Trigger point therapy - I need hope and advice!

[MonarchX]

I have suffered from severe trigger point pain for 6 years now. I was misdiagnosed several times, had X-rays, MRIs, etc. and they all come out perfect (no scoliosis or abnormalities). Eventually I was diagnosed with fibromyalgia and was prescribed anti-deressants. Thing is...I am not depressed (well...mildly...from pain!) and those anti-depressants had 0 effect.

I had a lot of success with trigger point therapy. I first started doing compressio using TheraCane and pushing it against the wall and my body. I incredible pain, but 90 seconds later I could feel my worked muscle twitch violently and lots of blood pumping. In areas where this blood pumping occured - trigger points got completely de-activated and have not come back (several months now). I also got rid of causes by fixing habits - bad posture, bookbag carrying on one shoulder, emotional stress, etc.

Given that I am 22, generally healthy, and compression method has permanently relieved some trigger points - is there a chance I can be pain-free using this technique?

I noticed that my trigger point workbook suggests rubbing trigger points in one direction. This forum suggests compression rather than rubbing. I noticed blood pumping and muscle twitching ONLY after compression. Rubbing does reduce the pain over time though. Which method should I use? Or should I combine the two?

Also, compression technique suggests pain level 7 out of 10. That doesn't work too well either...mine needs to be 10 out of 10 to a point of vomiting. That's what makes blood pump, muscle twitch, and then permanent relief...

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[gcoe]

Fibromyalgia is a blanket term for a syndrome of symptoms. There is much variation so some patients have more of the fatigue and often depression while others at the other end of the spectrum have more muscle pain and may not have much fatigue or depression. In the end it is not a very well understood problem.

It is great that you got such good results from your focal trigger point treatment. I would normally caution people not to be quite so vigorous in treating the trigger points – more for the risk of causing injury. However this did work with you and as you are young and healthy maybe that is ok.

I think that you need to take a long term view of managing this. In the long term treating trigger point symptomatically might not be so effective . You are likely to find that you have a propensity to having future problems but by keeping fit and strong, maintaining good posture and managing stress it is possible you may keep the symptoms permanently at bay.
It is good that you have addressed posture and stress issues - sensible things to do.

Other long term keeping fit seems to be one of the most important components of managing fibromyalgia. Keeping a high level of aerobic fitness (heart beat raising exercise) appears to be very effective. Aerobic fitness may have a beneficial effect on modulating pain. With Fibromyalgia you have an altered pain perception with your nervous system being sensitised to pain signals. Also keeping strong with weights at the gym may really help. In the long run these might be more important

One warning – if you detrain and let your fitness go the symptoms may return.

Personally I think it is good to understand why you might have developed trigger points. Trigger points don’t just happen in a vacuum. One theory goes that fibromyalgia is partly due to muscle imbalance problems. So the symptom of muscle pain is due to muscles not working optimally. Promoting muscle balance so that weak muscles are kept strong and shortened muscles don’t get shorter but are kept flexible may be really helpful. A good consultation on your muscle balance may be warranted.

[MonarchX]

Thanks for the advice. I was spending my time with PC too much as a teen and I was tall skinny-fat (high body fat %, little muscle, many trigger points). At 18 I had change of personality and went to the gym 3-4 times per week. I ended up getting pretty darn fit but, but weight lifting was just...OMFG..super-painful, but I did it because I thought I had weak muscles and strengthening them will solve the pain. Some physician told me to contract and relax muscle that hurts all day...it made things so much worse. I had a lot of bad advice and gym that actually made things worse. I just worked 1 week on neck trigger points which are amazingly painful, but they are nearly deactivated and my headache/TMJ is gone!

So, I kind of quit gym 1 month ago because it made pain worse, it was sore longer, I couldn't do therapy like that. I go once a week to maintain. What works is to deactivate trigger point and then strengthen it. So, since I made it a habit to lift weights and do cardio I think I can keep trigger points from coming back. I also spend all day focusing on keeping shoulders relaxed and be stress-free. It needs to be like this for several months until its a habit. But dang I am happy I found a solution that works.

Also, my physician gave me Darvocet...which is worthless for this. I want to take some opiates to use infrequently and do this therapy without being in super-pain. I don't intend to get addicted, but I want oxy or hydrocodone. Is there one that helps with this type of pain specifically? I know ibuprofen removes soreness from therapy, but not radiating pain from trigger points.

[gcoe]

Yes if you have had problems with weights - then go easy on that side. WEight lifting can imply really full on - as in the sport - that may be way too much intensity. Progressive resistance training may be good but the intensity of ex shouldn't be too high especially to start off with. One thing to think about is just introducing one component at a time and letting your body get used to it. So I would definitely start with the aerobic component first. Much better to gradually introduce things and gradually increase exercise intensity and thereby avoid stopping because you have made yourself sore.

And it might be good to get some advice from a PT who looks at muscle imbalance issues so that you strengthen up the right muscles

Re pain medications: It sounds to me as if you need some ongoing support with this side, particularly as you aren't finding something that really helps. I am not really qualified to advise you on medications - really is more a physician thing. There are a number of options re: chronic pain modulation so it is worth exploring further. But make sure you are dealing with a physician who really knows about dealing with chronic pain.


One thing though - I would be cautious of taking opiates with a chronic pain problem - that group of drugs may be great in the short term but they can cause all sorts of problems with your nervous system over time - drug dependency being just one of them.

[MonarchX]

Thanks again!

Does neck have good blood circulation? I don't think so... I find it very hard and extra-time consuming to get rid of neck trigger points (side of the neck). For my back trigger points I can apply a lot of pressure and the pain will be severe but I can handle it. On my neck though...a slightest touch with nearly no pressure creates burning sensation in my shoulder that is simply not bearable. The progress for neck trigger points is awfully slow. It took 6 days of maybe 8-10 compressions per day in sets of 5 to reduce pain by some 30-40%, but it was a permanent decrease thus far.


Also, I think that the distance between my spine and end of left shoulder is greater than between my spine and the end of right shoulder. I am deformed...I guess. This explains why I have a whole lot more of them around my left shoulder blade, not so much about right.

[pt8am]

Trigger points can be a mine field and very difficult to treat but i think you deserve recognition and respect for taking a pro active self management approach to this problem with a large portion of perseverence on top.

All i can add to whats already been said is regarding your shoulder position. It sounds like your middle and lower trapezius may be weak and you pectoralis minor may be tight. This is a generalised guess from what i see a lot of every day. The weakness here means the muscles are constanly under tension to try and anchor you shoulder blade in position (ie back towards you spine) and often this will cause trigger points to develop. Try searching for exercises to strengthen the weak and lengthen the tight. Postural stuff will help for sure but sometimes the battle needs to get more technical!!

As for your neck...well they certainly sound pretty nasty. One key muscle in this area would be levator scapulae which will also be under tension from poture as it tries to take the wieght of the the forward positioned head. Its a long shot but maybe doing some deep neck flexor exercises alongside your TPR may help (these DNF muscles are postural stability muscles and designed to do this job) You could also try gentle stretching and soft tissue work on your Suboccipital muscles (under back of head) as these also tighten when the head is forward a lot and rarely recover without some help. Simple tipping you head forward as if you were putting a pillow in a pillow case (!) and stretching genlty by roating your head to direct you ear upwards should get the blighters.

Maybe this helps....

[maureen_frost]

I came across some brilliant products in South Africa exclusively treating trigger points. They are totally natural and approved by FDA.
And more importantly, they work !
As I am a new member here I am not permitted to publish the web site but hope it may help to know that there are products that treat these puzzling spasms. Maybe I will be allowed to post the details later.

[gangaa]

Myofascial trigger release technique will help you. it has lots of methods. but, now a days mannual myofascial trigger release technique become very popular and it will releive you. You need to consult a Physiotherapist. Self therapy does not work. If you want to gain theoritical knowledge about trigger points, read the book by Travell and Simons which also available in this Physio Shop too.

[Gregde]

If you have either fibromyalgia or multiple trigger points an integrated approach using trigger point release, stretching and postural exercises is required. Others can answer these specifics for you. Another possibility is a practitioner who uses deep tissue dry needling techniques.

Additionally, outside the strictly physio realm, a nutritional approach may need to be added as nutritional deficiencies can maintain chronic trigger point activation. The most likely culprit (at least in East Australia due to geographic reasons, can't answer for elsewhere but most likely to remain relavent due to modern diet) is often a deficit of Magnesium with additional conutrients (B Group Vitamins in balance, Malic Acid) but you will need a quality Magnesium (chelated forms) as it is a complex nutrient. Products will vary due to national administration requirements but generally practitioners can supply far better supplements for medical purposes than across the counter supplements.

If fibromyalgia is present a more complex approach may be necessary that includes gastrointestinal balance ( 100% of fibromyalgia patients have gastrointestinal imbalances), neurotransmitter and endocrine support, CoQ10, carnitine etc...see an integrated medical or naturopathic doctor (if in US, naturopath in Australia or elsewhere) as this is far more complex.

Also ensure you are getting plenty of sleep, particular the first two hours of sleep as you will require phase 4 sleep cycles, only achieved in this period, for adequate growth hormone secretion, critical for muscle recouperation.

Best of luck.

[mulberry]

trigger points are the result of inflammatory processes within a fascial compartment that causes protective muscle spasm of the muscle fibres. to fix this the nervous system has to be assessed and cleared neural provocation tension testing will demonstrate contributing factors to the condition. arthrogenic assessment should be performed to identify contributing levels of the backbone and then the myofascial slings of the affected limb should be investigated and cleared see the great work from italian physiotherapist luigo and carla stecco for further information.finally a movement assessment should be performed to identify changes in movement patterns and treatmetn direction tests to identify positions/directions of ease and positions/.directions of pain. finally emotional responses to movement should be assessed to identify protective or provocative patterns and anxiety/fear issues with movement the patient may have.
once all the above has been treatment will consist of mobilisation and MWM techniques to release arthrogenic contribution and neural mobilisation to improve the function of the nervous system. myofascial release of the fascial planes see tom myers myofascial meridians for futher detail and muscle release with movement see the ridgeway method for furhter detail. finally training the body to move better and maintain good form and function see shirley sahrmann's work for further information.

[gcoe]

trigger points are the result of inflammatory processes within a fascial compartment

. Do we know that? Are there studies that have examined the pathophysiology of TPS that have establshed the presence of inflammatory markers or processes?

As solutions go what you say all makes sense but I just query this issue of inflammatory nature of the problem. There may be such as study/studies but do you know of them? I'd love to have some evidence for this.

I think we have a long way to go to really understand the TP phenomenon and it would be good to seem more research in the area - it seems to be the poor cousin of neuro-musculoskeletal pain.

[mulberry]

absolutely ! look up acupuncture of trigger points fine needle biopsies have been perfromed and reports were as i have explained above
the sports physio journal in australia about 2 to 3 months ago there was a neat article about this experiment go look it up

[gcoe]

Oh come on Mulberry

You have made the claim - you give me the reference. Don't give me some vague direction. I don't think there really is an Australian Sports physiotherapy journal unless you mean their newsletter. How about an actual reference for a peer reviewed journal? Who are the authors? What have you read a review or a lab experiment