Self Care in Trigger Point Therapy

Self Care in Trigger Point Therapy
By Bernard L. Gladieux, Jr.

Pain, as most of us know by our own life experience, comes in a variety of forms, at any age and at any time of the day or night, often when we least expect it or when it is most inconvenient. Accordingly we would do well to consider devising an accessible approach to self care for that time when, by accident, over-use or chronic condition, our pain level rises to the point at which we become dysfunctional or distracted or both.

If the idea of taking positive charge of your own well being in this way leaves you anxious or confused or weak in the knees, seek out the help of a knowledgeable friend or health professional. Often a coach or personal trainer or massage therapist can offer insights and pointers that will lead you in the right direction.

Since most garden variety pain has more to do with soft tissue or muscles, here is where you will likely find the best answers to your most basic questions. One approach to the matter of pain is to think of the three ways of dealing with most of it that you will encounter in your everyday life. These are: Prevention, First Aid and Long Term Management.

“Since most garden variety pain has more to do with soft tissue or muscles, here is where you will likely find the best answers to your most basic questions. One approach to the matter of pain is to think of the three ways of dealing with most of it that you will encounter in your everyday life. These are: Prevention, First Aid and Long Term Management.”

Prevention:
There is no way to guarantee that you will be able to live pain free, no matter how protective or cautious you are. However, a regular program of moderate, well balanced exercise with generous amounts of aerobic, cardio vascular activity, some strength training and stretching with some variation in routine will go a long way to keeping your body tuned up, strong and limber enough to do all of the things you have always enjoyed and which give color, texture and energy to your life without your having to be concerned about hurting yourself.

Of course if your interests turn toward mountain climbing, sky diving, or skiing steep and deep powder, and the like, you will certainly want to step up your conditioning to levels appropriate for your sensible and realistic aspirations.

First Aid:
Pain is often the signal that something is amiss when injury strikes. Listen to it even as all of your best plans are falling apart. Assess the damage. Is it a broken bone, a joint sprain, a muscle strain, a traumatic injury or an over-use syndrome on the rise? Your answers may or may not point you in the right direction, but they will add to your store of experience that should help protect you in the future. For most athletes and sport oriented therapists and trainers, icing, rest, compression and elevation are the traditional first treatments for soft tissue injury. Broken bones and more severe muscle and joint damage take longer and more complicated repair and recuperative protocols.

Long Term Pain Management:
Eventually prevention and first aid lead to and then blend in with long term management of symptoms. All of these care phases then become a seamless whole. In the quest for pain free and optimally functional long term fitness, serious seekers of effective self care will search for knowledgeable, pain management clinicians, but, as David Simons, M.D. has said,* “…finding a truly skilled practitioner can be frustratingly difficult.” But, he adds, “There is no substitute for learning how to control your own musculoskeletal pain. Treating myofascial trigger points yourself addresses the source of that kind of common pain and is not just a way or temporarily relieving it.”

This self care principle is a direct outgrowth of the trigger point identification and treatment protocol that was developed both before and after World War II by Hans Kraus, M.D. and Janet Travell, M.D., among others including aerospace researcher and physician David G. Simons, M.D. By the late 1970s, nationally popular exercise therapist and promoter, Bonnie Prudden and friend and associate of Drs. Kraus and Travell, had developed her own, non invasive trigger point protocol that was a direct extension of the early work of Kraus and Travell.

Prudden called her technique Myotherapy, wrote a book on it and founded her own Academy for Physical Fitness and Myotherapy in a former elementary school in Lenox Masachusetts to train professional myotherapists. The elements of the Prudden Myotherapy treatment include the following key elements:

The success of this therapeutic protocol is measured by the subjective reduction in pain, increased flexibility and range of motion as well as in increased strength, endurance and over all physical function. Success is also measured by the degree to which patients become active participants in their ongoing self care.

Over the past thirty years the myotherapeutic model has been widely practiced by physicians and therapists representing the span of professional disciplines that define mainstream, physical medicine. And it is now well accepted as an effective and conservative treatment option.

Precipitating factors. By thorough patient intake interviews, the myotherapist
seeks to discover the conditions and circumstances that contribute to the patient’s symptoms.

Deep, manual, soft tissue ischemic compression and myofascial release of trigger points.

Individualized active and passive stretching exercises often facilitated with topical application of coolant spray.

Detailed patient instruction in home self care including deep muscle compression, stretching and strengthening exercises and the management and avoidance of precipitating factors.

In Good Heath,
Bernard L. Gladieux, Jr.
President,
The Pressure Positive Company®

When Your Back Goes Out

You’re  smart.  You fulfill your obligations; you mind your own business and generally do the right thing in whatever enterprise engages you at the moment. You take care of yourself, exercise in moderation, eat right, and enjoy good health and a relatively high fitness level and all of the benefits that usually flow from your admirable lifestyle.  Unfortunately freedom from back pain is not necessarily one of those benefits.You might be one of the lucky ones and escape this particular torment through yourlifetime.  If you do, you will be in an elite minority.  Congratulations, and lucky you.

For most of the rest of us, however, we would do well to have some kind of a game plan to call into play when it feels like we have been hit in the back with a jackhammer.  Knowing what to do when that happens or feels like it is about to happen depends largely on the nature and level of your pain, its location and its root cause.

If you are relatively young, take heart; eventually you should become an expert on your symptoms and will learn to identify and avoid the factors that bring on a back pain episode and what works best to prevent and ease your own, special travail.  In the meantime, here are some suggestions to try out the next time the hammer strikes.

Rest:  For many habitual athletes, the word is anathema, but when your back is in unremitting spasm, you have little choice.  At the same time you need not baby yourself too much or too long and should become as active and as soon as your pain level will allow.  The days of long term bed rest for garden variety back pain are pretty much over since it was found that extended inactivity actually lengthens the recovery period.                        

●Ice:  As for other muscle injuries, cold therapy can work wonders.  You can use packaged chemical coolants, gels that stay mushy even when frozen or old fashioned ice packs. Avoid frostbite with a towel between your skin and the pack, but make sure you cool the tissues deep enough to reach the core of the spasm.  In the early, acute stages, you can effectively ice up to three or more times a day.  Remember to keep the rest of your body comfortably warm while you are icing, especially in colder weather..

●Drugs: You may get your physician to prescribe a muscle relaxant or a heavy duty pain-killer.  Such pills can get you through the worst of it.  You might also try Ibuprofen,

a generic, over-the-counter anti inflammatory and pain medication. Although with Ibuprofen, you may need to take it for several days or even a couple of weeks to sustain a therapeutic blood level to achieve the anti inflammatory effect, beware of the risks that accompany long term dependency. When in doubt, check with your physician.

●Massage: If you are fortunate enough to have access to a skilled, strong massage or other hands-on therapist who can and will apply deep muscle compression, go for it as soon and as often as you can.  There are a variety of theories underlying the various techniques used to release trigger points, relax taut muscles, improve range of motion and mitigate muscle pain; you may find that with experience you will prefer one method over another.  In the end it is the therapist who leaves you feeling more flexible, more relaxed, and in less pain who will likely give you the most satisfaction.

●Professional Care: If your pain leaves you unable to move, you may have no choice but to seek the care of a physician.  Your family doctor may be your first stop unless you have access to a physician who specializes in physical medicine, pain management, sports injury rehabilitation, chiropractic, orthopedic, physical or occupational therapy.

There are excellent practitioners in all of these specialties and more. Selecting the professional who offers the best match for you requires that you do your homework,most effectively before you are in a painful crisis. 

●Exercise: Once you are out of the woods, and can move around without going into spasm, you can start some benign strengthening and stretching exercises.  Abdominal curls done flat on your back with knees bent can be started early on and will produce the best payoff.  You can take exercise and stretching classes at you local gym or refer to self care information at the http://www.pressurepositive.com/ website described below.

●Self Care: As important as outside sources of help can be to relieve your aching back, do explore all the possibilities available to you to help yourself. In addition to appropriate medical care, rest, ice, stretching, exercise, and other lifestyle choices, there are tools that can help you manage your back pain issues by allowing you to apply deep, static, soft tissue compression that will quell muscle spasms and chronic pain, easing tension in the involved muscles sufficiently enough to allow deliberate, targeted stretching.  Over time such a regular regimen, as a component in a balanced self care program, will not only help you heal but will be effective in preventing future recurrences.  In the interests of full disclosure, my own enterprise, The Pressure Positive Company specializes in the design and manufacture of such self care products that are displayed along with a wealth of detailed information on self care at our corporate website at: http://www.pressurepositive.com/ .

 ●Learn:  In the end the more you know about yourself, what works and what doesn’t, how to recognize the warning signs when something is about to go wrong and what you need to do to stay upright and well over time is your best, most dependable defense.