Sunday, January 2, 2011

Trigger Pont Therapy Work

Out of all the therapies that I researched, this is one of the most promising. It allows the musician or person with the problem to be in charge of their own care, at least for part of it. One of the books referred to below, "The Trigger Point Therapy Workbook" by Claire Davies should in my opinion be on every musicians shelf. It is helpful to have some professional trigger point work done prior to try it on your own, but if that isn't possible, this book can teach anyone how to work their own trigger points out, even the difficult-to-reach ones in the back. This book is available at Borders and online.
Trigger Point Therapy
Trigger point therapy is not a form of massage, nor is it related to acupressure as it may seem at first glance. Trigger point therapy has its' roots in Western medicine and there are studies using diagnostic tools such as microscopes that have been used to observe trigger points. A trigger point is a knot or contraction in the muscle and/or myofascial tissue that keeps a constant tension in the muscle and any muscles or ligaments that are attached to the contracted area. Because of the constant contraction, circulation is reduced, as is the removal of waste products generated by cells and tissues. The area is also deprived of oxygen and nutrients because the circulation is restricted. This in turn causes the muscle to contract even further, creating a cycle of pain that continues to worsen as time passes. The theory of trigger points states that the pain that is felt by the patient, more often than not, is "referred" pain. This means that the pain may appear in one area of the body, while the "trigger" for the pain (the trigger point) is actually in another, seemingly unrelated, area. An example of this might be pain in the wrist or hand that results from a knot in the forearm just below the elbow.
Many chiropractors and massage therapists are now becoming aware of trigger point therapy and are using it in their practices. It is, however, a fairly simple theory and most people can learn to treat themselves. There are trigger points that are located out of reach, (for instance in the back area), but there are tools that have been designed by practitioners of massage that can enable the patient to treat even these areas.
It is the contention of some practitioners of trigger point therapy that much of the pain suffered by people is the result of undiagnosed trigger points. Treatment of myofascial trigger points for the relief of pain is not part of the normal education of doctors. The fascia is the layer of tissue that surrounds the muscle. When there is a prolonged contraction of the muscle, as in the case of a developing trigger point, the fascia becomes hard or tight and inflexible. Although there has been material published regarding this therapy since the mid 1980s, it is still primarily the province of massage therapists and other alternative therapists.
Diagnosis of trigger points is relatively easy. They are extremely painful when palpated or pushed. This may seem to indicate that one should avoid them. The therapy for relief of the pain is just the opposite. The trick, however, is to find the trigger point that relieves the pain that is being experienced. The causes of trigger points are similar to those that cause other muscle problems. One of the most common causes is overuse of particular muscles. This relates specifically to musicians. Those caused by this type of problem tend to recur unless the root cause of the problem is resolved. This may include changing the workstation, taking frequent breaks, or changing position in the performance of any work that requires repetitive motion. Other causes of trigger points can be being overweight, carrying heavy bags, briefcases, babies etc. or, for men, carrying their wallet in their back pocket and sitting on it. Trigger points can also be caused during an accident or fall, when the muscles contract suddenly. Other causes can be injections, surgery, or even a skeletal imbalance, whether genetic (as in one leg shorter than the other) or created through surgery, ill-fitting shoes or other causes. Some trigger points are very persistent and seem to return despite repeated treatments. This is usually because the motion or factor which caused the trigger point in the first place has not been resolved. Other reasons may be that the body is genetically not symmetrical, lack of physical activity which can cause stiff muscles, and repetitive movement. Another cause of trigger points can be poor nutrition. Lack of minerals, such as calcium, iron, magnesium and potassium can negatively impact muscle function. Certain vitamins are also necessary to maintain optimum muscle health. These include the vitamins B1, 6 and 12, vitamin C and folic acid. Lack of these vitamins may be either from inadequate intake or from environmental factors that destroy these vitamins before the body can use them. Some of these influences may be smoking, dieting, pregnancy, alcohol, certain medications including oral contraceptives and antacids.
Treatment of trigger points takes three forms. The first, performed only in a doctor's office, is injection of the trigger point with an anesthetic, usually procaine. This is difficult, because the trigger points can be quite small, and it requires skill on the part of the practitioner. The second method for treating trigger points is called spray and stretch. This involves spraying the skin with a refrigerant that numbs the skin, then stretching the muscle and thus the trigger point. This also requires a doctor or other practitioner to perform. The third method, the only one that can be done by the patient, is massage. The massage must be deep and firm in order be effective. The downside to this method is that because trigger points are, by their nature, very painful to touch, it may be difficult for the patient to apply the requisite amount of pressure in order to release the trigger point. This can be learned, however.
The book The Trigger Point Therapy Workbook is designed for the patient to learn to self-treat this condition. While the author recommends professional massage as the best method to treat trigger points, he postulates that self-treatment has a number of advantages, including being able to treat whenever needed and being able to identify points and pressures accurately. The book has a section on the theory and history of this type of therapy, including some of the common causes of trigger points. There is a chapter on how to perform the massage correctly. Then the book is divided into sections of the body. The author shows which trigger points in which areas of the body create "referred" pain in other areas. There is a section specifically on Carpal Tunnel Syndrome, as well as an entire chapter on pain in the arms and hands. The section on Carpal Tunnel Syndrome is included in this chapter. At the beginning of the chapter, the author provides an easy-to-read chart that details various areas in which pain may be felt, such as the outer elbow or outer forearm. Under each heading there is a list of the trigger points that can be the cause of this pain and the page in the book where one will find out how to locate them. Upon turning to the referred page, one finds an illustration that details where the pain is, the corresponding trigger points and how to massage them. Upon looking at the illustrations of the patterns of pain, one can see that they correspond to many of the problems that are experienced by musicians. On page 107, for instance, the thumb and wrist just above the thumb is shown as the area of pain, while the trigger points that cause this pain are in the upper area of the arm. In the section "Causes", the author states "Oboe, clarinet, and some saxophone players often suffer from chronic pain and numbness in the thumb of their right hand, which has to continuously support the weight of the instrument. Though the thumb itself may seem to be the trouble because that's where the pain is felt, the real problem is in the brachialis muscle which has to stay contracted all the while the instrument is being played. In addition to frequent trigger point massage, a wind player should put the instrument down at every opportunity and let the arm hang at the side, allowing the brachialis to lengthen and relax."42
Just skimming this section and glancing at the illustrations of where pain may occur covers almost all of the conditions experienced by musicians. The author illustrates the trigger points which will relieve pain and other conditions such as numbness and tingling in these areas. The rest of the book covers other areas of the body, such as the lower back, the chest and abdominal areas and the legs and lower extremities. The book is well illustrated, easy to read and explains the theories and techniques in a manner that makes it easy to learn how to perform the treatments. The index is also very helpful. It can direct the reader immediately to the pages which correspond to the particular condition in which they are interested.
The article "Position Paper on Trigger Point Injections", available online at www.dringber.com/tpoint, is an article that is appealing to the medical community to find funding for the study of Trigger Point Therapy. There is one mention of musicians in the article. The article states that cases have been presented at the American Academy of Physical Medicine and Rehabilitation that show that Trigger Point Therapy has been useful in treating focal dystonia, a particularly difficult condition to treat. There is no further reference to the case and it is not included in the bibliography of the article. Nevertheless, because focal dystonia is such a difficult condition to treat, the reference is included in this paper.
The on-line article "About Myotherapy: Bonnie Pruden Myotherapy" is more an advertisement for a particular type of therapy than an objective statement. Nevertheless, the article contains a definition of trigger points and an explanation of the therapy. For this particular style of therapy, the patient must be "cleared" by an allopathic practitioner, thereby eliminating any illness as a cause for the pain. The article has one line about musicians, stating that " For athletes and performing artists, relief is usually immediate and followed by enhanced performance".43
The book Performing Arts Medicine mentions trigger point therapy in the chapter entitled "Therapeutic Management of Instrumental Musicians". This book points out that while this must be considered as a potential cause of pain in the musician, most practitioners are not trained in the recognition and treatment of these trigger points. The section on this aspect of treatment covers how to diagnose and treat this condition. The authors also state that "There are no radiographic or laboratory findings in MPS (myofascial pain)."44 The authors also include the clinical characteristics of trigger points. These authors recommend as treatment massage, compression of the point, electrotherapy, cold spray and stretch, and as a last resort, injections.
In the chapter titled Self Care, the following material either recommends or mentions trigger point therapy: Shoulder, Upper Back and Neck: Free Yourself from Pain (page 69 ) and Carpal Tunnel Syndrome: How to Relieve and Prevent Wrist Burnout (page 71) both by Rosemary Atencio, recommend trigger point therapy; Susan Weiss in The Anatomy Book for Musicians (page 74) recommends trigger point therapy; Play It Safe (page 86) by Christine Zaza, recommends trigger point therapy ; and the website Musicians and Injuries (page 92) by Paul Marxhausen recommends trigger point therapy.