a Active Trigger Point.  When you get
a bit better at time you end up doing some thing that irritates your
Trigger Points again so you have a relapse.

        What the book teaches is three techniques to get rid of trigger
points, it also covers a exercise for each muscle to get each muscle in
the body stretched out to its maximum length, with out over extending it.
You do these exercises very slowly and gently.  Over doing, by
stretching to far, could damage your ligaments.  You need to do them
often and the should never make you feel any worse than when you
started.  They should make you feel just a bit better, maybe not much
when looked at on a day by day basis, but looked at over a longer period
of time they do help.

        When the muscles are relaxed at their optimal length they tend
to not to go into the very painful spasm. ie. Your tight neck muscles.
You need to keep doing the exercises to keep the muscle lengthened out,
to keep the spasms from coming back.

        I wish I could figure out how to describe these exercises, as
they are mostly pictures in the book.

        The three techniques are:

1) Injection of a anesthetic by a doctor into the Trigger Point site,
doing it wrong will just give you more Trigger Points.  We can forget
about this one in this context.

2) Number two is known as Stretch And Spray.  As a Therapits stretches
your muscles as they spray them with a very fast evaporating cooling agent
[Florla Methane I think but I'm not sure.] that causes the muscle to
lengthen.

3) Direct Trigger Point pressure.  This is some thing you can learn to
do your self with a bit of practice.  All thou for some Trigger Points
that are on your back it is easier to have help from some one else to
press on them.  When you, or some one finds a Trigger Point, you'll know
it.  It will make your pain much worse, and muscles tighter, and keep in
mind that the Trigger Point may be far removed from where your pain is,
thou it will always be within the same muscle as the pain.  However you
can get a overlapping effect because many muscles do overlap [A Trigger
point might be on the muscle under the one that you are actually
pressing on.  A trained therapits knows how to deal with this, the book
is a bit hard for me to follow in this area].

        If you had the book you can look at the pictures and charts that
say if it hurts here, press there.  Don't start by pressing where it
hurts, that is almost never the Trigger Point, thou there are exceptions.
Without the book you just have to explore.  The pressure that you apply
should be a firm continuous pressure, no poking, no jabbing, no rubbing
in circles, and never press so hard that it causes bruising.  Since it
makes the pain worse you have a tendency to try to wiggle away from the
pressure, because of this it is more effect to have some one else press
them; how ever you can learn to do it yourself.

        Ok, now why would you want to press on a Trigger Point if it is
going to make the pain worse?

        With brief pressure the pain gets worse, but with sustained
[Seconds to minuets, it just depends] pressure the muscle will relax.
One of the theories (there are several) of what happens here is that the
pressure on the Trigger Point causes some thing call 'no-knox-ia' (Not
sure of the spelling that is how the word sounds to me), ie.  The amount
of oxygen going to the muscle is cut down, the muscle can't work with
out oxygen so it relaxes.  Some times they stay relaxed, some times they
don't, it depends on what caused the Trigger Point in the first place,
and what might keep them irritated.  If you can keep the muscle relaxed,
and the Trigger Point unirritated, the trigger point goes away after
awhile, or at least not cause pain any more.

        Thats the best that I can do for a introduction to Trigger
Points, I have not done the subject justice, but I hope that it at least
points the way..."