Try this, reach your left arm across your body supporting the underside of your elbow with your right hand. Now pinch and roll the large muscle that goes from the top of your shoulder up to your neck. Chances are you’ve just discovered a nodule or taut band within the muscle and in doing so discovered what a myofascial trigger point or simply a trigger point (TrP) is. If you were previously aware you had pain generated from this area that would be classified as an active trigger point and if you just discovered pain after you rolled over the region for the first time you have a latent trigger point.
Dr. Janet Travel (President Kennedy's personal physician) brought trigger points to the forefront. She was the only one who could help him with his chronic low back pain. A trigger point is a taut band of tissue within a muscle that has poor oxygen and blood flow. It is a hyperirritable point that can refer or “trigger” pain to different regions of the body. The pain does not follow a typical dermatomal (nerve) pathway and can be caused by TrPs in seemingly unrelated locations. For example, pain at the base of the skull, back of the eye, cheek or jaw can be caused by a TrP in the scapula or mid back. This is why TrPs can be difficult to resolve unless you receive clear differential diagnosis by a skilled clinician, one with years of experience and awareness of myofascial TrPs as potential contributors. Affected muscles are often inhibited and weak. Some of the more common muscle groups where trigger points are found include: upper trapezius, sternocleidomastoid, levator scapulae (contributing to headaches and neck pain), quadratus lumborum, gluteus minimus and serratus posterior-superior (contributing to back pain) along with the lateral quadriceps (IT Band Syndrome), gastroc-soleus complex (knee & ankle pain) and in the muscles of mastication/chewing (Temporomandibular Dysfunction, commonly referred to as TMD).
Don’t worry, you’re not alone. Millions of people just like you suffer from Myofascial Trigger Point Syndrome. We spend too much time hunched over our laptops, texting on our smartphones, crouching into the windshield and generally slouched. Other contributors include repetitive stress or overuse, hard training, poorly fitting equipment and bad ergonomics. We are hanging on our muscles, asking them to perform work they are not designed to do. Eventually, they’ve had enough and they let us know about it. We develop imbalances between strength and flexibility, typically resulting in tight weak muscles when strength and flexibility is the combination that allows our bodies to perform at their best. Now, remember it’s not just about your muscles. Let’s not forget about our skeletal system That’s right, your bones and joints are being stressed too. In fact, skeletal problems need to be addressed first; treating only the muscles is the equivalent of running the sump-pump in your basement instead of addressing the crack in the wall of the foundation. For full resolution we need to address the source rather than treat the symptoms.
Is there any hope out there for me?
It can be very hard and often a frustrating process to identify the appropriate clinician to best address your neuromusculoskeletal problems. 20 years of clinical experience utilizing many different sprays, tools and techniques that resulted in mediocre outcomes with partial or temporary relief motivated me to pursue an intense advanced training program to address these problems. Medications and injections always come with some level of risks, side effects and potential complications. TheraCanes, balls and rollers can be good intermediaries or provide some temporary emergency relief in a pinch. We now have an inclusive, effective approach backed by science that addresses both the bony problems as well as the muscle or soft tissue contributors. They both must be addressed for a successful outcome. The first with high velocity low amplitude manipulation or other indirect techniques to free up fixations and restrictions within the spine and extremities and the later with Western trigger point dry needling to elicit a local twitch response and a reset of the motor loop which ultimately releases the tightness in the muscle to allow the return of blood flow and oxygen to the muscle and the resumption of normal slide and glide of the muscle fibers. If you only address one component (remember the sump-pump analogy) successful long-term resolution is impossible.
One stop shopping with an Osteopractor!
An Osteopractor is a physical therapist or medical doctor that has completed an evidence-based post-graduate training program in the use of spinal and extremity manipulation, dry needling, instrument-assisted manual therapies, and differential diagnostics for the management of neuromusculoskeletal conditions. Osteopractic Physical Therapy is an approach to care, a sub-specialty and more accurately describes the kind of physical therapy services (rather than simply “physical therapy”) within physical therapy that helps the public, potential patients and colleagues, identify the appropriate practitioner of choice.
For example when you break a bone, you look for an orthopedist, not just a general medical doctor. When you have a skin condition, you go to the dermatologist. When your child needs medical care, you look for a pediatrician. Likewise, when you have neck pain, low back pain, headaches, tennis elbow, heel pain, carpal tunnel syndrome, knee osteoarthritis, plantar fasciitis, shoulder impingement, joint pain or myofascial trigger points, it makes sense to look for a specialist within physical therapy, i.e. an Osteopractic Physical Therapist or Osteopractor, not a generalist. The Osteopractor is specifically trained to treat these neuromusculoskeletal conditions including myofascial trigger points. They can address the bony problem (foundation) and the muscle problem under the same roof at the same time. The Osteopractor may work closely with a massage therapist or a strength training specialist.
If you have pain or limitations in areas of your body it is likely inhibiting your athletic and daily functional performance and overall enjoyment of life. You owe it to yourself to schedule an appointment. Dr. Gregory Shea, DPT, Dip. Osteopractic, is the only Osteopractor in the Valley. His practice is located at The River Valley Club and it is easy to self-schedule at PrecisionOPT.com. He approaches each patient as a unique individual and would be honored for the opportunity to work with you. He also offers free 15 minute screenings every Thursday (sign up online at PrecisionOPT.com). If you are looking for an Osteopractor outside of the Upper Valley there is a database that may be helpful (spinalmanipulation.org/osteopractor-directory/).