Saturday, January 11, 2014

Is there a therapy for you? The role of treatments in chronic pain by Celeste Cooper

Body-work is important to the health of muscles that are dysfunctional, such as seen in myofascial pain syndrome. Myofascial pain syndrome  (MPS) is thought by many experts to be a main peripheral pain generator in most chronic pain conditions.  Chronic myofascial pain from sustained, untreated, or undertreated myofascial trigger points (knotted up pieces of muscle fiber that can be easily felt unless the muscle involved is too tight, too deep, or behind bone) is thought to be kept in perpetuity by the metabolic and autonomic effects of both FM and ME/CFS, meaning it makes treatment more difficult to sustain than it does in other patient populations.

Until myofascial trigger points are treated and muscle fiber is returned to its normal resting length, a sustained hold of the muscles involved, whether it be through Yoga or prescribed by a physical therapist, will not only discondition the muscle, it can create more pain and further development of MTrPs.  This is because the muscle has already reached its maximal capacity of stretch when trigger points are involved. More pain and dysfunction should not be the goal of therapies, but some do not realize they are doing more harm than good because they do not understand the pathophysiology behind trigger points. These same recommended therapies are helpful on down the road AFTER the muscle is returned to its normal state. We must educate those who treat us. We talk more about this in the next edition of Broken Body Wounded Spirit: Balancing the See-Saw of Chronic Pain, Spring Devotions, and our BIG book (here)  is devoted to understanding the role of chronic myofascial pain from trigger points in both FM and ME/CFS.  

Optimally, we need someone standing beside us using trigger point pressure and stroking the MTrPs as we move the muscle through its range of motion in order to coax the muscle back to its normal resting length. This is the theory behind Active Release Therapy, and though MTrPs are not addressed specifically in Feldenkrais Movement Therapy,  Alexander Technique, and Craniosacral Therapy, these therapies do help with restrictions found in skeletal muscle and connective tissue.  Spray and Stretch, Myofascial Release, and Myofascial Trigger Point Therapies are massage-like therapies .  

Addressing perpetuating factors with body work is done in Ashton Patterning, and Trager Work and an important part of prevention. Therapies for addressing the mechanical and emotional aspects of body-work are Hellerwork, T'ai Chi, Yoga, and Rosen Method.  The success or failure of each therapy is dependent upon patient dedication, education, and a therapist who is skilled in communicating with our body.  

All these therapies, including self treatment, are discussed at length in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and throughout the Broken Body, Wounded Spirit series. Read more about the books here

My New Year’s resolution is to educate others on the myofascial and its role in chronic pain. Many of these therapies are not covered by insurance. However,we have evidence based research to show that body-work treatments are more effective than medications and other invasive treatments in treatment of soft tissue dysfunction as the result of a musculoskeletal problem. We need  to move integrative therapies into mainstream. If we can convince Medicare, Medicaid and private insurance companies that therapies such as these are more cost effective, we have a chance.

For now, some of the therapies can be costly. Most of us with disabling chronic pain have limited financial resources, myself included. For this reason, I believe self care through the use of tennis balls, a Theracane, mechanical massagers, rolling pins, swim noodles, Yoga balls and practicing gentle movement and stretch therapies are good alternatives. 

You can find helpful links on my website here

~ • ~ • ~ • ~ • ~ • ~

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,


PainInVirginia said...

Frank Gresham, Celeste.... I can't tell you how many of my patients get better just from making the changes to stop trigger points from existing. One lady last week had bad migraines/headaches, low back , sciatica pain for years...her sleep positions were terrible...her hip height was off...and she had Morton's toe (causes low back pain) She called and made an appt one week later after our initial consult. Her pain was down to a 2 from an 8-10 range. Those things were the "why" of her pain. Now I can release those muscles and truly get her (fibromyalgia is what they diagnosed her with) pain free. Thanks for posting your article.
a few seconds ago ·

The Pained Ink Slayer said...

Always good to hear from you Frank. Being able to affect chronic pain in a positive way must be so rewarding. If only more physicians would embrace the role of myofascial therapy and at least learn more about it. Not all things can be treated with medication and invasive therapies, as I am sure you know better than anyone. Identifying and addressing perpetuating factors is also important. Of course one can't do much about Morton's toe, spinal disease, large breasts, etc, but we can do something about posture, repetitive motion, well fitting clothes and shoes, etc. I wish we could clone you and put you in every city in the nation. I have been fortunate to find a good body-worker here in AZ that studied Travell and Simons (she was recommended to be by the integrative pain MD I was seeing before she moved away.) When I get back to MO, I rely on ART by my PT and self treatment. Keep teaching. What you do is a tremendous service to many.

sophia said...

Great!! you explained the topic very well. The contents has provided meaningful information thanks for sharing information..

physical therapy treatments

Celeste's Website

Celeste's Website
Click on the picture