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Trigger Point Therapy - Sciatica
by Judith Winer on Jan 04, 2016
When we analyse the traffic through our clinics at the end of each quarter, sciatica seems to be always up there in the top ten. There are probably two good reasons for this. The first is that sciatica is one of those conditions where the pain can be extremely severe. The second, is that manual therapy has long since been recognised as being effective for providing relief, even by most medical doctors. In fact, any therapist familiar with trigger point therapy will tell you that they're always upbeat going in to treat sciatica, as the effects of the therapy are in most cases, extremely positive. This is something that has been reaffirmed in a number of studies.
Sadly, too many therapists remain out of the loop, when it comes to understanding trigger points. In the case of some (mostly PT's, but others included) there is still a tremendous cynicism. This is generally because these therapists have received a negatively biased education, and have somehow avoided the opportunities to learn and explore trigger point therapy first hand.
For anyone willing to take the time to piece it all together, there is plenty of freely available research to support trigger point therapy. Mainstream acceptance of trigger point therapy has grown rapidly in recent years. We're committed to playing our part to push for the introduction of trigger point therapy as a standard teaching requirement for all manual therapists.
In todays trigger point blog we take a deeper look at where trigger points come from.
There are, without a doubt, many ways to address any condition - treating pain is no different. There are conservative approaches along with invasive procedures.
When treating trigger points and Myofascial Pain it is generally in the best interest of the patient to exhaust the conservative treatments before beginning the invasive ones. Many times invasive procedures do not resolve the condition and sometimes make it more difficult to treat later.
Granted, this is why it is of utmost importance to educate yourself, as you are doing now, about your condition so you can make an informed decision. Whatever decision you make -- stick with it -- treatment, no matter what it is, does not work if you do not follow the direction of the practitioner.
A conservative approach is any type of therapy that is not adding foreign materials to the body or invasively piercing the skin.
Myofascial Trigger Point Therapy
Myofascial Trigger Point Therapy was pioneered by Janet Travell, MD who was the White House Physician during Kennedy and Johnson's term in office. This therapy employs the use of manual therapy techniques to deactivate trigger points and restore normal range of motion. Once normal range of motion has been achieved a person may return to a pain free lifestyle. Modification of habit, which is generally simple and practical, is usually required to keep the pain from returning. Types of modalities a therapist may use, but not limited to:
Trigger Point Pressure Release - a therapist will locate and compress a trigger point until it refers its pain. The patient will let the therapist know when the pain begins to dissipate at which time the therapist will slightly increase pressure and repeat until the pain is no longer referred. The muscle is then stretched to its normal range.
Active Myofascial Release Techniques - this manual therapy technique is designed to break through adhesions which form in the fascia (connective tissue) of the body. This is usually performed on patients who have had their pain for long periods of time where this physical change has taken place.
Vapocoolant Spray and Stretch - spray and stretch is applied to encourage relaxation of a muscle by essentially distracting the central nervous system and allowing the targeted muscle to relax. A cold spray is applied over the area of the muscle and through its pain pattern while at the same time the practitioner is moving the muscle into a stretch.
Post Isometric Relaxation (PIR) - this manual therapy technique is used to facilitate more range of motion from a group of muscles. The patient will be placed into a position where they will be asked to exert low level force against the practitioner for about 5 seconds. The practitioner will then tell the patient to relax and will move the body part into the stretch position for the muscle group for which they are applying the PIR.
Heat - heat is applied to relax muscle and help with restoring range of motion.
Massage therapy is growing faster and faster all the time because many people are finding relief without having to use as much medication to control conditions such as pain and anxiety. The effect massage has on the body is stress reduction which in turn can translate into less pain in the body. Other physical benefits can be achieved depending on the type of technique utilized. In my opinion people do not look to massage for pain relief because of the mentality behind it. Massage is still looked upon as a 'pampering' or 'luxury' service. All I can say is that you do not know until you give it a try -- if you get the right therapist you may be very happy with the results.
Last, but certainly not least, is chiropractic care. From being in this field for 7 years, I have noticed a very important thing about chiropractors. They can do what I cannot. Chiropractic care is designed to manipulate joints, primarily in the spine, although some chiropractors will manipulate other joints as well. Chronic myofascial pain patients many times need manipulations after trigger point therapy to restore the motion of the joint itself. This sometimes must be done by what is called a HVLA adjustment, which stands for High Velocity Low Amplitude. The response I usually get from chiropractors is their patients adjust much easier after having muscle work performed.
Other devices are used in the chiropractic community such as activators and various electromechanical devices. Once again, it is important to find a chiropractor who fits your needs, and more importantly, keeps your best interests in mind. I like chiropractors who encourage their patients to keep themselves healthy so they do not need constant care and tend to refer to those types of chiropractors.
Moderately Invasive Techniques
Dry Needling and Trigger Point Injections (TPI's)
While these techniques are a part of trigger point therapy, they need to be separated because they may only be performed by properly trained and licensed health care practitioners. Types of practitioners who perform these techniques are MD's, DO's, PT's*, Nurses (RN's)*, and acupuncturists (AP). The practitioners with the * beside their credential are not licensed in all 50 states to perform this technique, but the others are.
Dry needling is performed by inserting a dry needle (a needle that will not be injecting any medication) into a trigger point. The practitioner is looking for a local twitch response (LTR), which is a clinical sign of a trigger point. The practitioner will then move the needle around while staying within the same injection site to penetrate and deactivated all trigger points in the area. A patient will then be stretched and given specific range of motion exercises to perform before returning for another round of therapy. Many times, because of this technique, a patient is sore from the needle being used to perform the technique. The pain does however go away and usually leaves the patient pain free.
Trigger Point Injections (TPI's) are essentially the same as dry needling except a medication or mix of medications are injected into the region of the trigger point. The injection will help with the post needling soreness along with making the actual therapy more tolerable to those with low thresholds for pain. Keep in mind, it is the needle that does the job, not the medication being injected.
Invasive techniques are ones which pierce the body and remove tissue/bone and leave scars. Most surgeries are considered invasive procedures. Do not let surgeries scare you as they are sometimes necessary to alleviate pain, but many times can be avoided if a person pays careful attention to themselves and addresses conditions that come up in a prompt manner.
There are many different types of surgeries used for pain, so rather than talking about all of them, I will mention that it is far better to keep a certain mentality when considering surgery.
When considering surgery:
Try to make it a last resort. Most surgeons will agree with this statement and will order therapy for a specified time period before considering a procedure especially with 'borderline' patients.
Get a second opinion. You cannot undo a surgery so it is always good practice to have another specialist look at your case and give their opinion. The opinion may not have to do with getting surgery or not, but perhaps the approach or procedure itself could be different allowing a better chance for resolution and faster recovery time.
If you smoke - stop. Most surgeons will not operate on a smoker especially if a bone fusion is being performed. The body will not fuse properly, and sometimes not at all, which is called a non-union.
Ask for referrals for a surgeon from a practitioner who works with cases like yours as they know who can provide the best resolution for you. The surgeons I recommend in this area I believe are top notch and always on the cutting edge of their field. Furthermore, they treat their patients with respect and allow a person to feel comfortable in making this important decision for themselves.
This article was written by Jeff Lutz, CMTPT of The Pain Treatment and Wellness Center, 245 Humphrey Rd., Suite 2, Greensburg, PA 15601, 724-853-2353, http://musclepainhelp.com/index.html
There is no doubt that your self-image, and the way others view you, are directly affected by your body posture. We have all observed people who seem to draw attention and attract positive energy, simply because of the confident, self-assured way that they carry themselves through a room, or briskly stride down a crowded street.
Conversely, poor posture is very often related to poor self-image. You have probably noticed that many people with slumped posture have a tendency to look helpless, weak, and tired. Some people seem to literally carry the weight of the world on their shoulders. There are many causes of poor posture, including structural and biomechanical problems that should be treated by a qualified professional. Some of the possible negative effects of poor posture are much more than a cosmetic concern and can include muscular pain, headaches, neck and back pain, fatigue, reduced lung capacity, and reduced levels of blood and oxygen supplied to the brain. Since some spinal conditions can only be detected by x-rays or by thorough physical examination, I personally believe that it is a good idea to consult a qualified Doctor of Chiropractic for a spinal checkup, even if you are not currently experiencing pain or symptoms.
As far back as 1250 B.C., the ancient Greeks were looking to the spine as a cause of dis-ease in the human body. The nerves exiting the spinal cord through the openings of the spinal column directly supply the pure energy that regulates and controls every system of your body. A healthy spine positively affects the free flow of pure energy throughout all the systems of your body, including the digestive, reproductive, respiratory, and immune systems.
As a chiropractor who has treated thousands of patients over the years, I have personally witnessed the phenomenal healing and energizing power of the human nervous system on a daily basis. Consequently, I truly believe that maintaining a strong, healthy, properly aligned spinal column is essential to achieving overall health and optimal well being in your daily life. A healthy spine is the strong foundation of a healthy body. Strengthening the muscles of the back increases the stability of the spinal column and can help prevent serious problems caused by musculoskeletal imbalance. By balancing the strength in the front and the back of your body, you will have less chance of injury in your daily activities.
Usually, the most under exercised muscles in the body are in the back. Building up some muscles, while ignoring others, may pull your body out of balance. For example, if you develop strong chest and abdominal muscles without working on strengthening your back, you will eventually start to slump over. Strengthening the hamstring and abdominal muscles also helps stabilize the spinal column, due to the connection of these muscles to the pelvis.
Exercising both sides of your body evenly can prevent imbalance of muscle strength on either side of the spine. Muscular imbalance can be a result of overuse of the muscles on one side, and underuse on the other and can eventually lead to structural imbalance of the bones and joints. Musculoskeletal imbalance can also be caused or aggravated by the type of work that you do, by unilateral sports such as tennis or golf, or by always favoring one side when you carry a briefcase, handbag, child, or other heavy object. Whenever possible, change sides or positions to prevent muscular imbalance and subsequent structural imbalance. Most of us favor one side or the other for certain activities in our daily lives without being consciously aware of our patterns.
Another example of a repetitive physical activity that negatively affects the musculoskeletal and nervous system over the years involves the cervical (neck) portion of the spinal column. Any activity that requires you to look down for long periods, especially reading, computer use, and deskwork, can produce a chronic forward head position. Eventually, this repetitive strain can lead to a decrease of the normal C-shaped curve in the neck, which makes it difficult for the neck to support the heavy weight of the head. Biomechanically speaking, the normal C shaped curve in your neck makes it stronger, and with a decrease of that natural curve, (which is sometimes the case after whiplash type injuries and ligament damage caused by trauma) the neck loses some of its weight-bearing strength.
Fortunately, one of the most effective ways to improve your posture is simply to become more aware of it. Seeing yourself as others see you is often the first step to making improvements in your posture. I recommend evaluating your body in a full-length mirror from the side view -- a position in which you rarely see yourself -- viewing your posture while using a hand held mirror. You may even want to have a friend take a picture of you from the side, standing as you normally stand.
With correct posture, when viewed from the side, your ears are balanced directly above the arches of your feet, and your head is only slightly forward of the neck, shoulder blades, and lower back. A plumb line dropped from overhead should pass through the ear, shoulder, hip, knee, and ankle. Your head should not tilt to one side or the other.
To help you become more aware of your posture, try the following exercise while standing in front of a mirror. Imagine two gentle hands on either side of your head pulling you upright, and a light helpful hand at your back pushing your shoulder blades together. Think tall, lengthen your neck, and let your head move upward, with the chin slightly in. Concentrate on lengthening your spine, still imagining the top of your head reaching toward the ceiling. Keep your stomach in and buttocks tucked. Slightly bend your knees without locking them, since locking your knees puts unnecessary stress on your lower back.
Now, visualize yourself walking with a certain presence, a way of carrying your body that projects self-confidence and inner strength. Picture yourself with regal posture, head held high, shoulders back, feeling tall, proud, and self-assured. With continued practice you will start looking and feeling like the self-confident person that you have always known you are.
I have always loved the old saying “To be, act as if.” When you assume the body posture of a strong, energetic, and confident person, walking with a spring in your step and a smile on your face, you will find that the physiological changes also positively affect your mind and soul --lifting your spirits and sometimes even changing your whole outlook on life.
Taking some time to pay attention to your posture and take care of your spine is an integral component of achieving optimal health and expressing your pure life energy. Remember, it is how you carry yourself that counts. Think strong, energetic, and confident!
Dr. Suzy is a retired Doctor of Chiropractic and active Health And Fitness Educator. The information and suggestions that she shares on this website are for reference purposes only and not intended to be diagnostic in any way nor a substitute for consultation with a physician or other licensed health-care professional. Always obtain a complete physical examination and discuss your specific conditions, limitations, and health history with the qualified health care provider of your choice before making major lifestyle changes. Information and statements regarding dietary supplements have not been evaluated by the FDA.
The Pressure Positive Company and TriggerPointProducts.com have partnered to offer visitors to the Pressure Positive website an opportunity to use a very cool tool. The Interactive Symptom Checker is the fast, easy way to find the root of your trigger point pain and can be the first step on your journey to ending your pain.
The Trigger Point Symptom Checker was developed by Cerified Myofascial Trigger Point Therapist (CMTPT), Jeffrey Lutz. Jeff has a practice in Greensburg, PA, the Pain Treatment and Wellness Center, and is one of the co-founders of TriggerPointProducts.com. Jeff served for 5.5 years on the Executive Committee of the National Association of Myofascial Trigger Point Therapists and is that organizations incoming new President. He teaches seminars in Myofascial Therapy, and the anatomy course at The Pittsburgh School of Pain Management.
In an interview with Paul Ingraham of SaveYourself.ca Jeff says,
"It’s is a dynamic tool that helps practitioners and pain sufferers alike to identify the root of pain associated with activated trigger points.
When dealing with pain in the body from trigger points, we found the easiest way for people to identify the problem trigger points is by using pictures. I noticed that in my practice when a client would have a difficult time explaining their pain I would ask them to look at a trigger point diagram on the wall and tell me which pattern of pain looked most like theirs. The patient would look over all the possibilities; suddenly their finger would shoot out like a dart — “That one!”
After doing this enough times, I began to realize the potential for people to identify the muscular aspect of their pain so long as the medium is visual. Because trigger points refer pain in random, yet consistent patterns, we wanted to create a visual type of experience for the user to identify their pain.
There are 45 muscles outlined by the symptom checker (44 bilateral, one central). While this may sound like a small number considering there are over 600 muscles in the body, we have featured the muscles where trigger points most often form — the ones responsible for the vast majority of pain, tightness, and dysfunction.
When a user finds the pain pattern that looks most like their own pain, they can click on the image and read more. If it matches their pain, they can go further and click on a button to learn more, such as self-treatment options, how the muscle may have been injured, and activities to avoid. We are also careful to provide other possible causes of pain. Although we welcome visitors and know that they will find our Symptom Checker very useful, we also offer a warning: not every pain is caused by activated trigger points in muscles."
THE TRIGGERPOINTPRODUCTS.COM SYMPTOM CHECKER IS NOT INTENDED TO TREAT OR DIAGNOSE ILLNESSES & DISORDERS AND THE PRESSURE POSITIVE COMPANY STRESSES THAT IT IS IMPORTANT TO UNDERSTAND THE TERMS AND CONDITIONS FOR USING THE TRIGGER POINT SYMPTOM CHECKER. YOU MAY VIEW THE TERMS & CONDITIONS OF USE BY CLICKING HERE.