Trigger points complicate injuries and other painful problems. Many trigger points feel like something else. It is easy for an unsuspecting health professional to mistake trigger point pain for practically anything but a trigger point. For instance, muscle pain is probably more common than repetitive strain injuries RSIs , because many so-called RSIs may actually be muscle pain.
The daily clinical experience of thousands of massage therapists, physical therapists, and physicians strongly indicates 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. Trigger point science is as disappointing as an empty Christmas stocking. Some critics have harshly criticized conventional wisdom about them. So all the more reason to have a rational tour guide to take you through a murky subject. Who disagrees and why? What are the major pitfalls? Sometimes half-baked ideas turn out okay if you just keep them in the oven.
Cartoon by Loren Fishman, HumoresqueCartoons. Trigger points are medically neglected because medicine has always had many much bigger fish to fry, and musculoskeletal medicine has only just recently started to get any real attention. No medical speciality claims it. They are busy with a lot of other things, many of them quite dire. What about medical specialists? They may be the best option for serious cases. Doctors in pain clinics often know about trigger points, but they usually limit their methods to injection therapies — a bazooka to kill a mouse?
This option is only available to patients for whom trigger points are a truly horrid primary problem, or a major complication. An appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points. Physical therapists and chiropractors are often preoccupied to a fault with joint function, biomechanics, 30 and exercise therapy. These approaches have their place, but they are often emphasized at the expense of understanding muscle pain as a sensory disorder which can easily afflict people with apparently perfect bodies, posture and fitness.
Massage therapists have a lot of hands-on experience of muscle tissue, but know surprisingly little about myofascial pain syndrome.
Their training standards vary wildly. Even in my three years of training as an RMT the longest such program in the world 31 , I learned only the basics — barely more than this introduction! Like physical therapists and chiropractors, massage therapists are often almost absurdly preoccupied with symmetry and structure. No professionals of any kind are commonly skilled in the treatment of trigger points.
Muscle tissue simply has not gotten the clinical attention it deserves, and so misdiagnosis and wrong treatment is like death and taxes — inevitable! Those clinicians who have become skilled at diagnosing and managing myofascial trigger points frequently see patients who were referred to them by other practitioners as a last resort. They are too historically important not to be familiar with. Muscle Pain the blue one is just as important.
I highly recommend it to any professional who works with muscle or should. Fibromyalgia is a syndrome, not a disease, which means that it is unexplained by definition, 35 It is just the label we give to undiagnosed chronic widespread pain. It would be nice if such a clear distinction were established someday. FM and MPS are both imperfect, imprecise labels for closely related sets of unexplained symptoms, which makes them harder to tell apart than mischievous twins who deliberately impersonate each other. They may be two sides of the same painful coin, or overlapping parts on a spectrum of sensory malfunction, or different stages of the same process.
Some cases are effectively impossible to tell apart. Whatever the causes or labels, therapeutic approaches for MPS seems to be helpful for some FM patients as well, 38 although pure FM cases seem to be mostly immune to massage. Pain is a trickster; it is often not always what it seems to be. Trigger points are a common alternative explaination. Got a bizarre pain that just flared up one day?
Sure, it might be something scary or rare. But it can feel worrisome. This is where trigger points really get interesting. In addition to minor aches and pains, muscle pain often causes unusual symptoms in strange locations. For instance, many people diagnosed with carpal tunnel syndrome are actually experiencing pain caused by an armpit muscle subscapularis. Sometimes trigger points cause such crazy symptoms that they are mistaken for medical emergencies. I treated a man for chest and arm pain — he had been in the hospital for several hours being checked out for signs of heart failure, but when he got to my office his symptoms were relieved by a few minutes of rubbing a pectoralis major muscle trigger point.
I narrowly escaped a breast biopsy because of trigger points in the pectoralis major. I was on the table, permit signed, draped. I left confused, relieved … but still hurting. The physical therapist pulled out the big red books on trigger points, and we read together. Treatment was a complete success. A month-old severe pain that I had been treating with ice packs in my bra and pain-killers — gone!
Janice Kregor, competitive swimmer, retired pediatrician and medical school instructor. But most symptoms caused by myofascial pain syndrome are simply the familiar aches and pains of humanity — millions of sore backs, shoulders and necks. Some of which can become quite serious. Muscle knot pain can be savage. Over the years I have met many people who were in so much pain from muscle dysfunction that they could hardly think straight.
Not if you have it! In just three appointments, her pain was completely relieved. She was quite pleased, I can tell you! A big thank you for all your help. Or consider Jan Campbell.
Jan developed a hip pain sometime in early during a period of intense exercising. The pain quickly grew to the point of interfering with walking, and was medically diagnosed as a bursitis, piriformis strain, or arthritis. I did not believe any of these were likely, and treated a trigger point in her piriformis muscle once on June 12, One trigger point therapy treatment completely relieved a nasty stubborn hip pain that I'd had for five months! Every good trigger point therapist has a bunch of treatment success stories like this. Although most such cases involve relatively minor symptoms, this is not to say that they were minor problems.
In almost every such case, the pain was relatively mild but extremely frustrating and persistent for many years, then relieved easily by a handful of treatments — an incredible thing, when you think about it. So much unnecessary suffering! Can a good enough massage therapist remove all trigger points in a session? Or even less. The skill of a therapist is only one relatively minor factor among many that affect the success of massage therapy for trigger points — or any therapy, for any pain problem.
Even the best therapists can be defeated by a no-win situation. It really depends. For comparison, can a good enough dog trainer train any dog in a hour?
It depends on the situation. It depends, it depends, it depends. There are several things you can look for that will help you to feel more confident that, yes, muscle pain is the problem instead of something else. The next several sections will discuss all of them in detail, comparing and contrasting with other conditions. If you have ever had muscle stiffness, wrenched your neck around trying to stretch and wiggle your way free of discomfort, or gotten a friend or partner to dig into that nagging sore spot in your back, then you already have some experience with this — you have trigger points.
Editorial Reviews. About the Author. Alan Tucker, author of The Mother-Earth Series as well as the time travel adventure series, Tales of Uncertainty, is a dad. Knot in Time (Tales of Uncertainty) (Volume 1) [Alan Tucker] on awiqutyl.tk * FREE* shipping on qualifying offers. My name is Darius Arthur Heisenberg, but.
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Trigger points and crepitus joint popping and more 2. Consider a little more method in your madness 5. Stretch tolerance 8. John Method of Neuromuscular Therapy? Is there a print version? Electronic only, sorry. Can I read this offline, like at the beach? Like any webpage, it can be saved for offline reading easily. Who sells this? I sell education about a notoriously tricky condition, not false hope. Headache coming soon, fall of Most patients only need one book, because most patients have only one problem.
But the set is ideal for professionals, and some keen patients do want all of them, for the education, and for lending to friends and family. And, of course, you do get a substantial discount for the bulk purchase. But no rush—complete the set later, minus the price of any books already bought. More information and purchase options. Of course many people turn away, but 60, people have gone for it. This is a tough number for anyone to audit, because my customer database is completely private and highly secure.
This count is automatically updated once every day or two, and rounded down to the nearest It includes all individual and bundled books for sale on PainScience. Just send me an email after purchase to ask for a money-is-tight refund. Do me one additional favour and tell me your story? Something interesting about your case, perhaps? Anything at all. Can I read it on my iPad, Kindle, etc? Any Internet-enabled gadget works fine. The e-Ink Kindles are not a good choice. Satisfaction guaranteed, right? Of course—and no time limit.
When reading about time travel, many would wonder about the Grandfather Paradox, which According to Wikipedia goes as the following: The time traveler went back in time to the time when his or her grandfather had not married yet. Under the over-swinging lamps—swinging ever brighter in the better streets, and ever dimmer in the worse—and by lighted shops, gay crowds, illuminated coffee-houses, and theatre-doors, to one of the city gates. Oct 09, Dennis Michaels rated it it was amazing. Miss Manette, your mother took this course with you. But what is the matter! Sometimes trigger points cause such crazy symptoms that they are mistaken for medical emergencies.
Can I buy this anywhere else? Not yet. Maybe someday. Can I lend it? Yes, with a 3-person limit. Can I give it to my clients? I have a generous lending policy, but not that generous. Why do you want my postal code? To prevent fraud strongly recommended by my payment processor , and to identify customers for login and repeat business. Are you going to send me e-mail? Just a receipt. Why should I trust you with my credit card? They handle all the high-tech security. You can also keep reading more without buying.
Here are some other free samples from the book, and other closely related articles on PainScience. But charts tend to put the focus on the wrong thing, and people need principles way more than they need diagrams. Probably not! This is a very short version of my full review. I used to wonder why I even bothered to create this tutorial!
Why not just recommend the Workbook? Delving into the nature of the beast — the science — is the strength of this tutorial. But the Workbook has fallen behind the times on that score. The current edition still promises too much and neglects important new knowledge. This topic is too important for such neglect. This tutorials offers a more realistic and balanced view of trigger point therapy, meets the challenge of difficult cases head on, and hard-nosed reviews of every possible treatment option.
Which is quite a bit less than even a single appointment with someone who claims to do trigger point therapy. This is a list of resources relevant to chronic pain in general, but muscle pain in particular. I avoided publishing this section of the tutorial for many years, because I am generally not impressed by the resources available to both patients and professionals , especially online resources. I remember a slightly testy conversation with someone from an American organization that shall rename nameless :.
Years later that organization still has only a few dozen certified therapists in its directory, and yet it remains one of the few and largest directories of its kind. But certification of trigger point therapists is generally an amateurish and fragmented mess, with many businesses and organizations competing to be the standard. For inclusion in this section, an organization or business must be defining the field in some way, and they must have a strong online presence. For instance, although professional associations are rarely of much interest to patients, they may provide directories of professionals to help patients find practitioners.
NAMTPT provides resources for both patients and professionals, such as a trigger point therapist directory just over therapists and a symptom checker. The International Myopain Society IMS PRO — A nonprofit health professionals organization dedicated to the promotion of information about soft-tissue pain disorders like myofascial pain. A CPE educates clinical peers, patients, families, and caregivers on ways to relieve pain by the safest means possible.
ASPE training is not focused on muscle pain. They provide a directory of members and listings of pain clinics. The Pressure Positive Company PRO PATIENT — The best and oldest American manufacturer of good quality massage tools , Pressure Positive has also been a superb corporate citizen, contributing to the advancement of trigger point therapy in many ways, such as collaborating with writers like myself and supporting and promoting scientific research — admirable qualities in a field so often afflicted with pseudoscientific hype.
Their website provides many useful resources for both patients and professionals. David G. When she showed it to her cousin Ned, he confided that his grandam, the dowager queen Isabella, crossed herself whenever a white hart was mentioned in ballad or romance, a reminder of her part in Edmund's murder. She'd done nothing to stop the Earl of March, her lover and partner in rebellion, from beheading Joan's father for his loyalty to her husband, the king.
Joan hated her for it. Unfortunately, Joan and the dowager queen were bound to each other. To atone for his uncle's unwarranted execution, the present King Edward, Isabella's son, had taken responsibility for Edmund's widow, Margaret, and her children, making them part of Queen Philippa's household.
A cruel charity for which Joan was no more grateful than was her mother. So, through the summer and into the autumn Joan had bent to her work, embroidering the white hart emblem while keeping in her mind the charms of protection she'd learned from her nurse, Efa, and then, in secret, stitching the square onto a large banner, whispering a spell of power. Now she and Ned watched from behind a screen as Isabella and her ladies spilled into the great hall, taking their seats in a circle at the south end, where there was morning light for their needlework.
Look up, Joan whispered, as if Lady Isabella might hear her. In the rafters just there. See how the morning sun lights up the white silk and the gold thread. Feel the power of my father's blood that flows in me and my brother. But the dowager queen had her head down, fussing with her embroidery frame, fingering the threads in her basket, choosing a color. At last, as she waited for her servant to thread her embroidery needle, Isabella sat back to survey the hall. Yes, Grandam, up! Ned whispered, crouched beside Joan.
Though three years younger, he was taller than she, and considered himself her champion. Even against his grandmother. Look up! Isabella's full lips parted, dark blue eyes widened, ivory skin blanched to a deathly pallor. The jet beads on her black velvet mourning flashed as she reared up, a thundercloud charged with lightning, stabbing at the air with a bejeweled finger, pointing to Joan's banner. Oh, it was worth all her hard work to see that look of rage on Isabella's face. But why must her mother choose that moment to enter the hall?
Countess Margaret believed the invitation to celebrate Martinmas at Woodstock was meant as a peace offering, and though she could never forgive what Isabella had done, she thought it best for Joan and her brother that they accept with grace. King Edward, Queen Philippa, and the two princesses were in the Low Countries, the eight-year-old Prince Edward, Ned, left behind as titular Keeper of the Realm, but the boy answered to his grandam, the dowager queen. Best to keep in her good graces at the moment. Now Joan cringed to see her mother's expression of dismay as she, too, stared at the banner, then looked around, searching for her daughter.
Joan backed away from the screen, then turned to dash out the garden door. Outside, her puppy greeted her with his terrier's high-pitched bark. She had forgotten him in the excitement. Bruno was in hot pursuit, but with his short legs he fell behind, his barks growing fainter as Joan ran. Halfway down Ned passed her, laughing, flying like the wind on his long legs. Ned waited for her beneath the great oak, their special place, taking her hands as she arrived and spinning her round and round until he had no more breath and they both slumped to the ground, leaning back against the wide trunk.
It was here, three years ago, that he had found her, crumpled on the ground in pain, her ankle so swollen that her soft boots were cutting into her skin.
She'd run out of the hall in a temper, disgusted by her mother's passive acceptance of the dowager queen's condescension, determined to run away from court and never return. An exposed root had caught her foot, twisting her ankle as she pitched forward. By the time she reached the oak, she could only hop on her good foot. Climbing back up the hill to the palace was impossible.
Ned had stayed with her as night fell, covering her with his padded jacket, shooing away the night creatures, sharing some dried apples meant for his horse, telling her tales of how she would be his queen one day, the most beautiful and powerful woman in the realm.
They had been good friends ever since, delighting in elaborate japes and escapades, fierce in defending each other. Now he was grinning ear to ear as he caught his breath. Or the bees in Roger's helmet! She heard it now, leaves rustling and twigs snapping. Someone followed their path, quick but light.
They both stood, ready to run. But it was just little Bruno who burst from the brush, barking triumphantly, his tail wagging wildly as he rushed up to claw at Joan's skirts, then at Ned's leggings. Joan scooped Bruno up and held him close, letting him lick her face. He loves a good run. Ned sat back down, still frowning, pulling off his shoe and reaching for the hem of Joan's gown to clean it. She plucked her skirt out of his hand. And don't pout.
You remind me of your grandam when you pout. Let me enjoy my victory for a while. Mother will sour things soon enough. As if she'd conjured her, Joan heard Countess Margaret far away, calling her name. Let her worry. She was consorting with the enemy. Joan looked at the still grumbling Ned--at such moments she disliked him as well. He, too, was the enemy. The whole royal family. They'd not even tried to save her father. Hugging Bruno close, she started down the slope in the direction of the village.
Ned might do as he pleased. She had just stepped out of the woodland path onto the village track when he caught up with her. It was a young couple in their best clothes, turning to each other to clasp hands, an older couple holding flowers and murmuring encouragement. They crept to the side of the church and peeked round the corner. As the man began to speak, Ned turned to Joan, taking her hand and echoing Bran's vow in his high voice, changing only the names, "I, Edward of Woodstock, will take you, Joan of Kent, as my wife.
Joan shook her head. Bruno had been Sir Edward's pre-betrothal gift to her. In such moods, he could forget his affection for her. Rather than risk his lashing out she bowed her head, crossed her fingers on both hands, and rushed through the words, "I, Joan of Kent, will take you, Edward of Woodstock, as my husband. Ned gloated. It's better than your banner. Joan of Kent, Queen of England. He would make a mess of it. You must promise me you'll say nothing to Lady Isabella. Or she'll punish Mother. Even so, Ned's taunt would give the dowager queen an excuse to do something unpleasant.
Or to make certain her son the king refused Edward Montagu in favor of a husband who would take Joan far away from home.