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Pain Relief Protocols

Article by Dr Peter Richard Pedersen

Pain Relief Protocols have been developed to provide better results... naturally.

Ever been disappointed with treatment for headache, neck stiffness, shoulder pain, frozen shoulder, tennis elbow, wrist and hand problems, bursitis, chest pain,low back stiffness, sciatica, knee pain, shin splints...any muscle or joint problem? Please read this information...

Muscle-health has a huge influence on the quality of our lives. Muscle pain can make us less active, more tense or fatigued. Everyday pressures and stresses, overuse injuries in athletes, whiplash trauma and conditions like fibromyalgia or arthritis can produce muscular or "soft tissue" pain often characterized by "trigger points."

Trigger points can present themselves as referred patterns of sensation such as sharp pain, dull ache, tingling, pins and needles, hot or cold; they can create symptoms such as nausea, ear ache, equilibrium disturbance, or blurred vision. These small, hyperirritable sites in the muscle tissue sometimes refer pain to other locations as in headaches or sciatica. 

Trigger Point Dry Needling may be the answer.

It is a therapy which examines and treats muscles and muscle attachments with very specific needling, a bit like acupuncture, but different. It is a researched and established procedure, dating back to the 1940s, It addresses surface muscles  and connective tissues, deeper ligaments and connective tissues. 

Trigger points usually occur up and down your body along the length of the muscle.  They are most common in the axial muscles (muscles that control movement of the body from side to side), especially those used to maintain posture, but can be found throughout the body.  Trigger points generally occur in more than one location.

Referred Pain

Trigger points cause referred pain in specific areas called pain reference zones.  These areas have been charted and are predictable, consistent, and usually the pain is experienced in areas located away from the trigger point.  The referred pain is often described as dull, aching, and deep, and it can be constant or occur off and on. Manipulating a trigger point elicits referred pain and often slight nausea. When you get a massage and a new pain develops deep in a muscle, that can be a trigger point being activated.

Active and Latent Trigger Points

Trigger points can be classified as either active or latent. Active trigger points cause ongoing, persistent pain; latent trigger points are pain free until pressed. Both may create a local twitch response when pressed. They are often associated with decreased range of motion, weakness in the affected muscle group, and decreased ability of the muscle to stretch. Often, active trigger points can cause "satellite," or secondary, trigger points in the reference zone that respond (because of the increased stress) to the involved muscle groups. For example an active trigger point in the back can create pain and eventually and satellite trigger point in the shoulder.  Treating the shoulder trigger point will not have a lasting effect without treating the originating trigger point in the back.

Focal or regional autonomic dysfunction may occur with palpation of a trigger point. Skin temperature decreases have been noted at trigger points, and skin temperature can decrease in pain reference zones.

Origins of Trigger Point Therapy

Trigger point therapy is one of the largest and fastest growing muscle therapies today. Dr Janet Travell,, the White House physician under former President John F. Kennedy, and her research colleague, Dr David Simons initially coined the phrase "trigger point therapy" to describe their then cutting edge treatments involving saline injections into muscle, stretches and heat therapy to resolve trouble spots. Travell used these techniques to treat JFK’s back pain. During the 1970’s Travell and Simons’ methods were developed into a system of non-invasive, dry-needling techniques, meaning no injections, and are widely used today by physiotherapists, osteopaths, chiropractors, and are recommended by medical doctors.

A Typical Treatment Session

A thorough physical examination is performed, with a focus on the area of pain and discomfort. We start by observing the patient's movements and posture, looking for poor posture, muscle strain, pain that increases guarding, and increased pain in other muscle groups. Trigger points cause muscle shortening with secondary weakness and decreased range of motion which can be observed. A  musculoskeletal exam with strength testing and relevant neurological assessment is often preformed.

Trigger points can be felt by palpating the muscles; trigger points will consist of tender, hard knots or nodules surrounded by what feels like normal muscle tissue. Once a trigger point has been found, it is unmistakable. You can feel it as sharp or numb, but when it is pressed hard, can be stabbing-sharp pain. The trigger points are usually between or beside the bones and tendons or ligaments or actually deep on the boney attachment.

Trigger point dry needling is more than a pain-relief techniques to alleviate muscle spasms and cramping. The needle deactivates the trigger point, the previously tender areas become pain free, more importanlty, the entire muscle relaxes and begins to function normally. Where muscles have been damaged or acquired a re-occurring spasm that worsens painfully when aggravated, dry needling restores normal function, eliminating spasm.

So, the major goal is to eliminate the spasm, allowing new blood flow into the affected area. The spasms are partly maintained by nervous system feedback (pain-spasm-pain) cycle. Spasms also physically reduce blood flow to the trigger point area (ischemia), reducing oxygen supplied to the tissues and increasing the spasm. The tendon of the muscle also loses blood supply and tendinopathies occur. Dry needling the muscle trigger point is an effective treatment for tendonitis, without painful massage or anti-inflammatory injections.

Trigger Points - How they are created

Trigger points are clustered areas of pain in or around muscles that usually radiate pain in a predictable pattern. When a muscle, or group of muscles, incurs injury, it automatically contracts around the painful site to support and protect the area. If pain is resolved quickly, the muscles can relax. If pain persists, muscles can become habitually contracted. Sometimes contractions press on nerves causing tingling, numbness, and more pain. Like a sponge that is squeezed, a contracted muscle can’t hold much blood. Blood transports oxygen and nutrients to the muscles and carries away waste products. When a muscle is deprived of healthy circulation, it doesn’t receive enough oxygen and nutrients, and waste products accumulate. This can result in fatigue and soreness. It can also irritate nerves in the area, causing pain to spread beyond the congested area.

Finding the Real Source of Pain

Most trigger points are easy to detect by locating the pain, applying pressure and experiencing the subsequent release, however, in some cases, the real source of pain may be an originating trigger point located quite a distance from the "satellite" trigger point (pain site). For example, an originating trigger point for the wrist, forearm and hand is frequently located in the region of the shoulder blade. Thus, pain associated with the wrist, forearm and hand may require treatment of both the originating trigger point and the localized satellite point.

The Pain-Spasm-Pain Cycle

The "pain-spasm-pain" cycle is a complete chain of events, which is reinforced by each event in the cycle. Pain often begins with injury, illness, inadequate stretching before sports or physical activities, or overuse of a muscle. Each event, especially stress, can add to or even start the cycle. The pain cycle involves these major events: pain, which leads to muscle tension and pressure on nerves, causes reduced circulation and muscle shortening. Reduced circulation and muscle shortening results in restricted movement and causes trigger points to form. Trigger points cause more stress and more pain. Any single event in the pain cycle can set off the complex chain of events that ultimately leads back to pain. Treating trigger point pain  interrupts the pain-spasm-pain cycle without drugs or negative side effects.

Trigger points are not visible with traditional medical testing such as MRI or X-ray. When trigger points are not treated, they will create satellite trigger points in the affected area. For instance, a trigger point in the trapezius may cause a trigger point to appear in the temple. The trigger point in the temple then may cause a trigger point to appear in the jaw. And, voilà! - a case of TMJ.

Summary and Conclusion

  • "Trigger Points" are tender spots in muscles and "Dry Needling" refers to needles without an injection. "Myofascial Therapy" tells us that the treatment is directed to muscle and connective tissue. It is not acupuncture. Acupuncture uses diagnosis of energy flow (Qi) and needle treatment into specific points that are located on the energy channels (meridians).

  • Trigger Point Dry Needling is a cost effective and efficient technique for the treatment of myofascial pain and dysfunction. The approach is based on Western anatomical and neurophysiological principles.

  • Physicians Dr Travell and Simons defined a myofascial trigger point as a "Hyperirritable spot in a skeletal muscle." The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.

  • Myofascial trigger points (MTrPs) are commonly seen in both acute and chronic pain conditions. Researchers Hendler and Kozikowski site Myofascial trigger points as the most commonly missed diagnosis in chronic pain patients.

  • Over the years it has been shown that it is possible to deactivate TrPs by injecting them with a large number of disparate substances (Lu & Needham 1980) The only reasonable inference drawn from this is that the pain relief obtained is not dependent on the specific properties that the substance may contain but rather on the stimulation of the needle used for the injection itself.

  • One of the first physicians to employ Dry Needling extensively for this purpose was Dr Karel Lewit of Czechoslovakia. Lewit (1979) reported favourably on the use of this technique in a series of 241 patients with musculoskeletal pain. The work of Hong and Jennifer Chu support Lewitt's work and emphasize the therapeutic importance of eliciting a LTR (local twitch response).

  • Dry Needling may mechanically disrupt the integrity of the dysfunctional endplates within the trigger area - resulting in mechanical and physiological resolution of the TrPs. A fascinating new study by Jay Shah shows biochemical changes in the TrP following twitch elicitation. This was done by real time blood micro-sampling of the TrP as it was needled.

  • Many years of work by Drs David Bowsher and Peter Baldry amongst other show a strong pain inhibitory role played by Opioids released by needling stimulation of A delta receptors.

  • Dr Chan Gunn in his I.M.S. approach and Dr Fischer in his segmental approach to Dry Needling strongly advocate the importance of clearing TrPs area in both peripheral and spinal areas.

  • Today many Medical doctors, Physiotherapists, Chiropractors and Acupuncturists are using Dry Needling effectively and extensively within their practices for the treatment of Myofascial Pain & Dysfunction

Dr Peter Pedersen (Chiropractor and Osteopath) has researched Myofascial Therapy Trigger Point Therapy and Neuromuscular Technique for over 35 years and has developed "Pain Relief Protocols" incorporating Dry Needling, Biomesotherapy, Golgi Organ Tendon Stretch Technique and Applied Kinesiology Reflex Release.

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