Myotherapy .............................................. $50/1hr $70/90 min $90/2hr
Myofascial Pain Syndromes & Trigger Points
Myofascial Pain Syndromes
Myofascial pain syndromes are characterized by the presence of hypersensitive areas called trigger points in muscles or the fibrous membrane (fascia) that covers them. Trigger points may originate when muscle tissue is subjected to excessive strain or abrupt stretching. When stimulated, these trigger points cause a specific syndrome of pain, muscle spans, stiffness and weakness both locally and in distant target areas. This referred pain may occur in seemingly unrelated parts of the body, but the pattern is consistent from person to person. The more common forms of the referred pain syndrome have been mapped anatomically. Once established, trigger points can be activated by often seemingly minor physical or emotional stresses.
Trigger Points
Trigger points have been implicated in a variety of pain phenomena, including muscle pain (myalgia), muscular (non-joint) manifestations of arthritis, muscle inflammation (myositis or myofascitis), and inflammation of the white fibrous tissue that comprises muscle sheaths and fascial layers of the whole muscle, joint, tendon, ligament system (fibrositis or myofibrositis). Trigger points, particularly those found in the upper regions of the back and shoulders, are often associated with palpable nodules of fibrous tissue. Physiologically, they form a self sustaining cycle of pain, more spasm, more pain. This vicious cycle may be interrupted at the sensory (afferent) or at the motor part of the mechanism. Trigger point compression, dry needling or injection of an anesthetic solution will intervene at the sensory level, possibly by stimulating brainstem production of enkephalins and endorphins. The result is a palpable softening of tense muscle tissue, signaling muscle relaxation and pain relief which may last for days.
Myotherapy: The Trigger Point Compression Technique
Myotherapy, the trigger point compression technique, was developed and reported by Bonnie Prudden in 1980. A well known physical fitness expert, Prudden was familiar with the trigger point injection technique long promoted by Janet Travell, White House physician during the Kennedy administration. Prudden made the serendipitous discovery that manual compression of offending trigger points for a period from 5 to 7 seconds was equally effective in bringing about muscle relaxation. This approach had the advantage of being non-invasive, and multiple trigger points could be “erased” at the same sitting. Compression of trigger points is slightly painful, but as soon as the pressure is released the pain subsides. After a group of related trigger points has been inactivated, the muscle is gently stretched. The sequence of trigger point compression and passive muscle stretching continues throughout the treatment. At the end of the treatment, active range of motion exercises are begun. Myotherapy combined with the corrective exercise program effectively interrupts the pain, spasm, pain cycle at both the sensory and the motor levels.
The Corrective Exercise Program: Key to Permanent Pain Relief
The corrective exercise program component seems to be the key to long term pain relief achieved over a short period of time. Exercise has indeed long been used for pain control. It is a known mood elevator and allows patients to become actively involved in their recovery. But it is also true that for many patients with pain due to active trigger points, exercise is initially not a viable option. However, once the pain factor is removed, most people will find exercise enjoyable. The homework exercise program is tailored to the individual needs of each patient and includes progressive range of motion exercise (warm ups), muscle strengthening and flexibility routines. These exercises are easy to perform, should not elicit any pain, and are to be done frequently throughout the day, preferably to music. The exercises are reviewed during each session. Towards the end of the treatment program, patients are coached to engage in a regular physical fitness activity such as walking, running, swimming, water exercises, etc., appropriate to their lifestyles.
Myotherapy: A Successful Approach to the Challenge of Pain
The simplicity of Myotherapy which involves neither drugs nor surgery is especially remarkable when the severity and disabling nature of many of the myofascial pain syndromes is considered. Persistent intractable pain will increasingly dominate a person’s life, leading to depressive behavior, economic deprivation and disruption of family dynamics. Therapeutic drugs often have undesirable side effects, and surgery is usually unsatisfactory for long term control of myofascial pain syndromes. In the continued search for treatment and relief of chronic pain, the patient encounters alternating cycles of hope and despair and eventually halts all expectation of ever being able to lead a normal life again. Thus, by the time Myotherapy has become a treatment option, considerable emotional support may be needed to rekindle the motivation to get well. The uniqueness of the Myotherapy approach lies in the exercise component. Since the technique is not only comprehensive but also simple and relatively free of side effects, it is to be hoped that Myotherapy will find its place as a first line method for control of chronic pain syndromes.