Trigger points

I find myself practicing a lot of trigger point therapy these days. I hadn’t planned on specializing in this area, mind you, hadn’t planned on focusing on pain therapy in general, as far as that goes, but the results of TPT can be so dramatic and so immediate that I’m mighty glad I have it in my arsenal.

What they are

For a variety of reasons – trauma, overuse, strain, stress, and god-knows-what – muscles and their connective sheaths (called fascia) can develop localized tender-to-the-touch knots. Interestingly, and one of the challenges for diagnosis, this pain can be referred pain – i.e. show up in an area away from the site of palpitation. Sometimes trigger points announce themselves clearly and sometimes they play ventriloquist.

Treatment

After consulting with a patient and deciding that a trigger point treatment is what they need and the pain is indeed coming from a tight muscle, we get to work. Unlike most other kinds of acupuncture treatment, where patients may not even sense the presence of the needles, a direct an aggressive stimulation of the trigger point is called for. The goal is to get the muscle to twitch. Once I see this happening, I know I’m on target. If it’s a new patient I definitely go easy. After all, it may be the first time they’ve had acupuncture.

Patient responses

Here are some comments the treatment has elicited: "I have been waiting my whole life for that," "it is like you are scratching my muscle right where it needs it" and "that feels so weird". (OK, so the last one doesn’t come across so well out of context. But I guarantee he was smiling at the time.)

Patients look forward to trigger point treatments, and some experience such relief they beg me to release more muscles.

My thoughts

I think of TPT as restarting the muscle’s metabolism, reminding it how to function normally. It seems the most common places to hold stress in the body are the neck and shoulders, lower back and hips, and the stomach. No TPT for the stomach, though. But don’t worry. If that’s where the problem lies, we have other therapies to bring to bear. Maybe that’s a topic for next time.

Acknowledgments

I want to thank Matt Callison (at the AcuSport Health Center in San Diego) and William Duarte (OCOM here in Portland) for getting me started on this path.

PS

Western medicine treats myofascial pain with trigger points of its own, and pain specialist Dr. Peter Dorsher of the Mayo Clinic published an interesting article earlier this year comparing them with those of acupuncture.

Another case of East meets West.