Sunday, October 19, 2008

Chronic Injuries B Gone - Trigger Point Therapy

You can lie to yourself, but deep down, you know what it is. Your elbow, knee, or some other part of your body is always hurting. For a while, it was only right after you were physically active.

That's normal, right? It just means a good workout.

Then it started to hurt during a workout.

That's not a big deal. I'll just rest it for a day or two, then I'll be good.

But after a few days of rest, it's starting to hurt all the time. When you wake up, when you're watching TV, when you're at school or trying to go to sleep. Even now, a lot of times you'll lie to yourself.

I'll rest it for a week, I'm just training harder and my body isn't quite used to it.

It feels a bit better after the week, then you start training again and it immediately gets worse.

Finally, you can't lie to yourself anymore. It's some sort of chronic injury. This scenario describes overuse injuries, but there are all sorts of causes for chronic injuries. It could have been a single injury that never fully heals right, or it could just occur over time due to poor posture.

Chronic injuries, to put it bluntly, suck. There are so many possible causes for “sore elbows” it's not even funny. You can go to ten different medical professionals and get fifteen different diagnoses. Tendonitis, tendonosis, tight forearm muscles, tight upper arm muscles, weak back muscles, back muscles that are too strong, weak triceps, triceps that are too strong, shoulders that are rolled too far forwards, shoulders that are rolled too far back... you get the idea.

The worst part is that most chronic injuries will never fully heal on their own. You'll always be dealing with it. Every day, people quit running, or climbing, or tennis or whatever their favorite activity is because it causes too much pain. Quitting often doesn't even help address and fix the problem, it just helps prevent it from getting worse.

I've been dealing with elbow problems for close to 9 months now. They developed due to a combination of factors (which is pretty common, a lot of bad things stacking on top each other), but it was primarily from bouldering (rock climbing). Way too much.


Going from having never climbed, to climbing “two hours a day, five days a week, for ten weeks” too much. In retrospect, it was dumb. Really dumb. But it was winter in Rochester, New York. It was cold, and there was nothing to do at night except climb.

There were certainly other factors that contributed to it. I didn't stretch after I went climbing, and usually I biked about 2 miles home in sub-freezing temperatures. I sat at my computer with my elbows dangling off the side of the desk. A few other things as well, but it was definitely primarily the climbing.

I didn't notice anything until week 8 or so. I might have taken a day or two off, but I just pushed through it. The quarter ended, and Charlie came back home with me for Spring Break. We did a lot of parkour training then, and my elbows kept hurting more and more. I finally recognized that this was a problem, and stopped all activity for a while. I thought it was okay around week 4 or 5 of Spring quarter, started doing some things, relapsed. Since then, I've been taking upper body work very easily, barely doing anything with my arms unless I absolutely needed to.

It helped, but not much. The constant pain went away, but whenever there was any sort of activity, it'd hurt again.

I started reading about other solutions. Everything from surgery to injecting the tendons with a saline solution, which was supposed to fix all tendon problems via pseudo-magic. Then I started reading about trigger point therapy.

Trigger point therapy is a type of massage that has been around officially for about 40 or 50 years, but has roots and influences all the way back to ancient China's acupuncture. It essentially is the study of “knots” in muscles and tendons - how they effect the body, how to find them, and how to allow them to release. These aren't the knots that your girlfriend massages out of your back though (although those are common trigger points). These trigger points are often located deep inside a muscle, or under the shoulder blade. Sometimes you have to release a smaller one to get the muscle to relax enough to access the other ones you want. Finding one usually results in pin-point pain, and with constant pressure over a period of time, the pain decreases (sometimes it increases before it decreases) as the trigger point starts to release.

A good way to understand what exactly trigger points, or knots, are, is the rubber band analogy. Take a rubber band, pinch it with your thumb and forefinger. Now with your other hand, grab the other side and stretch. The rubber band stretches, except for the point that you're pinching - that's still tight. Now imagine that the rubber band is a tendon or muscle, and that tight spot being pinched is a trigger point. These knots can be created by any of the things we talked about earlier – overuse, injury, poor posture, improper care of your body.

Though the name may sound like it, Trigger Points are not energetic sites as one finds in Chinese acupuncture or Indian ayervedic medicine. They are physical bodies, of tight and perpetually contracting tissue that can be palpated, or massaged, directly. The existence of Trigger Points have been recognized ever since we figured out that kneading and pressing on muscles and tissues feels good and helps rid us of aches and pains.

They have been treated in some form or another with every type of bodywork, including traditional Chinese medicine practices, Anma (the original type of official massage performed exclusively by blind men in Asia), thousands of years ago. But until real research on treatment options began in the 1960s, there was no physiological proof of trigger points. The study and therapy of Myofascial Trigger Points is medical science, not mysticism. You don’t need to “believe” in it – the treatment either works, or it doesn’t. Trigger points are identifiable, verifiable, and the problems they create are very predictable. In short, trigger points are very real.

An important part of trigger point therapy is what is called “referred pain.” That means that if your elbow hurts, it might be because there is a trigger point in your back. If you have ankle pain, it could be in your calf, or your quads. There are entire books full of diagrams of referred pain patterns. If there is pain here and here, the likely trigger point is over here, etc. Referred pain exists because the body is a single, interconnected ball of organic matter. If that rubber band has a knot in it, it can go anywhere from causing discomfort or pain to physically limiting range of motion. Your body will naturally shift posture try to compensate and avoid pain or reclaim that range of motion, and this can often cause even more muscle imbalances, posture issues, and problems.

According to medical research over the last 50 years (and especially in the past 15-20), between 75% and 80% of myofascial pain is due, at least in part, to trigger points. A lot of times something is diagnosed as tendonisis, arthritis, or bursitis, but it's really due to trigger points.

I read this, and started thinking about my elbow problem. I hung out in a Barnes and Noble for three hours and read a couple books about it, learned a fair amount. It's hard to apply to yourself, however, especially with no formal instruction and only a few hours of book learning.

And then I met Graham Musler. He is a student at Monroe Community College who was interested in Parkour. He came out to train with us one day, and while we were walking back to the car, we started talking. Turns out, he had graduated from Monroe Community College with an A.A.S in massage therapy, and then spent an additional year at the Pittsburgh School of Pain Management studying Myofascial Trigger Point Therapy.

Coincidence? I think not.

I've had three appointments with him so far, and each one has done wonders for my elbows. They're not better yet, but they've made huge amounts of progress. I've also learned tons about my body. There's one trigger point in the upper back where, when pressed, you feel pain (but good pain) shoot from the trigger point, up your neck, around the back of your head, and around your ear. It's absolutely fascinating to not see, but feel, how all of the muscles, tendons, ligaments, and bones are connected and how intricately they work together.

Last session, he was working a trigger point on latissimus dorsi (lats, side of the torso), and I felt one of the more painful spots on my arm start to tingle and release. This is an area I never thought would effect my elbow... but it does.

A lot of people don't believe Trigger Point therapy is a real, valid treatment. I say, from experience, those people are wrong. I'm not 100% fixed yet, but the progress I've already seen is proof enough for me. Trigger Point really focuses on addressing the causes of the problem, not just the symptoms like many other treatment methods do.

As a way of saying thanks to Graham, I'm going to post his contact information here. If you have any sort of chronic pain or lasting acute injury, please do yourself a favor and contact him. If you just want more information on self-care, trigger points, or any other treatment he offers, shoot him an email. After the first session, I guarantee you'll recognize the value. Would you prefer living the rest of your life in pain, preventing you from doing what you enjoy? Or take a chance and give Graham an hour of your time.

Contact info:
Graham Musler

Services offered:
Myofascial Trigger Point Therapy
Chinese Acupressure
Friction, Pressure, & Pull
Lomi Lomi Hot Stone Therapy
Thai Massage Therapy
Sandstone Rejuvinate Therapy

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Anonymous Anonymous said...

Happiness is not a matter of events, it depends upon the tides of the mind.

October 19, 2008 at 9:23 PM  

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