Self Discovery:
Try this, reach your left arm across your body supporting the underside of your elbow with your right hand. Now use a pincer grip between your left thumb and index finger and roll the large muscle that goes from the top of your shoulder up to your neck between your fingers. 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.
Definition:
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 can be described as 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 clear differential diagnosis is required by a skilled clinician. However, the referral patterns are well documented. With years of experience and the awareness of myofascial trigger points as potential contributors, the clinician becomes proficient at identifying these regions. The involved muscles are often inhibited and weak. Here are some common muscle groups where trigger points are found:
upper trapezius, sternocleidomastoid, levator scapulae (contributing to headaches and neck pain)
quadratus lumborum, gluteus minimus and serratus posterior-superior (contributing to back pain)
lateral quadriceps (IT Band Syndrome)
gastrocnemius/soleus complex (knee & ankle pain)
the muscles of mastication (chewing) (Temporomandibular Joint Dysfunction, often colloquially referred to as TMJ)
Why Me?
Don’t worry, you’re not alone. Millions of people just like you suffer from myofascial trigger pain syndrome. We spend too much time hunched over our laptops, texting on our smartphones, crouching into the windshield, and generally slouched. Other contributors can be repetitive stress or overuse, improper training, poorly fitting equipment, and bad ergonomics. We are hanging on our muscles, asking them to perform work they are not designed to do. Consequently, they’ve had enough and are now letting us know about it. 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. Problems here actually need to be addressed first, otherwise it’s 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?
It can be a very hard and often frustrating process to identify the appropriate clinician to address the problem. Many years of clinical experience utilizing many different sprays, tools, and techniques that resulted in mediocre outcomes with partial or temporary relief motivated us 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 problem as well as the muscle or soft tissue contributor. They both must be addressed for a successful outcome. The skeletal system is treated with high-velocity, low amplitude manipulation to free up fixations and restrictions within the spine and extremities. The muscles are treated with Western trigger point dry needling. This technique elicits a local twitch response from the muscle, indicating a reset of the motor loop and release of the tight muscle, allowing 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 resolution is impossible.
The Osteopractic Approach:
An Osteopractor is a physical therapist or physician who 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. The Osteopractic method 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 which helps the public to 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 (the cracked foundation) and the muscle problem under the same roof at the same time. When the time is right, they may refer you for additional soft tissue massage and strength training as part of a comprehensive long-term plan.
If you have pain or limitations in areas of your body that are 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 or Dr. Taelon Parson, DPT, Dip. Osteopractic are the only Osteopractors in the Upper Valley. We offer two convenient locations at The River Valley Club in Lebanon behind the food Co-op and in the Nugget Arcade building on main street in Hanover. We offer easy online self-scheduling at https://www.precisionopt.com/. We approach each patient as a unique individual and would be honored for the opportunity to work with you.
