Treating each trigger point is relatively simple. Treating the whole myofascial pain syndrome so that pain fully goes away is a more complicated process.
Since a trigger point is the contraction mechanism of the muscle (sarcomere) locked into a shortened position, the treatment of the trigger point involves unlocking that contraction mechanism. This can be achieved in several ways.
Remote Treatment via Tel-appointment combines all the features of an in-person consultation with a one-on-one class in trigger point self-treatment methods. Pain issues, relevant medical history, range of motion tests, postural/structural analysis, myofascial pain tutorials, and customized rehabilitative exercises can all be done by webcam in the comfort of your own home. To treat the muscles, I will describe and demonstrate how to find the relevant trigger points, watch you do it on yourself, and provide feedback. It is best to have a copy of The Trigger Point Therapy Workbook by Clair and Amber Davies, a Backnobber, and a tennis ball handy for your appointment. Set your device up so that I can see all of you; sitting, standing, lying on the floor. You might have a favorite rug or yoga mat. You will be able to see me moving as well. I will show you how to use tools and work from the book so that you will be able to work more on your own if you wish. I will then explain and/or demonstrate how to move and stretch to rehabilitate the muscles, then we will do these exercises together to get them right and another tool to keep pain from returning.
Cold Laser Therapy, or Low Level Laser Therapy supplies energy in a small, focused area to a trigger point in the form of non-thermal photons. This light is transmitted through tissue, with the light in the 830nm far-infrared wavelength penetrating the deepest, causing an anti-inflammatory as well as an immunostimulant reaction. Doctors have been using this for several years to enhance healing of injuries, and more recently have found this treatment to be highly effective at deactivating trigger points. It is safe, painless, and causes little or no post-treatment soreness.
Manual compression involves applying gentle, direct pressure with the elbow, knuckle, thumb or finger tips to the trigger points causing the pain as well as to other trigger points in adjacent and related muscles. The pressure is held for a few seconds until the trigger point releases and the muscle softens. Sometimes a tool, such as an Index Nobber, can be used instead.
Spray-and-stretch technique is the method which uses a fine jet of vapo-coolant spray. The cold spray evaporates the instant it contacts skin, too fast to chill the muscle, but distracting the nerve from pain. Absent of the spasm-inducing pain sensation, the muscle is able stretch more easily, helping to release the trigger point and breaking the pain-spasm-pain cycle.
Each of these methods is followed by gentle, passive stretch, further reducing or eliminating pain, and fostering restoration of full function.
Along with hands-on treatment to release myofascial trigger points, your therapist will:
- Take a full medical and pain history
- Evaluate your pain map for referred pain patterns
- Assess the ergonomics of your work station and other regular activities.
- Assess and make suggestions to improve the quality of your sleep
- Make nutritional recommendations
- Teach you how to choose an appropriate exercise/movement program and help you to incorporate it into your life.
- Teach you to do self-treatment on your trigger points.
Your therapist will show you exercises to safely and effectively stretch specific muscles for maximum efficiency of recovery, and prescribe a home rehabilitation program. If followed, you can expect steady improvement and also find you have a powerful tool for your own pain management!
Goals are set cooperatively with you at the initial session and are periodically reassessed. Your input, insight and creativity are highly encouraged.
What to Expect from Treatment
Many patients experience relief from pain during the first treatment. For others several treatments are needed before their pain starts to diminish. It is common for patients to experience some soreness for one to two days after manual therapy, but not usually after cold laser treatment. Any soreness usually resolves after the first few treatments. You may experience fatigue as chronically tensed musculature is allowed to relax and return to a normal tone; however some patients experience an increase in energy. As the work-load of the musculature shifts and returns to a normal balance, pain patterns may change. This is a temporary and normal stage of recovery from chronic pain. It is not uncommon for people to experience relief from symptoms they were not seeking treatment for, such as chronic hand and forearm pain clearing up after being treated for a stiff neck. Returning to normal activities without pain is most often accelerated by adherence to the self-care program given to you by your therapist. Minimizing stress, pacing your activities and avoidance of overexertion (as well as focusing on what you can do instead of your limitations) are of prime importance. Good communication, patience and a positive attitude are essential.
Factors that Affect Rate of Improvement
- Type and length of time injured
- Overall physical health
- Level of fitness
- Underlying skeletal abnormalities
- Nutritional intake
- Quality of sleep
- Depression or anxiety
- Patient compliance with self-care
- Other medical conditions (i.e. allergies, diabetes, thyroid dysfunction, etc.)