Friday, October 11, 2013

October is Physical Therapy and Massage Awareness Month: Focus, Trigger Points and Myofascial Pain Therapy

The Physical Therapist

Not all physical therapists are created equal.  If you suspect you have myofascial triggerpoints (MTrPs) or myofascial pain syndrome (MPS), it is extremely important that you do some investigating before you ask your physician for a referral.  A physical therapist that understands the myofascia, what trigger points are, and what they can do is imperative.  The specially trained physical therapist may or may not be one who specializes in sports injury, but they should be educated about myofasical pain syndrome.  If they are specially trained, they can offer active release therapy, myofascial release, or other muscle targeted therapies and education to help you get you back on the road of recovery.

The Massage Therapist or Body Worker

There are many types of massage used for different reasons and massage is gaining favor as a therapeutic intervention for those with chronic pain.  Because there is one particular problem that is inherent in most if not all chronic pain conditions, we are focusing on trigger point massage. A good MTrP therapist or body worker understands the work of the pioneers in myofascial medicine, Dr. Janet Travell, and Dr. David Simons. You might be able to find one who is part of the NAMTP (NationalAssociation of Myofascial Trigger Point Therapists)  or ask for a referral from an integrative pain specialist in your area.  Before you make an appointment you should first ask, “Do you have, or are you, trained in the work of Travell and Simons.”

Experts tell us that to get the most benefit, it is important to learn how to do self therapy between professional sessions. Your physical therapist, specially trained massage therapist, or body worker, and even some integrative pain specialists can show you how to do this or make referrals to materials that teach you.

If you have had a long standing history of MPS, and trigger points that have been neglected, it will take perpetual work to get and keep myofascial trigger points under control, but don’t give up.

So, what is a trigger point?

Trigger points are knotted up muscle fibers in a taut band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight, in which case "specific myofascial therapy," must be used to loosen up the taut band of muscle in order to isolate the specific myofascial trigger point (MTrP) causing pain, dysfunction and radiation of symptoms in a specific pattern associated with that specific MTrP.

Common Abbreviations© 

  • MPS: myofascial pain syndrome 
  • CMP: chronic myofascial pain
  • MTP: myofascial trigger point 
  • TrP: trigger point 
  •  From Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeffrey Miller PhD

What do MTrPs do?

Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber. Numbness and tingling, burning, certainly pain, can all result from a MTrP which is entrapping a nerve. These symptoms can be local or radiate in a specific pattern that remains consistent among all patients. Circulation/temp changes can occur if MTrPs are located next to a blood vessel, and swelling can develop if the MTrP is located next to a blood or lymph vessel).

You can learn more detailed information about trigger points and myofascial pain syndrome on my website here

What is Myofascial Pain Syndrome?

The development of trigger points can occur from usual muscle strain or injury, surely you or someone you know has woken up with a “crick” in their neck.  Generally, these are isolated events that can be easily and successfully treated. But, when trigger points start to develop in all four quadrants of the body, and they persist for over three months, it is important to consider the existence of myofascial pain syndrome.  Myofascial pain syndrome has been found in many if not most chronic pain conditions, including but not limited to, fibromyalgia and chronic fatigue/myalgic encephalomyelitis, migraine, spinal degeneration, teeth grinding, restless leg syndrome, TMJ, interstitial cystitis, irritable bladder, arthritic joints, and can result from post surgical scaring. When not treated by a therapist who understands the work of Travell and Simons, the patient does not get any lasting relief.

The pain that exists because of trigger points depend upon the location of trigger points and you can refer to the links following to decide if you need to know more about trigger points and how they can affect the body and various diseases.

There are many dedicated physical therapists and myofascial body workers that dedicate their lives to helping you.  Many times the therapies they use to treat you can put them at risk for developing myofascial issues, whether they work specifically with the myofascia or not. So please take the time this month to tell them thank you.

Following are few articles written with you in mind:

You can learn more about trigger points and myofascial pain syndrome, including various treatments known to help in “Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection.” Available from our publisher Healing Arts Press and Imprint of  INNER TRADITIONS, Bear and Company here, Amazon here,  Barnes and Nobel, here, and other major retailers. It is also available in Kindle and Nook.

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All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website,


Frank Gresham CMTPT said...

Good info.... a good MTPT will find out "why" you're getting the pain first..and not go right to the site of the pain and work on you first.. Dr. Travell's protocol is the the best for eliminating chronic pain. It should only take a few visits for the patient to be pain free once the perpetuating factors are identified. I wish more people did this Celeste. Unfortunately there are only a handful that understand and use Travell's true teachings.

The Pained Ink Slayer said...

For certain Frank. I had a fantastic integrative pain doc in AZ that used Travell and Simons TPI protocol and ultrasound guidance. She moved! I am heartsick, but she did refer me to a therapist such as yourself. I am excited to get back. It takes a great deal of maintenance when the patient also has FM. They seem to feed off one another and we need more research as to why this is. That said, in the meantime, there are therapies that can HELP, but few doctors understand this. Few understand that MPS is present in most, if not all, chronic pain problems.

My mission as part of is to see that myofascial therapies get covered by insurance. A lofty goal, but one that should save healthcare dollars and improve patient outcome.

TY for all you do to help so many.

emilyharrie said...

Nice Post! Meniscal injuries in arthritic knees challenge me. While some patients are more than willing to start with physical therapy (PT), some like the idea of a "quick" surgical fix over the perceived drudgery of a course of PT.

Physical Therapy Colorado Springs

sophia said...

This kind of post is always inspiring and I prefer to read quality content so I'm happy to find many good points here in your post. Writing is simply great! Thank you for the post..

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etoims said...

Great one blog I had ever seen. Thank you so much for this. Etoims is a best and unique therapy to heal muscle and whole body pain. Etoims is completely unique treatment for individuals suffering from Myofascial pain , neck pain and lower back pain because the patient is often able to immediately feel the sore muscle groups in their body begin to stimulate the healing process. Visit at once.

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