Are trigger points real, or this is false claim that has no clinical value?
Lately much discussion transpires on trigger points. Something like
Are trigger points real?
What are trigger points?
What is the mechanism of trigger points therapy; how it work?
Is it necessary to include trigger point therapy when providing medical /orthopedic massage?
In the end of my commentary you’ll find a brief scientific review on the subject, but prior to reading it, I would like to offer some additional layman considerations.
From our own experiences we know that sometime when we experience pain at any reachable part of our body, by instinct we try finding pinpoint localization of pain, as well as by instinct compressing it and experiencing somewhat good feeling or so-called healing pain.
These facts are supported by real life experiences. Would like to ask the opponents of this notion, whoever claims that there is no such a thing as trigger points. Is it real pinpoint localization of pain we people find and compress them by instinct? How would you then call pinpoint localization of pain?
Now talking from research and clinical points of view. Medical/orthopedic massage is not a new methodology of treatment.
Medical massage was initially researched and proposed in 1936 by the Russian physician Anatoli Sherbak, M.D., Ph.D. About 20 years later, two German physicians, Dr. Glezer and Dr. Dalicho, developed maps of reflex zones abnormalities in the skin, fascia, muscles, and periosteum. Their work was based on the database of Dr. Sherbak. The first edition of the textbook by Drs. Glezer and Dalicho was published in 1955. Reflex zones maps of Drs. Glezer and Dalicho help tremendously to detect/to locate and to address the above-mentioned abnormalities in cases of support and movement system as well as in cases of inner organs diseases. Since then this methodology was massively applied clinically, including hospital-based programs, outpatient clinics, the matter of fact , utilization of medical and sports massage, contributed tremendously to win most of the Olympian gold medals, from the period of 1960s-1980s. Mention above reflex zones abnormalities in the skin, fascia, muscles, and periosteum, is actually painful local areas, containing tension within fascia, muscles etc. all these painful areas, containing pinpoint pain localizations/trigger points. at article link I am proposing, you will find explanation on morphology of trigger points and more. No need to repeat all. Also in my two weeks ago published blog click here to read Simplicity and extreme healing power of massage therapy
I have explained why injections into the trigger points provide only temporary relief of symptoms. For better understanding of the treatment concept, I would recommend to read it again. It is impossible to reach results in cases of painful orthopedic disorders, if we will not provide adequate treatment including trigger point therapy.
Any scientifically and not scientifically developed protocols must be clinically proven as an working concept for a long time. Otherwise all can be scientifically sounds but will not work. You can have lots of references, but it will be only theoretical concepts, if clinically it will be not proven working. I am claiming the necessity to provide adequate treatment as was explained in Simplicity and extreme healing power of massage therapy based on clinically proven necessities to address abnormalities in the skin, fascia, muscles, and periosteum, as well as to provide trigger point therapy.
Those practitioners who deny the existence of trigger points and/or not addressing myofascial dysfunctions and trigger points, only inhibite trigger points, converting them to sleeping trigger points. What I have stated in this commentary, in my blogs, presented on my DVDs and other materials, is a longtime clinically and/or scientifically proven fact.
Below is the link to, I would call trigger points and trigger point therapy scientific review.
Please feel free to post any questions. Also please find link to medical massage books page by Dr. Ross Turchanonov. They are great texts. Books also including all Dr. Glezer and Dr. Dalicho, maps of reflex zones abnormalities in the skin, fascia, muscles, and periosteum. https://medicalmassage-edu.com/massage-books/223
You all are also welcome to visit medical and sports massage DVDs page https://medicalmassage-edu.com/dvds-only
as well as CEs programs https://medicalmassage-edu.com/ceu-programs
Please be advised that as a member of this group, you will be able to purchase any DVD including CEs programs at 30% discount. This is inclusive benefits for group members only. If you will decide to purchase any program using discounted prices please write to us [email protected] and you’ll provided the link to discounted pages.
Lymphedemas can cause the development of neuropathy such as the one accompanying diabetes
As I discussed in the last week post, the neurologist whom I helped with his neck problem started referring me patients. (Those not familiar with this narrative please click here)
Recently he called me about one a relatively healthy 72 year old man, who developed typical neuropathy such as the one accompanying diabetes, while as the patient couldn’t even be diagnoses as being in pre-diabetic stage. So he contemplated on this case and for a while couldn’t come to any conclusion.
When he introduced this case, the doctor mentioned that the patient’s had high level of cholesterol and was taking statin (cholesterol lowering) drugs. From my experience I knew that people who take statin drugs usually develop edema, especially in the ankle area and I shared this observation with the doctor. The doctor recollected that although his patient’s heart was functioning normally as well as other vital organs like kidneys, liver, etc. he did have some edema in the ankle area. I offered that this lymphedema could compress nerve and thus could promote neuropathy. The doctor was surprised and noted that he couldn’t find any scientific literature supporting that fact that edema could be the cause of neuropathy. As he promised to do more investigation on the matter, he also asked me to do something in reducing the size of this lymphedema.
I was glad to be of service in this case since Medical Massage has a special protocol for lymph drainage that significantly reduces and in most cases eliminates edemas. Since in this particular case we dealt with lymphdynamic edema, I expected it to be gone pretty fast.
When patient arrived, he was mildly sad and depressed, because he loved to play golf and the neuropathy was preventing him from enjoying his game. He was complaining that the last three months he wasn’t really himself and no one knew what the problem was. He was even afraid to drive because he couldn’t control his reactions.
From the first treatment I significantly reduced edema size. I knew that it could come back, informed him about it and recommend him to come back for treatments. At next visit, edema was still there, but to my surprise it didn’t return to the same size.
Subsequently I performed eleven more treatments. The patient’s feet regained normal color, the edema has practically disappeared as the symptoms of neuropathy. Because nerve damage wasn’t permanent, after twelve treatments nerve, in absence of edema, recuperated.
The doctor investigated the patient, called me and said that he was amazed at the clinical outcome. He also suggested that based on these results we should try this method with other patients and should write a paper. His suggestion was based on the fact that he had the hard time finding any description of such results in the scientific literature. I was doubtful in regard of such a paper. For me the interesting observation was no the fact that lymphedima could cause neuropathy. I was taught of this connection long time ago during my school studies and clinical practice. Sometimes, post surgical patients who developed lymphedemas due to ankle area traumas also develop neuropathy. In the case of diabetes, the vessels that supply blood to nerves are damaged. Thus people who suffer diabetes eventually also develop neuropathies. Interestingly, when edema is not caused by diabetes, although the mechanics of the disorder is different, its effect on nerves is similar. Edema compresses the region it interrupts the normal blood supply to nerves and eventually causes neuropathy. I didn’t want the article would come across as an example of a well known saying: “everything new is just well forgotten old.”
To me the interesting aspect of this clinical experience was that even though the patient continued taking statins, lymphedema and accompanying it neuropathy didn’t come back. Three weeks after the treatments were stopped; the patient reported no swelling and no neuropathological symptoms. This fact might be deserving of an article.
Simplicity and extreme healing power of massage therapy.
Massage therapy is a very simple and side effects free methodology. In certain cases, it can be so extremely powerful that it has no substitute. The doctor’s story I am about to present could be considered as an example of the massive phenomena of mechanical pain and dysfunctions that to a large degree could only be successfully addressed by means of massage.
Approximately 3 years ago I had a client who was a dual board certified neurologist. The referring physician told me that I should have prepared myself for questioning because the person he referred to me was very knowledgeable in conventional medicine and yet was very open to other methods of treatment. During almost 12 years the client suffered from upper back middle thoracic pain with the significant limitation in range of motion in cervical spine.
According to his report, 12 years ago It started with the minor pain in between scapulas region. Little by little the pain increased until it came to the point when it was difficult to sleep, as well as caused a high-intensity pain during the day and a specially at attempts to move during the day.
When this doctor arrived, I was listening to him very carefully. He performed all the tests including EMG studies, MRI, all blood tests and they all came out perfectly good and yet he was suffering.
During my palpation examination, checking the tension in fascia and muscles, and the fact that all the tests didn’t support the presence of this pains and movement restrictions, considered history of this abnormality development, I came to the conclusion that the pain was caused by excessive tension in fascia and muscles and subsequent trigger points developments in these tissues, which, surely, are not detected by radiological means and other undertook examinations. To me it was classic severe case of myofascial pain, that can cripple person, at the time all possible tests will come out perfectly good.
After the first treatment, almost all the range of motion with in cervical spine, was restored and the pain sensation was reduced significantly. After this, striking (from the point of view of my client) experience my client wanted to invite me for lunch with the purpose of finding out details on what I did in order to achieve so significant outcome. I told him that the lunch arrangement was not necessary and that I was happy to explain him physiological effect of massage, including, details on connective tissue massage, muscular mobilization, trigger points therapy etc., without being sweetened.
I told him that the main problem that produced his difficult clinical picture was tension in fascia and muscles and subsequent trigger points development. What I practically did was I palpated various localization of pain, detected tensions in connective tissue, muscles, performed connective tissue massage to release the tension in fascia, mobilized muscles and brought them to relatively normal resting tone. Performed ischemic compression on trigger points etc.
When muscles are constricted there is a significant deprivation of blood supply, which in turn, and if sustained a prolonged time, caused low grade inflammatory condition. Due to metabolic disturbances, this condition caused accumulation of tension in fascia, adhesions, as well as triggering trigger points developments.
During the course of several procedures he was practically rid of pain. He was very thankful but also very curious and inquisitive about my methodology as if he couldn’t comprehend that such simple methods could produce such tangible results, as if he felt there was something else, something hidden from the naked eye that he overlooked in his understanding. He kept on going back to the history of his disorder and the history of attempted treatments, requesting an explanation of why exactly they didn’t work while massage did.
During those 12 years of suffering, numerous times he received corticosteroids trigger points injections, achieving temporary pain releases. And then the pain was coming back. On his question, why wouldn’t sustain this reliefs I answered that he was suffering from the vicious cycle of abnormal developments within soft tissue. First painful muscles tension, then fascia tension, and then trigger points developments. Exercise just made it worse because they added additional tension to already exhausted and dysfunctional muscles, corticosteroids injections only inhibited trigger points with no positive effect on tension within fascia. This wasn’t an adequate treatment, and therefore symptoms were coming back.
Massage therapy procedure, however seemingly simple, directly addresses all causes of these symptoms, and therefore produces good results. I also have explained him, that in order to sustain results, and make sure pains will not return and the normal range of motion will be sustained or even become much better, he must to continue to receive 12 to 15 treatments. This number of repeated treatments was necessary to reset and sustain the higher level of threshold of pain. Because he suffered prolonged time, repeated treatment also will help “cleaning up” phenomenon of pain sensitization.
To him my explanation sounded absolutely scientific and he felt that this course of actions had good potentials for sustained results. Being open minded scientist and clinician, he was amazed by simplicity of massage therapy, its absence of side effects, and clinically proven concept of its methodology.
Several times after that he returned to me with problems caused by sports related injuries, within different body parts. Interestingly enough, the original case, he came with, didn’t trouble him during the last three years.
He also referred me many people with myofascial pains, sciatic nerve neuralgia and other neuralgias. Little by little he started trusting me. He is very responsible doctor and I really like how he establishes diagnosis. For example tension headache could be the result of a brain tumor, and other phenomena that produce symptoms that are very similar to tension headache symptoms. So first of all he excludes such possibilities.
I felt like at home with him, because as a professional, I grew up in the environment of the integrative approach to medicine . Diagnosis establishment by using differential diagnostic techniques, including different tests by MDs that exclude the possibility of the medical problem being not the cases for massage therapy, and then intensive massage therapy treatment.
Recently he called me about one a relatively healthy 72 year old man, who developed typical neuropathy such as the one accompanying diabetes, while as the patient couldn’t even be diagnoses as being in pre-diabetic stage. So he contemplated on this case and couldn’t come to the definite conclusion.
I will continue the discussion of this interesting case in my next blog…
for more information on methods of Medical massage please go to http://medicalmassahe-edu.com
I believe we all naturally born, it’s just important to realize.
20 years ago I have established the school in LA – Institute of professional practical therapy, school of massage physical therapy aid, and chiropractor assistant program. 3 years ago I sold my school and now it’s South California health institute. Now it’s a much bigger school and much broader program even though the fundamentals of this programs are the same – all general education training composes about 20 percent of the course time leaving 80 percent to hands on training.
On June 6th 2013 I was invited to address the alumni reunion of all the school’s past generations of graduates.
In trying to prepare for this event my thoughts were in disarray. Indeed what could I possibly tell people, some of whom had already 15 or 20 years of experience? So I hoped that when I see the people and feel their energy I would find the right words.
When I arrived and was asked to speak that’s exactly what happened. I shared with my audience my life long quest to find out why people chose the profession of massage therapist?
Many years ago I conducted my own research. Surely, I asked this questions only when the personal relationship between the teacher and the student were built to made sure that students would frankly speak their minds.
Many responses fell into several categories. One of them was that a person lost his or her job and seeing the ad from a massage school decided to try it. The other one was attracted by free schedule demonstrated by the neighbor who was massage therapist. It gave a possibility to earn some additional income on evenings and weekend. One more was that a friend advised to become a massage therapist and many more similar variations.
Eventually I came to the conclusion that what people were telling me was their conscious answer. Our subconscious mind is much more powerful. According to Karl Young, compared to unconscious mind the conscious mind is like the nut shell compares to the ocean. This means that mostly we make similar decisions on subconscious level.
Millions of people can see the ads of massage therapy schools and not reacting on them even if they lost a job, have neighbor working as massage therapist or look for a new career and only few of them decided to enroll into a massage school. I believe that those few people are naturally programmed to place our hands on people and to heal them by means of massage. It is very important to remember that we have a proclivity to heal with our hands. Conscious realization of this phenomenon immediately gives you a different energy when you start performing massage procedure.
If each of us would think of what I was saying at this reunion, probably somehow we would get to the same conclusion.
When I finished talking, I felt the energy of all the 200+ people at the alumni. It was the union of understanding and positive energy. Then I added that all the people in the alumni essentially practice the same methodology, the same techniques etc. But the scientifically developed healing art is like any art – everyone is expresses him/herself differently. Understanding this will greatly affect the treatment outcome and would make a therapist to love his/her occupation even more.
I felt that these words felt deeply in the hearts of everyone. When I came off the podium people in the audience started to hug me, hug each other and give each other high fives without talking. As I told you I wasn’t prepared for that speech, but when it came out it so naturally, it came through as so important, and became so unifying that, for a moment, it made brotherhood of massage therapists come to life. The massage therapy isn’t only about techniques, no matter how great they are, and it isn’t only about theoretical concepts. Not less important is the realization that we are artists, who chose this occupation not by accident, but because we were wired to do this since birth.
Consuming antidepressants and Lyrica is not always the solution.
Recently, a familiar physician, referred to me a 53 years old male, CEO of a huge corporation. The referring physician, who is a board-certified rheumatologist, diagnosed this patient with having a major depressive disorder. According to the physician, in addition to classic clinical depression symptoms, the patient also suffered from pain all over the body, tension headaches, sleep disorders and other similar to fibromyalgia symptoms. He also said:” However, during my initial examination I couldn’t discover the typical 11 tender points, typical to fibromyalgia cases and necessary to establish fibromyalgia diagnosis.
Being on good terms with the doctor, I had no problem discussing the clinical picture frankly. Therefore I said that if blood tests were done and autoimmune diseases were excluded, then, because of the absence of typical 11 tender points, the disorder isn’t fibromyalgia. I asked him then if, practically, clinical depression and major depressive disorders is essentially the same diagnosis?
He rejected this generalization because major depressive disorders symptoms include pain all over the body.
When this person appeared in my office, just by looking at him, I felt, that emotionally he was hurting, to exactly the same degree or more then from outside. He really was lost.
This session, including the initial evaluation and treatment, was scheduled for approximately one hour and 10 minutes. I have asked him if he would have more time to talk to me and then to receive the treatment. He agreed to do whatever’s necessary to make him feel better.
I called to my next client and reschedule her appointment for a later time. I asked him to provide me with all the details: describe the symptoms, the time when these symptoms appeared, and whether any emotional or physical trauma took place prior to symptoms appearance. I barely finished my phrase as he started crying.
In total he suffered from this devastating symptoms for almost 7 months. It started some headaches, minor pains all over the body, sleep disorders, waking up at 3 AM and not being able to go back to sleep. The last two months he was constantly catching a flu.
Little by little his symptoms got much worse. As he described, his job is very stressful, stockholders expect huge profits and his wife decided to leave him. I asked him how he was performing at work. He said that he has to be on top of the game. That didn’t sound like a response of clinically depressed person. Clinically depressed people cannot fight simply because they “have to perform.” I asked him how he reacts on taking antidepressant? He said that he started it only for the lasts two weeks and described it as having horrible effect on him. He even started to hallucinate as well as when he took the drug Lyrica, it’s really make him feel not like himself.
I advised him to talk to his doctor about it. He was of an opinion that everyone was thinking of him as being crazy so he didn’t want to bother anyone anymore, and just limited the drugs intake.
I was amazed how this smart and well-educated person can feel so lost. Obviously, sickness and life situations sometime can get the better of us.
I proposed to call to his doctor, discuss discontinuation of taking this medication and insisted on him doing it immediately. From my experiences I knew, “tomorrow could be too late.” In this situation taking this medication can cause suicide. From my office in his presence and with his permission I have called his doctor. As I have anticipated his doctor ordered him to stop this medication immediately.
Pondering over the clinical picture of this client, I came to the conclusion that stress and its side effects significantly disturbed the amount of lymph drainage. Accumulation of toxic metabolic waste within the body triggers the increase in muscular tensions. Exactly like in cases of fibromyalgia it leads to ATP crisis, dropping pH, activating pain analyzing system and producing symptoms similar to clinical depression.
I started the treatment by checking tensions within muscles and fascia. The tension in fascia was acceptable, normal, but muscles where very tense and contained many trigger points. I have explained him what the acceleration of Lymph drainage techniques does and proposed to dedicate first five treatments to detoxification. To him this approach seemed reasonable.
In the first week five times I have provided him with lymph drainage procedure. To my surprise, during the first week the clinical picture changed for the better. I actually expected that some evidence of improvement would come much later.
His mood changed for the better. He told me: ”Boris I’m going to make it.” When I asked him whether he had any doubt, he paused and said that the day before he came to me, he had doubts.
To me this was a scary moment. Considering his complaint on what this medications caused, and knowing how many people committed suicide, mentally I thanked the Almighty for the privilege to be in right time at right place – for the call to the doctor and the request to immediately stop the medication.
The next two weeks I provided 8 full body medical stress management massages, as well as have addressed the trigger points. I also advised him the home program of self-massage and we talked frequently so that he wouldn’t feel he’s alone in this struggle. He thanked me, told me of his progress, and of him being able to better perform his daily functions and return of the ability to be a good father.
Tomorrow I will see him again for 12 to15 treatment just to sustain results. Please click this link to read my article on Lymph drainage https://medicalmassage-edu.com/articles/47-article31
If you decide to read it, I would like you to be aware on typo with in article. Instead ofinspiration, you should read the inhalation.
This link is to article on fibromyalgia. https://medicalmassage-edu.com/articles/31-article15
I have no doubt that if I haven’t addressed those symptoms then, little by little, this condition could have evolved into Fibromyalgia or Fibromyositis, being a chronic, low-grade inflammatory condition of the muscle, fascia and other connective tissue, resulting in calcification, adhesions and tension within fascia and muscles.
You are also welcome, to read about my DVDs where I teach all techniques I have applied in this successful treatment. https://medicalmassage-edu.com/dvds-only/69
and post any questions.
- No doubt, this client can afford paying for his treatment. Interesting enough, when talking to me on the phone on Thursday, he said: ”…your treatment is expensive, but I calculated that your treatments are actually saved me money.” He simply calculated, how much money he would have spent for co-payments medications, deductibles.