As pain can be a frequent part of someone’s vocabulary with the daily experience of its intrusion into their world, one can wonder, “When will this pain go away?” Why we hurt could easily be a book in itself, but let us explore a small but really important reason for pain that is not playing fair and not going away predictably.
August 2020 NEWS
DO YOU HAVE PAIN FROM TRIGGER POINTS? HOW PHYSICAL THERAPY CAN HELP YOU!
INSIDE: � Trigger Points, Pain & You � Exercise Essentials � Practice News � Patient Success Story!
Health & Fitness The Newsletter About Achieving and Maintaining Optimal Well-Being
August 2020
DO YOU HAVE PAIN FROM TRIGGER POINTS? HOW PHYSICAL THERAPY CAN HELP YOU
WHAT ARE TRIGGER POINTS? As pain can be a frequent part of someone’s vocabulary with the daily experience of its intrusion into their world, one can wonder, “When will this pain go away?” Why we hurt could easily be a book in itself, but let us explore a small but really important reason for pain that is not playing fair and not going away predictably. Pain that originates from trigger points is one such source that does not play fair, and is a master of disguise in how it camouflages its origins. It does not play fair because it is not the type of pain that heals in a defined period of time like an ankle sprain or when you bite your tongue. Trigger points do not heal and do not follow some time table for improving. They are local nodules or tight knots in muscle, which when active can cause pain not only in that area, but at times even in areas remote from itself. This is where it can disguise and hide itself adding more confusion to a situation that is frustrating enough. Trigger points are created by a variety of inputs that can relate to muscle overload like in a rotator cuff muscle after working a long day in the yard, or from a trauma like a car accident where there is muscle overstretching and a strain such as in the neck. They are a very common source of chronic or ongoing pain, or pain that reemerges after heavy use and they like to nag you while you try to sleep or rest, or they interfere with motion and strength. TRIGGER POINT EXAMPLE Since trigger points primarily occur in muscle and are a large source of ongoing pain, it is sometimes surprising to learn the body hasmore than 600 muscles. So, it is not a huge leap in logic to see how trigger
points can be a significant problem to someone’s ongoing pain pattern. As an example, the rotator cuff is a vulnerablemuscle group for trigger points because these muscles are prone to being overwhelmed by heavy armuse in conjunctionwith poor postural control of the shoulder complex. Here is a picture of a common trigger point that refers deeply into the front of the shoulder; the irony is the muscle is located in the back of the shoulder (see picture). It does not hurt in the back, but refers to the front and even down the armmimicking nerve symptoms.
Here is a good example of how trigger points can mislead by treating only the pain site or assuming it is only tendon irritation since the pain is in the same location for a tendonitis; this would not treat the source of the problem. A thorough shoulder, muscle, rib and neck examwould be needed to really understand all the variables that could be causing pain in the shoulder. There are numerous examples of trigger
Rotator Cuff Trigger Points Trigger point denoted by X.
point pain which relate to all of our common orthopedic pain areas, and it is rare that trigger points have not developed if pain has been more chronic. What makes trigger points self-sustaining is when the muscle tissue forms a knot (which are actually just over shortened muscle fibers), it then sets up an environment where blood and nutrients are not (Continued inside)
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TRIGGER POINTS, PAIN, AND YOU
ad), or just a tennis ball putting pressure on the trigger point as one goes against the wall or floor. Compression initiates a reflex relaxation which allows blood and nutrients to infiltrate the area and address one of the self-perpetuating mechanisms. Foam rollers have come into use as well for certain areas. Each device seems to have its best use area and no one device seems to have all the answers, but compression in general is a helpful mode for trigger point management. Some people really cause themselves severe discomfort when addressing trigger points. I would suggest just compressing to the point of a mild hurt (a good hurt feeling) and wait for the tenderness to fade, then add deeper pressure until you are through 3-4 cycles. The Theracane has online videos you can access to learn how to use the tool effectively. If trigger points continue to return and affect your comfort and performance, it probably indicates the need for a more thorough look to identify the perpetuating factors and address the problem more comprehensively. At Full Potential, we are quite familiar with trigger points and how they relate to ongoing pain. Because trigger points are less objective and not as easy to define as a source of ongoing pain, some specialists do not always know what to tell you after they did surgery and you still hurt. This is a situation where we could help you understand the role of trigger points in your pain and what might be behind their activation. If you are in a chronic pain situation, or have lingering pain after a reasonable amount of time since surgery, consider getting a free consult. Remember it’s free, nothing to lose and much to gain. That is a bargain by any measure of the word. Or if you just want to get rolling, get a referral from your doctor and let’s get this body started back on the road to comfort with activity. Be well, Vince Hanneken, PT
flowing as needed into the tissue and waste products from the muscle cells are not being rinsed out as well. So this creates a more acidic and irritable condition in the muscle and prevents it from performing as needed. This is why increased use can stir up a trigger point which has been latent due to less demand and put back into an active pain referral state. Trigger points by definition typically will refer away from the tender area and this is one diagnostic tool when tested or aggravated. To verify the truth about trigger points, tenderness and referral, try having someone push on the back of your shoulder blade or better yet you do that to them, especially if they have a shoulder pain problem and it is not a fresh injury. Do you feel tight ropy bands of tissue and a nodular texture in the muscle along with tenderness? At times you can twang the tight band like a guitar string with it producing its referred pain. This is a good verification test. WHAT CAN BE DONE TO HELP TRIGGER POINTS? As mentioned earlier, muscles can get overwhelmed by extended work or play activity causing a muscle to over shorten and form trigger points. When an area is mechanically efficient, like in the shoulder, with good control of the shoulder blade and good muscle length and strength (i.e. muscle balance), this can prevent trigger points from forming. Knowing about stretching for a particular muscle group can help immensely, especially in muscles which are vulnerable for trigger point formation (hard working muscles). As well, muscle nutrition can be helped just by drinking enough water, getting proper electrolytes, and taking time to stretch during an activity for those muscles that historically have given you trouble. Here is where education and stretching instruction can be helpful. Last but not least, management can be assisted by self-massage techniques with compression devices such as a Theracane (see our
Healthy Recipe
TOMATO-WATERMELON SALAD WITH TURMERIC OIL
INGREDIENTS • ¼ cup virgin coconut oil • 1 tsp. coarsely crushed peppercorns • 1 tsp. coarsely crushed coriander seeds • ½ tsp. cumin seeds • ½ tsp. ground turmeric
• 4 cups cubed seedless watermelon • 2 medium heirloom tomatoes, cut into ½” pieces • 8 oz. mild French feta, cut
into ½” pieces • Flaky sea salt
DIRECTIONS Heat coconut oil, peppercorns, coriander seeds, cumin seeds, and turmeric in a small saucepan over medium until fragrant, about 3 minutes. Let turmeric oil cool slightly. Arrange watermelon, tomato, and feta on a platter. Drizzle turmeric oil evenly over and sprinkle with salt.
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Practice News!
HOW CAN I KNOW I ’M SAFE IN YOUR CLINIC?
SUFFERING FROM PAIN OR INJURY?
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5. All patients are screened and we do temperature checks as well to reduce exposure risks. 6. Wai t t imes in the lobby have been mostly el iminated and fami ly/ friends are discouraged from accompanying the patient unless necessary. 7. We are in compliance with state and federal recommendations and are regularly reviewing their guidelines to stay current with established practices. 8. When there is a questionable situation, we err on the side of caution with illness and have them cancel.
We understand that there is a lot of fear and uncertainty during this time. Below are the steps we are taking to make sure our patients are as safe as possible while they are being treated at our clinic: 1. After each treatment, the room, treatment table and equipment used are thoroughly disinfected. 2. Hand disinfectant is waiting for you in the lobby and is used pre and post in the gym. 3. Our lobby and front desk is disinfected each 1/2 hour. 4. Our staff is screened and temperature checks done each day for signs of Covid or illness.
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Open Letter
OPEN LETTER TO PATIENTS FROM VINCE HANNEKEN, PT
Our attention on you, the patient, is our top priority from the beginning with the start of care to the time you conclude your PT. The value we put on the relationship that is built over the course of several weeks is one of our most important goals. Whether a patient realizes it or not, having a resource that can help them overcome a painful condition and, in the process, learn how to avoid it in the future is a key asset as the years add up. Full Potential is here for you no matter what decade you are living in. When you start with us, we would hope we have started a relationship to help
things can go wrong like in this issue with trigger points. As well, we offer free screens to help you know what direction to go with a physical problem that is affecting the quality of your life. And, last but not least you can just call us and ask to speak to a PT. Or, speak to the therapist you have worked with in the past, they will get back to you if not available to advise and clarify. This is what I mean by having a resource that is geared to providing the best type of help – the help that gives you more personal control and understanding. Free screens are great opportunities
I would have to assume there are many people out there who are in similar situations. They could use some advice and some help. Do you know of any people in that situation? Maybe consider advising them on the free screen idea. Getting unstuck makes the future feel so much better, the first step is the free screen as many people who have taken advantage of that opportunity have learned. A patient once taught me a key piece of information about having a business. He called them “The Three E’s – Efficiency, Effectiveness, and Economy.” The first is all about making a difference in someone’s life, so being effective; doing it in a timely way, so being efficient. And lastly, that the costs were in line with the value they received, which is being economical. The cost of a service is an interesting element in the customer/business relationship, If the value you received is prorated over the life of the benefit then costs/unit of time will drop. If you apply what you learn in PT and do your program to keep what you gained, costs incurred over a four-week period could be depreciated over potentially years. This is real value and a true measure of the three E’s; the other word for this is relationship, building it one “E” at a time. So, thank you for helping put us on the map with the “Best of the Best” award. Believe me, our appreciation of you is parallel with yours of us.
A Big Thank-You Just prior to the Covid breakout we had a really amazing event occur. Each year we enter the “Best of the Best” contest in Holland. This is where the public votes for their favorite provider of a service. In the physical therapy world, we were voted the best for 2019. There are a number of excellent PT practices in Holland, so to win this award was really meaningful. The real irony here though is, this was the fourth year in a row we have won that award! Look at the Best of the Best stickers on our newsletter for confirmation. There are many places in a business where something does not measure up or can go wrong. Scheduling, billing, being on time, being friendly and welcoming, and that is all ancillary to the most important reason why someone comes to PT, to get the patient feeling better and back to living life. So, to win this four years in a row says so much about our support staff, our PTs and PTAs. There has to be consistency in the service industry to meet people’s expectat ions and wi thin that consistency has to be quality and effectiveness to come out on top. The experience starts over every time a patient walks in the door and Diane, Meg, or Amanda greets them with a smile and usually by name (although its tough with masks).
“Getting voted the best four years in a row says something about our ability to deliver “The Three E’s.” We value building relationships with our patients and we feel, especially in the complexities of life today where solutions to physical problems require a wide-angle lens, we are a key player in sustaining a person’s quality of life as the decades add up.”
you solve your body’s problems conservatively, without unnecessary drugs, injections or surgery. Yes, life happens and we need those inputs at times, but ultimately what most people want with their body is personal control over it. That each day is not a new ache or pain that seems to have no reason for starting and no reason to leave. Control comes in many forms for body problems, our form is to help you become more self-reliant in the orthopedic care of your body. We have all heard that statement, “Knowledge is Power,” but if in that word power is understanding it is a step for better self-management of our bodies. This is why we send out newsletters, so you can continue to learn about your body and how
to learn about your options in how to solve a problem. I have done hundreds of them and what is interesting is noting how people are stuck in a painful or limiting condition and have become resigned to it. They may have had surgery and it helped but there is ongoing pain. This not uncommon, the surgery did not address all the reasons why a patient was in pain, not unusual. A good example from a screen I did recently was a patient who had a lumbar fusion two years ago but continued to have lower back pain. She said, “I just push through the pain and continue to do my life.” I admire her determinism, but she is suffering unnecessarily. There were some simple solutions for her that had not been explored.
To “The 3 E’s” Vince Hanneken, PT Owner
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EXERCISE ESSENTIALS: Try these simple exercises to improve mobility
Upper back fatigue leading to trigger points is a common occurrence with prolonged sitting at a computer. Outside of a good work station set up, doing postural breaks is one way to avoid the negative effects of sitting for long periods. Simply speaking, postural breaks are doing the opposite of your typical position. Since we often slouch when we work doing the exercise below helps counter the slouched posture, Standing and bending backward gently is another great postural break. Set yourself a timer if you get lost in your work, do it regularly, not just when you hurt.
Setup
Tip
Begin in a sitting upright position with your arms resting in a neutral position on your lap.
Slowly arch your trunk backwards and hold, then return to an upright position and repeat. Keep your movements slow and controlled. Do not move through pain.
Always consult your physical therapist or physician before starting exercises you are unsure of doing.
Patient Success Story!
“ I no longer have discomfort in my legs, hips, and buttocks.” “The most positive change since starting PT is I no longer have discomfort in my legs, hips, and buttocks. The clinic strengths are that everyone is always kind, sympathetic, and careful teaching the new exercises!” —Gloria P.
“I can sleep at night now!” “The most positive change since starting PT is that I can sleep at night now! I can lift my arm with no pain. Everyone at Full Potential was super friendly and helpful. I loved the knowledge Vince shared with me!” —Holly G.
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