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Trigger Point Introduction

Jennifer, twenty-eight, who loved to run for her health every day in the fresh morning air, has had to stop running and is reluctant even to walk any distance because of relentless pain in her knees and heels.

Larry, fifty-two, can think of little else but the constant pain in his back. It's hard to get in and out of bed. His back hurts whether he's sitting, standing, or lying down. It makes him hate his job and has ruined his love life.

Melanie, thirty-six, spends her days at a computer keyboard and her nights worrying about her future and the unremitting pain in her arms and hands. As a single mother, she has to keep working no matter what.

Jack, forty-five, has shoulder pain that wakes him up at night. He can't raise his arm to comb his hair. Reaching up to scratch his back is impossible. A sudden movement brings a jolt of pain that feels like an electric shock and doubles him over, grimacing and breathless. Is this the start of the inevitable decline into old age, disability, and death

Howard, twenty-three, is a gifted violin student. After years of hard work under some of the best teachers in the country, he now fears a professional career is out of reach because of constant pain and an unexplained, increasing stiffness in his fingers.

Do you know anybody like these people? They're everywhere--on every job, in every office, in every home. The thing all these people have in common, other than chronic pain, is that they aren't getting the help they need. It's not that they haven't looked. They've gone the rounds. They've seen doctors, had tests, done physical therapy and filled out insurance forms, or--sick at heart--have paid the exorbitant bills themselves.

They've tried chiropractic, acupuncture, magnets, pain diets, and herbal therapy. They take their pain medicine and dutifully do their stretching exercises. Sometimes they feel better for a while, but the pain always comes back. Nothing really seems to get to the bottom of the problem. Despite being told there are no guarantees of success, they fear surgery may be the only solution. They're beginning to wonder if anybody really knows anything about pain.

If all this describes your own situation or that of someone you care about, this book may provide the help you've been seeking. It proposes to give you a sensible explanation of what's wrong and help you find the real cause of your pain. Even better, it may well show you how to get rid of the pain yourself, hands-on. No doctors. No pills. No bills.

There is growing evidence that most of our common aches and pains--and many other puzzling physical complaints--are actually caused by trigger points, or small contraction knots, in the muscles of the body. Pain clinic doctors skilled at detecting and treating trigger points have found that they're the primary cause of pain roughly seventy-five percent of the time and are at least a part of virtually every pain problem. Even fibromyalgia, which is known to afflict millions of people, is thought in many instances to have its beginning with trigger points.

Trigger points are known to cause headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis, tendonitis, bursitis, or ligament injury. Trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow and genital pain. Trigger points can also cause colic in babies and bed-wetting in older children and may be a contributing cause of such childhood horrors as scoliosis, attention deficit disorder and dyslexia. They are a cause of sinus pain and congestion. They may play a part in chronic fatigue and lowered resistance to infection. And because trigger points can be responsible for long-term pain and disability that seem to have no means of relief, they can cause depression.

The problems trigger points cause can be surprisingly easy to fix; in fact most people can do it themselves if they have the right information. That's good, because the time has come for ordinary people to take things into their own hands. The reason is that an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points, despite their having been written about in medical journals for over sixty years. There has been, and continues to be, great resistance to the whole idea.

Why has the medical profession not embraced the idea of trigger points? Partly, it's because trigger points are commonly confused with acupressure points. Acupressure, which has come down to us from ancient Chinese medicine, is alleged to have a positive effect on supposed flows of energy throughout the body. Although acupressure and other Eastern methods of healing do seem to have a beneficial effect, they're very resistant to solid scientific investigation and are viewed by many doctors and a large segment of the public as quack medicine with no proven results. If you don't know the difference, the claims about trigger points sound like quack medicine too.

Our knowledge of trigger points, however, comes right out of Western medical research. Trigger points are real. They can be felt with the fingers. They emit distinctive electrical signals that can be measured by sensitive electronic equipment. Trigger points have also been photographed in muscle tissue with the aid of the electron microscope.

Most of what is known about trigger points is very well documented in the two-volume medical text Myofascial Pain and Dysfunction: The Trigger Point Manual, by Janet Travell and David Simons. These books tell virtually all there is to know about trigger points, and the prospects for pain relief are very exciting. Much of the information in the Trigger Point Manual is couched in difficult scientific terms but basic trigger point science isn't hard to grasp if it's put into everyday language.

Travell and Simons describe a trigger point as simply a small contraction knot in muscle tissue. It often feels like a partly cooked piece of macaroni or like a pea buried deep in the muscle. A trigger point affects a muscle by keeping it both tight and weak. At the same time, a trigger point maintains a hard contraction on the muscle fibers that are directly connected to it. In turn, these taut bands of muscle fiber keep constant tension on the muscle's attachments, often producing symptoms in adjacent joints. The constant tension in the fibers of the trigger point itself restricts circulation in its immediate area. The resulting accumulation of the by-products of metabolism, as well as deprivation of the oxygen and nutrients needed for metabolism can perpetuate trigger points for months, or even years, unless some intervention occurs. It's this self-sustaining vicious cycle that needs to be broken.

The difficulty in treating trigger points is that they typically send pain to some other site. Most conventional treatment of pain is based on the assumption that the cause of pain will be found at the site of the pain. But trigger points almost always send their pain elsewhere. This referred pain is what has always thrown everybody off, including most doctors and much of the rest of the health-care community. According to Travell and Simons, conventional treatments for pain so often fail because they focus on the pain itself, treating the site of the pain, and overlooking and failing to treat the cause, which may be some distance away.

Even worse than routinely treating the site of the pain is the pharmaceutical treatment of the whole body for what is usually a local problem. Painkilling drugs, the increasingly expensive treatment of choice these days, give us the illusion that something good is happening, when in reality they only mask the problem. Most common pain, like headaches, muscle aches, and joint pain, is a warning—a protective response to muscle overuse or trauma. Pain is telling you that something is wrong and needs correction. It's not good medicine to kill the messenger and ignore the message. When pain is seen in its true role as the messenger and not the affliction itself, treatment can be directed to the cause of pain.

Luckily, referred pain is now known to occur in predictable patterns. The valuable medical advance made by Travell and Simons and their brilliant illustrator, Barbara Cummings, has been in delineating these very patterns. Once you know where to look, trigger points are easily located by touch and deactivated by any of several methods.

Unfortunately, the two clinically oriented methods put forth in The Trigger Point Manual don't lend themselves to self-treatment. The goal of this book is to build on the work of Travell and Simons and provide a more practical and cost-effective approach to pain therapy: a classic do-it-yourself approach, rather than multiple professional office visits. This new approach is a system of self-applied massage directed specifically at trigger points. Significant relief of symptoms often comes in just minutes. Most problems can be eliminated within three to ten days. Even long-standing chronic conditions can be cleared up in as little as six weeks. Results may be longer in coming for those who suffer from fibromyalgia, chronic fatigue, or widespread myofascial pain syndrome, but even they can experience continuing progress and can have genuine hope of significant improvement in their condition.

Self-applied trigger point massage works by accomplishing three things: it breaks into the chemical and neurological feedback loop that maintains the myofascial contraction; it increases circulation that has been restricted by the contracted tissue; and it directly stretches the trigger point's knotted muscle fibers. The illustrations in this book show you how to find the trigger points that are generating your specific problems, as well as the exact hands-on techniques for deactivating them. Special attention has been given to designing methods of massage that do no damage to hands that may already be in trouble from overuse.

This book's primary use is as a self-instruction manual, but it can also be used as a textbook for classroom use. This simplified and direct approach to treating myofascial pain with self-applied massage can constitute a foundational course in trigger point therapy in any professional training curriculum. Students in chiropractic colleges, physical therapy departments, and massage schools will derive particular benefit. If they can learn how to interpret their own referred pain and how to find and treat their own trigger points, they will know exactly what to do when they encounter similar problems in their future clients.

A class in self-applied trigger point massage would be a boon in medical schools for exactly the same reasons. When new doctors can learn how to fix their own pain with self-applied massage, they are in better touch with the realities of pain and with the great potential in the treatment of trigger points. Such an addition to medical education would profoundly improve the treatment of pain and lower much of its cost.

And it's not too late for physicians already in practice to learn about trigger points and myofascial pain and put the knowledge to good use. They will find this book a quick and practical introduction to the magnificent work of Travell and Simons and this neglected branch of medicine. Hopefully, many will be encouraged to go to Travell and Simons' Trigger Point Manual for a deeper scientific understanding and for even greater benefit to their practice. A large segment of the public needs help and encouragement in learning how to deal with their trigger point-induced pain. No one is better positioned to provide this help than the medical community.

The medical profession is not unaware of the deficiencies of current methods of treating pain. Doctors hurt too. Many of them worry like the rest of us about the relentless popping of pills, and many experience frustration with their inability to offer better solutions to their patients. Trigger point therapy, whether self-applied or administered by a professional, has the potential to truly revolutionize pain treatment throuhe world.

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