Trigger Point Therapy: A Guide for Pain Relief
Posted: 03-02-2009 7:41 pm by Geoff Lecovin, D.C., N.D., L.Ac., CSCS
Causes of Pain
Myofascial pain is characterized by tight knots known as trigger points. Trigger points can result in either local or referred pain. Many pain clinics have found that trigger points are a primary cause of pain over 90 percent of the time and the sole cause of such pain as much as 85 percent of the time.
Latent ("silent") trigger points tend to accumulate over a lifetime and appear to be the main cause of stiff joints and restricted range of motion of old age. These latent trigger points can also overstress muscles, causing shortening, which affects attachments and causes irreversible joint damage.
Trigger points can cause: headaches, neck and jaw pain, low back pain, symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis, tendonitis, bursitis or ligament injury. Trigger points can cause problems as diverse as: earaches, dizziness, nausea, heartburn, chest pain, heart palpatations, tennis elbow, tinnitus and genital pain. Trigger points can also cause: colic, bed-wetting 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, fibromyalgia, and lowered resistance to infection. Because trigger points can be responsible for chronic pain and disability, they can also cause depression and anxiety.
Causes of myofascial pain syndromes include macro trauma, such as a strain/sprain injury or car accident. They can also include repetitive micro traumas, such as those caused by typing or other repetitive fine motor movements.
Development of Trigger Points
There are numerous perpetuating factors that also play a role in the development or maintenance of trigger points. These include:
Metabolic and Endocrine imbalances:
Physical interventions are the most effective ways to deal with trigger points. Other therapeutic methods such as: heat, cold, electric stimulation or ultrasound can give temporary relief, but will be disappointing in the long term. In addition, conventional stretching exercises, when overdone, can actually worsen trigger points. For dependable results, therapy needs to be applied directly to the trigger point as well as to all the related areas. The goal of therapy should be twofold:
Trigger points can be lengthened through several means:
Muscle release therapy (MRT):
In MRT, local adhesions around myofascial structures are located and then removed, thereby restoring structure and function and eliminating pain.
MRT uses muscle testing and palpation to diagnose myofascial dysfunction. Once adhesions are located, they are reduced as follows:
As adhesions are broken up, local nerve supply, circulation and lymphatic flow are enhanced effecting range of motion and strength and restoring normal function.
Spray and stretch
Intramuscular stimulation (IMS or "Dry needling")
The above therapies often yield favorable results that are long lasting. In general, most conditions respond to 4-10 treatments over a period of 2-6 weeks. Results can be influenced by:
Rehabilitation should occur in phases:
Pain is among the top reasons that patients visit their physician. Treatment often consists of medications such as Non Steroidal Anti Inflammatory Drugs (NSAIDs), COX 2 inhibitors, analgesics, narcotics, antidepressants and anticonvulsants. These drugs have numerous side effects, some of which over time are irreversible. In addition, these drugs can inhibit cartilage formation and accelerate cartilage destruction, resulting in osteoarthritis and chronic pain. The medical profession is fully aware of the deficiencies of these current methods of treating pain, but unfortunately is unaware that there are better solutions.
Trigger point therapy is one of the most effective treatments known for a wide variety of pain problems. Billions of dollars and unnecessary suffering could be saved if medications that cover up myofascial problems were replaced by this approach.
Dr. Geoffrey Lecovin is a Chiropractor, Naturopathic Physician, Acupuncturist and Certified Strength and Conditioning Specialist. In his approach to care he emphasizes the Triad of Health: Structural, Biochemical and Psychological, believing that optimum health comes from treating the whole person and maintaining balance within the triad.
Dr. Lecovin integrates clinical nutrition, physical medicine, acupuncture, exercise and lifestyle modification. He is cofounder of Evergreen Integrative Medicine, LLP, located in Bellevue, Washington, where he maintains a private practice.