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Trigger points are an extremely common cause of myofascial pain that is routinely overlooked and underestimated by many conventional healthcare practitioners. Trigger points can form within a muscle when it is traumatized from an injury, overuse, repetitive strain or emotional stress The the muscle forms an adhesion within its fibers in response to this stress and creates a "knot". On the cellular level, the exchange of oxygen, fresh blood and waste removal slows down and inflammatory bi-products begin to build up causing decreased circulation, inflammation and pain in the area. Trigger points are highly irritable bands of muscle that are painful when pressed on and cause constriction and shortening of muscle fibers. More importantly, trigger points have a special property called referred pain. Referred pain means that a trigger point in one muscle can create pain in another area. For instance, when the muscle at the top of your shoulder (trapezius) has a trigger point it can refer pain up the back of your neck and into your head causing a headache. Another example are trigger points in the posterior hip muscles (gluteals) that can refer pain down the leg. Trigger points have been referred to as the "great mimickers" as they can be the cause of painful symptoms that are often times attributed to other conditions such as pinched nerves, bulging discs, TMJ dysfunction & carpal tunnel syndrome. In many cases, trigger points are the root cause of unexplained pain that seemingly has no definitive origin. The insult to muscle and connective tissue which results in the formation of trigger points can occur in multiple ways:
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After forming, trigger points can have two phases, "active" and "latent". The active, painful phase of the trigger point is the one which can produce nagging, unrelenting and debilitating pain symptoms and motivates people to seek relief. The active trigger point hurts when pressure is applied and causes pain locally as well as referred pain. The referral pain may feel like a dull ache, a deep pressing pain, burning or a sensation of numbness or fatigue and even dizziness. The dense and taut tissue may even compress and entrap nerves leading to additional symptoms and dysfunction. If unaddressed or ineffectively treated, other muscles surrounding the effected one eventually may be required to "take up the slack" thereby becoming stressed, overworked and leading to the development of secondary trigger points. It's not uncommon for chronic pain patients to have multiple, overlapping referred pain patterns making diagnosis and treatment more complex and difficult to interpret.
"Latent" trigger points are another very common type of trigger point which can lie quietly in muscles, sometimes for years, subsequent to a long-forgotten injury. They generally do not cause pain unless compressed. An old injury that periodically re-surfaces (a "bum-knee" or low back "going out") may very likely be due to latent trigger points "waking up" and becoming active again. This can happen due to a variety of circumstances including new activites, muscle overload, a cold draft, fatigue, illness or stress.
Erasing trigger points can be done in a variety of ways, but basically, the therapist applies pressure directly at the site of the trigger point for a short period of time, usually 8-10 seconds. This relaxes the muscle fibers within the adhesion and flushes out toxins that have built up. Fresh circulation, oxygen and nutrients can now infiltrate the tissue helping to begin repair and return the muscle back to its natural state.
Expect your first trigger point therapy session to be slightly uncomfortable in the "good hurt" sense. Make sure to communicate with your therapist about pain levels during treatment. If you try to grin and bear it or if the therapist works too deep, your muscles will tense away from the pain and reactivate the trigger points that may have already been erased. Many patients experience immediate pain relief during their first treatment. For others, several treatments are needed before their pain starts to diminish. It is common for patients to experience some soreness for one to two days after treatment. This usually resolves after the first few sessions. You may experience some fatigue as the chronically held musculature is allowed to relax and return to a normal tone. In very extreme cases, some people experience nausea or flu-like symptoms after treatment as excessive amounts of waste and toxins are flushed out of their tissue. It is important to drink plenty of water after a session and do any homework the therapist gives you such as ice, heat and/or stretches, for example.
Don't expect to be completely healed after one session. It may have taken years for your injury to manifest and it's just not feasible to expect instant gratification when it comes to your health. It's like expecting to lose 15 pounds during the first week of a new exercise program...it's just not realistic.
We create muscle memory in the body when we learn something new. When you learn to ride a bike you are creating new neuropathways from your brain to your muscles. Even if you don't ride a bike for years, you can get on one and remember how to ride. This is the positive effect of muscle memory. Muscle memory can also work against us. When you have developed trigger points from trauma, repetitive motion or stress to a muscle it will create muscle memory. When we experience an injury, our muscles form a natural splint. This is helpful at the time of the injury because the pain forces us to not use the injured muscle too much and create further injury. The downside is that, with soft tissue injuries in particular, the muscle assumes the injury is recurring whenever the muscle is put into use. The older the injury, the longer it takes to heal. The body heals at it's own pace and each person will do so at different rates. Trigger point therapy will help to greatly accelerate the process, but it is not a miracle cure.
When you first experience Trigger Point Therapy, you may notice that your pain covers a fairly large and diffuse area. As you progress, the pain will change and you may be able to pinpoint specific hot spots. You may also have a new pain in an area that never bothered you before. Don't be alarmed. You want the pain to change as this is a sign that it's working its way out of your body. Your brain can only focus on so many things at once. As one area of pain resolves others that were present, but not in your awareness may surface. When recovering from chronic pain, it may feel as though you're working through various layers of pain, like peeling back the layers of an onion.
When you begin treatment, you may experience a consistent drop in your pain levels. Then one week, you will flare up and your pain levels will rise again. This can be very discouraging and even frightening for some people, however, this is quite a common occurence. You should know that the pain from "flare-ups" is typically much less intense than the original pain and resolves much quicker. Flare ups are usually due to increases in stress, either physical or emotional.
Your therapist should give you some "homework" in the form of self-care and exercise to do on your own and, if you do it, you will see results faster than if you just rely on your therapy sessions alone. It is important to take responsibility for your health and your therapist is here to help you. Trigger Point Therapy has a very high rate of success in healing myofascial pain. But in order for it to work, you will need to receive treatment consistently. If you only seek treatment sporadically, your muscle memory will keep coming back and it will get stronger and stronger over time. Like exercise, being consistent will grreatly increase the chances of reaching your goals and acheiving complete recovery.
Bodies in Balance Advanced Muscular Therapy
15953 N. Greenway-Hayden Loop, Suite A, Scottsdale, AZ 85260
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