by Marty Kestin
I have been an Orthopedic Massage therapist for 19 years and have focused solely on rehabilitation and chronic pain. Some of my patients come via ham sandwiches or chef salads. That is I court medical doctors via buying them lunch in exchange for their time to hear me out. At one of these lunches a doctor once asked me, “Do you have a specialty? Hips, knees, back, shoulders?”
She was intrigued by my answer. “I treat from the big toe to the top of the head; if the injury involves skeletal muscle I may be able to help. Most orthopedic injuries and chronic pain share involvement of the nervous system and dysfunctional skeletal muscle.” I then added that the “neuromuscular system” is complex, messy and there is no specialist training in medical school for a “myologist” or “muscle doctor.” She nodded her head in agreement.
This is where you, the Pilates professional come in.
You are poised at the gate of the public’s query and concern for their aches and dysfunctional bodies causing them pain and distress. They walk up to you after class concerned about their shoulder, hip, back or knee pain and wonder if they should see a doctor.
This article will explore how you can better serve your students with an enhanced understanding of myofascial pain and dysfunction and how to better apply soft tissue therapy in your sessions.
This article will NOT address the fascia debate going on right now (“Are we really affecting fascia in a unique way with special fascia focused techniques or are we just affecting muscle? Or Both?”) I will direct you to www.saveyourself.ca. It’s the website of Massage Therapist and medical researcher Paul Ingraham. His site is a repository of articles dedicated to fleshing out topics concerning pain and physical health from a pure science perspective.
The heart of the matter: Muscle has 4 complaints that result in pain
- When its length is not optimal (adaptively shortened or stretch weakened);
- When weak;
- Chemical irritation (think achy body from the flu);
- Myofascial trigger points or (MTP’s)
The Pilates professional can help with weak and tight muscles and also rebalance muscle groups. MTP’s do not respond well to foam rolling. These tiny muscle contractions need exacting stimulation in a specific matter that will be explained later. Your students’ pain, stiffness and range of motion issues may be from MTP’s more than you think or believe.
Overview of Myofascial Pain and Dysfunction
Myo (muscle) and fascia (soft tissue white spider web like stuff) are not separable. They are a functioning whole. Myofascial pain and dysfunction is NOT synonymous with “myofascial release.”
The term “Myofascial pain and dysfunction” is from the two texts, “Myofascial pain and dysfunction, The Trigger Point Manual” (Amazon aff link.) This picture is of the first of two volumes. Two medical doctors in the latter half of last century took the initiative to compile a body of knowledge based on researching the medical literature of functional medicine and compiling thousands of case histories of clinical treatments. Why?
There is no medical specialty that claims “myo.” Muscle is the orphan of medicine. It’s complex and intimately linked to the nervous system. As a pathology causing, pain invoking, joint aching producing organ it seldom gets the attention it deserves in assessment of pain. Furthermore the assessment and treatment of MTP’s is often not in the curriculum for massage and physical therapists.
This is an image of a MTP in the gracilis muscle. See the tiny striations in the muscle in the lower portion of the image and then the darker circle above it? That is a MTP. It’s a sustained contraction of protein filaments called sarcomeres that become weak from prolonged exhaustion, acute overload and endocrine /metabolic diseases such as diabetes. Over time these tiny contractures build up immune system waste products (up to 11!) that agitate nearby pain receptors and the result is pain and sensation.
A “latent” MTP is one whose sustained contraction harbors a minimal number of the immune system waste products thus producing no pain whereas an “active” MTP you are very aware of (ow!) and has up to 11 of these noxious waste products. An MD, Jay Shah, inserted the trapezius muscle with needles that had tiny filament tubes attached to withdraw whatever was in the MTP’s. He found that the taut bands that hurt had greater concentrations of the waste products while the taut bands that did not hurt had minimal levels of waste products. His work and the work of other scientists validated the hypotheses of Dr. Travell.
The term “trigger point” comes from the confusing phenomena that pain, stiffness, numb like sensations and weakness are often referred elsewhere and NOT to the MTP itself. Why? Neuroscientists have a saying, “hat’s wired together fires together.” That is the distant referral zone areas probably shares an uplink and downlink with the spinal cord and brain the same as the MTP.
For example your infraspinatus (an external rotator of the humerus) due to modern living is for most of us stretch weakened. The sensation from MTP’s in this muscle is felt as an ache between the shoulder blade or a pain at the base of the skull or a pain in the front of the shoulder or a weird tingly sensation going down the arm and into the top of the hand.
- MTP’s cause pain.
- MTP’s mimic other pain problems.
- MTP’s complicate other issues.
- MTP’s can negatively affect joint play by altering the length and strength of the muscle.
- MTP’s are not on everybody’s radar in evaluating pain and dysfunction of the body.
Imagine going to your doctor, a PT or MT or chiropractor for the pain described above. A year later you show up at the office of a MTP aware therapist. They do a palpation exam of the shoulder and when palpating precisely a taught taut band of the infraspinatus your eyes bulge, you wince and go “that’s radiating down my arm” or “into my shoulder blade,” or “you recreated my pain!” Two – three 30 minute sessions later the issue is resolved by doing MTP therapy and restoring scapula retraction strength and stretching the subscapularis (the internal rotator that’s adaptively shortened keeping the infraspinatus stretch weakened).
The good thing is the “red books” above have every major muscle MTP referral zone mapped out and there are numerous self-help books with the same “muscle mapping.”
A More Efficient And Productive Way To Address Muscle Pain And Treat MTP’s
Self – Applied Foam Rolling and Trigger Point Therapy
- Slow “steam rolling” of muscle with foam roller with a gradual increase in pressure as tissue softens. This is also your way of finding the smaller contractions or “knots” that may or may not hurt and feel distinctly harder than surrounding tissue. Or just start with smaller tool and find those taut bands.
- Replace roller with small tool or ball: place ball on the knot and micro move over contraction 7-20 times with pain levels of 3-6. Feel the “bump” of going over the taut band.
- Or / and Static hold with deep breathing on taut band. As pain decreases increase pressure.
- Stretch the muscles worked.
- Moist heat to end session (moist heat followed by a stretch is good anytime).
- Correct the perpetuating factors as to why this muscle is dysfunctional.
What is achieved with Trigger Point therapy (steps 2 and 3)?
- It breaks into the chemical and neurological feedback loop that maintains the myofascial contraction.
- It increases circulation that has been restricted by the contracted tissue.
- It directly releases the trigger point’s compressed muscle fibers (taut band).
As a consumer of Yoga, Pilates, personal training and Aikido for years I can honestly say Pilates teachers on the whole understand anatomy and kinesiology better than the other three groups. You will stand out in the crowd even more by applying the knowledge in this article. In January we will also release a video to show your practical ways of applying self-massage techniques to treat trigger points.
Do you have questions? Ask them in the comments below!
Marty Kestin has been a bodyworker and massage therapist for 19 years. He is also a seminar teacher on form and function, orthopedic issues and chronic pain. He lives with his wife in Charlotte, NC. He can be reached at 704.335.8115 or [email protected] He would love to come to your studio and teach teahers and students in a 3 or 5 hour workshop format. He is available for Skype sessions on challenging student and personal pain issues. His blog can be seen at www.ensomabodyworks.com