Q. Do I need to see my doctor before I start treatment?
A. A physician’s referral is not required; however, checking with your physician is suggested in order to rule out other pathology and to prevent delay of appropriate treatment. In some cases, the therapist may require a physician referral to be sure that there is not a serious underlying medical condition that needs to be addressed, or to verify that MTPT is appropriate in the presence of certain medical conditions.
Q. How many sessions will it take to resolve my condition?
A. Since every condition is different, the frequency and duration of treatment may vary. The length of time you have been in pain, the severity of your pain, the number of body parts that are in pain and your overall physical health affect how long treatment lasts. In the majority of cases, a person will achieve a noticeable reduction within 2-3 visits. Some patients require or prefer to have more. Often the first visit gives significant relief. Being an active participant in your treatment will help you to recover more quickly.
Q. How can I help my treatment be more effective?
A. Your therapist will identify certain activities in your life that exacerbate your pain condition. We call these “perpetuating factors”. These areas must be addressed to achieve lasting pain relief. These factors include posture, ergonomics, stress levels, sleep and nutrition, among others. As part of your treatment program, your therapist will help you develop solutions to these perpetuating factors.
Q. Is Myofascial Trigger Point Therapy painful?
A. Trigger points can be very sensitive. Because of this, I use predominantly cold laser therapy to release them, which is painless. In the manual treatment of myofascial pain, pressure is applied to trigger points so yes, that hurts, but at an entirely tolerable and sometimes even satisfying level. Should we have occasion to use manual therapy, you are always in control of how much pressure is applied. You let me know when you feel a small amount of pain – perhaps a 5 on a 0-10 scale – and that’s where I stop. I like to say the therapeutic level of pain is “talking to you, but not screaming at you”. It is important to understand this when applying self-treatment techniques. This very light level of pain is the most effective therapeutic amount. Patients often describe this as feeling like “good pain”. More is not necessary, and in fact would be counter-productive.
Q. Is trigger point therapy performed with a full body massage?
A. No. Even though I am a Licensed Massage Therapist, Myofascial Trigger Point Therapy is a different kind of therapy from massage, and while MTPT may incorporate some techniques that the state licensing board defines as massage, the session is exclusively used for the specialized treatment protocol of myofascial pain. This includes range of motion testing, movement, feedback and education one would not expect to find in a massage session. See “How is MTPT Different?”
Q. Do I have to disrobe for a trigger point therapy appointment?
A. No! But Myofascial Trigger Point Therapists need easy access to the areas needing treatment. For manual therapy, you may choose to be treated in your underwear, a swim suit, or remain clothed in light-weight, loose fitting garments. Avoid denim jeans if we will be working on low back or leg pain. Bear in mind that a typical session will have you in a variety of different treatment and stretch positions and may have you standing and walking so that the therapist can assess your posture and gait. Cold Laser Therapy requires contact with your skin for best results. Wear loose, comfortable clothing that can be moved out of the way on the areas being treated. Sweat pants or shorts and a tank top are ideal. In the alternative, you may opt to undress and be draped.
Q. Is there anything I can do to treat my own pain?
A. Yes. Any time after your initial session, a Myofascial Trigger Point Therapist can teach you or your family members techniques that can be used at home. I can also recommend some good self-care tools as well as educational materials.
Q. Why isn’t trigger point therapy more well-known?
A. The main reason most medical practitioners don’t know about Myofascial Trigger Point Therapy has to do with the fact that they’re not taught much about it. As it stands, most medical schools, physical therapy schools, schools of nursing and chiropractic schools do not train their students extensively in elimination and treatment of trigger points. Additionally, standard medical testing procedures such as x-rays or MRI’s don’t reveal trigger points. So, although the taut bands of muscle tissue which signal the presence of trigger points can easily be felt by touch, that kind of physical examination often does not happen today.
Another reason is that typical appointments may last anywhere between 45 minutes to 2 hours. It’s not practical for MD’s to integrate such time-consuming therapeutic techniques into their practice. Although some basic understanding of trigger point treatment is increasingly becoming a part of the standard massage curriculum, the depth and extent of knowledge is still very limited within the massage field. For this reason, it is not easy, even for those physicians who do have knowledge of Myofascial Trigger Point Therapy, to find qualified therapists to whom they can refer patients.
Q. Can Myofascial Trigger Point Therapy help me avoid surgery?
A. Sometimes, yes. For example, carpal tunnel surgery – cutting the flexor retinaculum, or the carpel tunnel ligament – is one method of releasing compression of the ulnar nerve which passes through the wrist beneath that ligament. However, the flexor retinaculum can be released with hands-on compression treatment and stretching. In a case like this, myofascial trigger point therapy is much easier, less costly, less risky, and less invasive.
Another example is sciatic pain, which often leads ultimately to some kind of surgical intervention, even if only exploratory in nature. Yet this type of pain can often be relieved completely by treating trigger points in specific back, hip, and leg muscles. There are many other conditions such as TMJD, stenosis, and bone spurs which can be effectively treated by myofascial trigger point therapy in lieu of surgery.
The most compelling reason to consider myofascial trigger point therapy before surgery is that it is a non-invasive form of treatment which has no known side effects, and none of the risky complications that come with surgery, and if for some reason trigger point therapy does not help you, surgery remains an option.
— adapted from Trigger Point Therapy for Low Back Pain: A Self-treatment Workbook by Sharon Sauer and Mary Biancalana, see Resources