Must one work on Trigger Points directly?

[Guest guest]

Great post on TP's

.... " Passive (latent) TPs are less tender on palpation. They may be found

in clinically normal patients and are associated with restricted

movement (guarding) " ...

This is so true in horses in dressage and since their muscle mass is

so much, I usually use a TENS machine with the pads, wet the back and

turn on the intensity to see a twitch, then scan the whole back as to

find areas of more intense twitching or disconfort. I mark the areas

and come back after with a 4 " needle and go in the spot until I hit a

reaction injecting then with acua, Traumeel, Sarapin with a bit of

procain or lido. This is done after mesotherapy or acupuncture or US

guided injections of transverse intervertebral sinovial joints when

the restriction wont dissapeare.

The results are dissapearance of restricted and guarding issues with

an increase in performance in the arena.

 

Chinese Medicine , " "

< wrote:

>

> Hi Alon, & All,

>

> I wrote:

> > Also, Trigger Pts do NOT disappear to distant AP Pt needling, nor do

> > they disappear with rest or time-off-work. IMO, one MUST work on

> > Trigger Pts directly

>

> Alon replied:

> > Phil, i do not agree;

>

> > (1) most " myofascial " TPs are secondary to other dysfunctions.

>

> I would expand that to say that, regardless of the tissue in which

> they lie, most TPs are secondary.

>

> TPs can arise secondary to dysfunction elsewhere (for example

> myofascial TPs after a viral infection, like 'flu

> http://tinyurl.com/5m7dgv ) or secondary to regional or local

> dysfunctions, including local trauma, local infection, abscesses,

> over-stretch of, or other trauma to, involved muscle / ligament /

> tendon. Surgical scars / adhesions / infected tooth-sockets can hold

> TPs.

>

> RSI, bad posture (including in office, car, bed, etc), guarding of

> other body areas, stress, hypothyroidism & many other factors can

> induce or activate secondary TPs [http://tinyurl.com/66k3p2 ].

>

> > For example, Ed Styles DO in a meeting with Simons present showed how

> > all of the TPs that Simons identified disappeared by treating the

> > patient with osteopathic techniques addressing joint restrictions.

>

> One chiropractic trial [ http://tinyurl.com/5vqhb4 ] concluded: a

> single treatment of instrument-applied (Pro-Adjuster System) cervical

> manipulation combined with instrument applied soft-tissue

> manipulation significantly reduced upper trapezius MTrPs in the

> treatment group, while controls had no change.

>

> [it is unclear if TPs were treated directly in that trial but that

> appears to be the case].

>

> > (2) almost always one can demonstrate that by injecting an anesthetic

> > to involved joints or ligaments a myofascial trigger point would

> > disappear (ie become non tender and lose its referral phenomena)

> > showing it to be a referred phenomena itself.

>

> Though TPs usually ARE secondary, once present, they assume a " life

> of their own " .ACTIVE TPs can trigger and/or maintain pain & other

> DysFx (autonomic, proprioceptive, etc) long after the primary cause

> has eased or disappeared.

>

> Excluding osteopathic / chiropractic-type manipulations and injecting

> an anesthetic to involved joints or ligaments, do you agree that:

>

> (a) TPs do NOT disappear to distant and / or regional (viz NON-LOCAL)

> AP Pt needling?

>

> (b) TPs do NOT disappear with rest or time-off-work?

>

> I have no experience of the techniques that you mentioned. However,

> excluding those techniques, most of what I have read indicates that

> one must work directly on TPs to release them.

>

> Would you, or other members, care to discuss this further?

>

> > (3) it;s fairly rare that one actually cures pain by addressing only

> > myofascial trigger points.

>

> Alon, with respect, I disagree. I have seen and heard of several

> great results to direct stimulation / release of TPs in scar tissue

> or muscle when other methods (including acupuncture that did not

> include their removal) had failed.

>

> > I do agree with you about the differences in ashi concept and trigger

> > point concept.

>

> Do any other members disagree with this?

>

> > It is interesting however that most referred patterns from myofascail

> > triggers show close relations to the sinew channels.

>

> Alon, have you references to suport that?

>

> Best regards,

>

>

> PS:

> Types of TPs: There are different types: active and passive, primary

> and secondary. All TPs are associated with dysfunction but only

> active TPs are associated with pain. Primary and secondary TPs may be

> active or passive.

>

> Active TPs are very tender on palpation and associated with existing

> pain or other dysfunction. They may vary in irritability (associated

> with variation in symptoms) from hour to hour and day to day. The

> severity and extent of the referred pain depends on the irritability

> of the TP, not on its size or the size of the affected muscle. Active

> TPs can become passive after alleviation of the precipitating

> factors, rest or inadequate therapy (Verhaert 1985).

>

> Passive (latent) TPs are less tender on palpation. They may be found

> in clinically normal patients and are associated with restricted

> movement (guarding) and weakness/fatigue of the affected muscles.

> (Muscles " learn " to avoid movements which cause pain). Passive TPs

> can be activated easily by many factors, especially

> overstretching/overuse, and can then trigger clinical pain or

> dysfunction. The fitter the muscle, the more difficult it is to

> activate its passive TPs (Verhaert 1985).

>

> Primary TPs are those which arise as a direct result of physical

> injury, local irritation in virus diseases or direct environmental

> effects on myofascial tissue. Active primary TPs, causing pain,

> " guarding " and increased muscle stress elsewhere, may recruit

> secondary TPs in the same or other muscles.

>

> Secondary TPs are those which arise due to foci of irritation

> elsewhere, such as in visceral disease or as recruits to very active

> primary TPs elsewhere.

>

[Guest guest]

Hi Phil

All the statements i made before apply to " myofascial triggers " via

travell. I do agree that at times using direct treatment to these give

good result if no other pathology exists. These are usually do to

simple strain or short over use. I do not agree that one gets great

results if the condition is more chronic and secondary, there are

always exceptions like with anything. As far as triggers getting a

life of their own, yes i agree, but again good results is not the rule

unless the primary problem is addressed. Also, for the most part i

agree with you that direct needling works better than distal

acupuncture, but not always. I have seen TP disappear with Japanese

type therapies, but again not the rule. What is see all the time is TP

not disappearing with repeated local needling and/or injection, they

improve but come back quite often, again if primary cause is not

addressed. As far as referral patterns there is some information in my

book, but just look at travell maps and sinew channels, there are many

overlaps

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus@wan

 

 

 

 

 

[Guest guest]

Hi Alon, & All,

 

I wrote:

> Also, Trigger Pts do NOT disappear to distant AP Pt needling, nor do

> they disappear with rest or time-off-work. IMO, one MUST work on

> Trigger Pts directly

 

Alon replied:

> Phil, i do not agree;

 

> (1) most " myofascial " TPs are secondary to other dysfunctions.

 

I would expand that to say that, regardless of the tissue in which

they lie, most TPs are secondary.

 

TPs can arise secondary to dysfunction elsewhere (for example

myofascial TPs after a viral infection, like 'flu

http://tinyurl.com/5m7dgv ) or secondary to regional or local

dysfunctions, including local trauma, local infection, abscesses,

over-stretch of, or other trauma to, involved muscle / ligament /

tendon. Surgical scars / adhesions / infected tooth-sockets can hold

TPs.

 

RSI, bad posture (including in office, car, bed, etc), guarding of

other body areas, stress, hypothyroidism & many other factors can

induce or activate secondary TPs [http://tinyurl.com/66k3p2 ].

 

> For example, Ed Styles DO in a meeting with Simons present showed how

> all of the TPs that Simons identified disappeared by treating the

> patient with osteopathic techniques addressing joint restrictions.

 

One chiropractic trial [ http://tinyurl.com/5vqhb4 ] concluded: a

single treatment of instrument-applied (Pro-Adjuster System) cervical

manipulation combined with instrument applied soft-tissue

manipulation significantly reduced upper trapezius MTrPs in the

treatment group, while controls had no change.

 

[it is unclear if TPs were treated directly in that trial but that

appears to be the case].

 

> (2) almost always one can demonstrate that by injecting an anesthetic

> to involved joints or ligaments a myofascial trigger point would

> disappear (ie become non tender and lose its referral phenomena)

> showing it to be a referred phenomena itself.

 

Though TPs usually ARE secondary, once present, they assume a " life

of their own " .ACTIVE TPs can trigger and/or maintain pain & other

DysFx (autonomic, proprioceptive, etc) long after the primary cause

has eased or disappeared.

 

Excluding osteopathic / chiropractic-type manipulations and injecting

an anesthetic to involved joints or ligaments, do you agree that:

 

(a) TPs do NOT disappear to distant and / or regional (viz NON-LOCAL)

AP Pt needling?

 

(b) TPs do NOT disappear with rest or time-off-work?

 

I have no experience of the techniques that you mentioned. However,

excluding those techniques, most of what I have read indicates that

one must work directly on TPs to release them.

 

Would you, or other members, care to discuss this further?

 

> (3) it;s fairly rare that one actually cures pain by addressing only

> myofascial trigger points.

 

Alon, with respect, I disagree. I have seen and heard of several

great results to direct stimulation / release of TPs in scar tissue

or muscle when other methods (including acupuncture that did not

include their removal) had failed.

 

> I do agree with you about the differences in ashi concept and trigger

> point concept.

 

Do any other members disagree with this?

 

> It is interesting however that most referred patterns from myofascail

> triggers show close relations to the sinew channels.

 

Alon, have you references to suport that?

 

Best regards,

 

 

PS:

Types of TPs: There are different types: active and passive, primary

and secondary. All TPs are associated with dysfunction but only

active TPs are associated with pain. Primary and secondary TPs may be

active or passive.

 

Active TPs are very tender on palpation and associated with existing

pain or other dysfunction. They may vary in irritability (associated

with variation in symptoms) from hour to hour and day to day. The

severity and extent of the referred pain depends on the irritability

of the TP, not on its size or the size of the affected muscle. Active

TPs can become passive after alleviation of the precipitating

factors, rest or inadequate therapy (Verhaert 1985).

 

Passive (latent) TPs are less tender on palpation. They may be found

in clinically normal patients and are associated with restricted

movement (guarding) and weakness/fatigue of the affected muscles.

(Muscles " learn " to avoid movements which cause pain). Passive TPs

can be activated easily by many factors, especially

overstretching/overuse, and can then trigger clinical pain or

dysfunction. The fitter the muscle, the more difficult it is to

activate its passive TPs (Verhaert 1985).

 

Primary TPs are those which arise as a direct result of physical

injury, local irritation in virus diseases or direct environmental

effects on myofascial tissue. Active primary TPs, causing pain,

" guarding " and increased muscle stress elsewhere, may recruit

secondary TPs in the same or other muscles.

 

Secondary TPs are those which arise due to foci of irritation

elsewhere, such as in visceral disease or as recruits to very active

primary TPs elsewhere.