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It was my birthday party in May and before we all started eating, Briana asked if I wanted to say something to my guests. Unbeknownst to them, I had been feeling a nauseous gurgling in my guts all day, so I was trying to hold it together and was caught a bit off guard. But I looked around at this group of shining faces and said the first words that came to me: “Community is medicine. Thank you for being here.” And that was enough.
Immersion in loving community is deeply fortifying, supportive, and uplifting. Studies show that when a suffering person holds someone’s hand, their suffering is reduced. I think the same is true of metaphorically holding many hands through community engagement. And while it’s therapeutic to be seen and held in our challenges, there’s also value in the way that being oriented to our community gives us a break from self-scrutiny and self-indulgence.
Like eating green vegetables or meditating, sometimes we can forget to prioritize community when we’re busy or immersed in a personal struggle. But as some wise person once said, our community is like our muscles. Besides supporting and empowering us, they need to be engaged regularly in order to stay strong. If you neglect your muscles, they get flabby. If you neglect your community, they probably won’t turn their backs on you, but for numerous reasons they won’t be able to support you as well as they could.
From our book, The Well Life, here are some actions you can take to mindfully build your community:
- Ask people for help – whether it be in your garden, with your taxes, or finding a great preschool. Learn what gifts and wisdom those around you have and give them opportunities to share.
- Be involved. Go to local meetings. Participate. Know your community’s plans for the future – and how you fit into them.
- Know the names of people you see often – the grocery cashier, the gas station attendant, the school principal, the guy who takes the same bus as you every day. Allow them to be real people in your life.
- Make eye contact with the humans you pass on the street. Be the one who says “Hi!” first.
- Protect the green spaces.
- Fix something that’s broken – a neighbor’s fence, your niece’s bike, the librarian’s flat tire.
- Support local businesses – even if it costs a little more.
- Learn about others’ traditions and celebrate together. Look for local festivals to attend, even if they’re for an event you wouldn’t normally observe.
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- Be curious. Attend lectures at the library, senior center, or local university, check out a high school science fair, and – foremost – learn what cool stuff people are up to in your town. What are people building? What are they learning? Who can tell you about the history of this place?
I want everyone to have the experience of being part of a healthy, loving, supportive community. I hope you’ll engage with your community today and be reminded of how nourishing it is.
Be well,
Peter
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A couple weeks ago, I wrote about the differences between acupuncture and “dry needling” to alleviate pain, and in that article I explained a bit about the phenomenon of myofascial trigger points. After I said I believe these are the cause of most of the physical pain humans experience, a number of readers asked me to explain more. For the science lovers out there, I’m going to dive deeper this week.
Besides the most common forms of pain, like lower back and headaches, I’ve had patients with digestive problems, sinus congestion, chest pain, ear ringing, numb hands, painful intercourse, acid reflux, vision changes, and other health issues that were eventually discovered to be due to myofascial trigger points. I believe everyone should know about them and how they work – it could save us a lot of time and worry.
Basically, a trigger point is a small, irritable region in a muscle (or the surrounding connective tissue – “fascia”) that stays stuck in a contracted state, making the muscle fibers taut. This can cause reduced muscle strength and range of motion, pain, numbness, itching, and other forms of dysfunction. Sometimes a trigger point feels like a palpable nodule or “knot,” but to untrained fingers they’re often tricky to find.
A unique property of trigger points is that they’re able to produce symptoms in other parts of the body – from a few inches to a couple feet away. For instance, there’s a trigger point that can form in the soleus muscle of the calf that’s capable of producing pain in the lower back. For this reason, the work of Janet Travell, MD and her colleague David Simons, MD, was groundbreaking. For each muscle in the body, they mapped where trigger points tend to form and what kinds of symptoms they cause.
If you were experiencing pain along the outside of your leg, you might assume that something was wrong with that part of your leg, perhaps with the often-tight iliotibial band (IT band). But this diagram might be helpful. The X’s show where trigger points can occur in a muscle called gluteus minimus above the hip socket. The red shading shows the potential areas of pain that can result. You might not suspect this muscle because, as you can see, there’s no pain at the site of the problem!
There are a handful of mechanisms that can promote trigger point formation, such as irritation of nerves, chronic organ problems, nutritional deficiencies, and autoimmune disorders. Most often, though, the cause is trauma to our connective tissue. When a muscle is strained by being worked too hard, too fast, or beyond its natural range, there is frequently a sort of “recoil” that occurs as segments of the muscle fibers bunch up and remain that way.
This is especially common when someone works out without warming up; when someone does a very ambitious workout after not having exercised for a long time; when someone makes a sudden movement (like reaching out to catch something or trying to stop oneself from falling); and especially when someone does any of the above when in a state of diminished resilience (e.g, when stressed, upset, sleep deprived, eating poorly, etc.).
Even more commonly, the trauma is a form of “postural stress” that’s demanding on muscles in a way that’s difficult to perceive at the time – such as doing the same relatively motionless activity (like sitting at a desk or driving) for hours, days, months, or years. One possible mechanism is known as the “Cinderella hypothesis.” During static muscle exertion – holding a position for a long time, as dentists, musicians, typists, and others engaged in precision handwork do – the body tends to engage a certain group of small muscle fibers, called Cinderella fibers because they’re put to work first and are the last to be disengaged. Even though they’re not doing heavy lifting, these muscle fibers (often in the neck, shoulders, back, and forearms) are continually activated and overworked, which makes them susceptible to trigger point formation.
Whatever the cause, the result is that eventually the muscle never completely relaxes. Muscles are composed of numerous parallel fibers that work together to shorten (contraction of the muscle) and lengthen (the return of the muscle to its relaxed state). Within each of these fibers are many end-to-end contractile units called sarcomeres, and in the case of a trigger point, a group of sarcomeres gets “stuck” in a shortened state. This makes the affected fibers taut and often “stringy” feeling.
To make matters worse, the contracted region clamps down on tiny blood vessels causing local ischemia (inadequate blood supply), reducing in-flow of fresh, oxygenated blood and out-flow of toxins. This leads to a localized hypoxic state (not enough oxygen). The tissue pH changes, local metabolism is impaired, and fluid and waste products tend to build up in the area. This combination of factors ultimately activates pain receptors – it starts to hurt – and when this happens you use the affected muscle less.
Instead, you overload “synergists” – nearby helper muscles. The body makes the surrounding musculature tense as a protective mechanism. Meanwhile, there’s a disruption of the balance between the affected muscles and their “antagonists” – those muscles that lengthen when the primary muscles shorten and vice-versa (for example, the triceps is an antagonist of the biceps). Altogether, this restricts natural movement of the original muscle, which just perpetuates the imbalance. Finally, with longstanding trigger points, the body may deposit gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
The good news is that there are now books, charts, online tools, and practitioners that can help track down likely trigger points that may be implicated in your discomfort. I have such a tool in my online pain relief course, Live Pain Free, and I teach many approaches for deactivating trigger points.
The most basic methods involve simple mechanical disruption of this holding pattern. First, drink some water if you’re not well hydrated. Second, you or a friend can methodically feel around (ideally guided by a trigger point chart) for points that are sore, and ideally that reproduce the very sensation you’ve been experiencing. Third, maintain firm pressure on the epicenter of the point (with a finger, elbow, ball, or other tool) for about half a minute, consciously breathing into the area and intending to let it go, until there’s a palpable release. Then move on to all the other nearby points that are tight and tender and do the same.
This approach is called ischemic compression. By compressing the tissue enough to block blood flow, the body responds with reflex vasodilation, meaning it opens these vessels and flushes the tissue with a dramatic increase of blood. This will usually produce a significant improvement in the pain or dysfunction, though it will typically return sooner or later. These points tend to go from being active trigger points to “latent” trigger points, which have a certain “memory” (not the good kind of muscle memory) and are capable of getting reactivated. For this reason, persistence is important. The best results come from working on a trigger point consistently – usually from one to several short sessions per day (or less frequent if the sessions are intense) – and continuing for a while even after everything seems better.
As I said, this is a most basic approach, and while it’s often effective, sometimes a more nuanced intervention is required. There are many techniques that build on compression. We can replace fixed pressure with slow, deep strokes in the direction of the muscle fiber, as if re-lengthening this segment. We can work the trigger point back and forth across the direction of the muscle fibers. We can combine pressure on the trigger point with engagement of the affected muscle or antagonistic muscles. We can combine manual work on trigger points with topical herbs and/or internal herbs and nutrients that improve circulation and reduce inflammation. We can utilize release points on the same acupuncture meridian as where the trigger point occurs - or complementary points on other parts of the body. And more.
If all of this sounds interesting and relevant to you, I encourage you to do a little research. It might well be the end of a problem you thought had no solution. And if you need more guidance, check out my online course, Live Pain Free, where I go deeper into trigger points and much, much more to help people get out of pain of all kinds.
While I said I believe trigger points are the cause of most of our physical pain, I think it’s worth mentioning there are usually even deeper causes, such as stress and withheld emotions, poor body mechanics, dehydration, and an inflammatory diet. Holistically addressing these issues will lead to a more complete resolution of the condition. Always look at the big picture.
Be well,
Dr. Peter Borten
[post_title] => The Science Behind Our Pain: Inquiring Minds Want to Know
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Recently I wrote about the Fire Element, which governs the summer season, and how as a culture we tend to glorify fire qualities (such as passion, activity, consumption, and drive) while overlooking water qualities (like receptivity, humility, reflection, and stillness). I explained that the natural order is a balance between these two. In parallel with this cultural imbalance, much of the planet is heating up, exhausted of resources, and drying out. Inviting water – and, more broadly, yin – in equal measure to fire is essential for our evolution and survival.
To follow up on this theme I want to clarify that fire isn’t intrinsically pathological. It’s all about how we embody it. In fact, if we tap into our innate fire in a way that’s governed by clarity, balance, and love (rather than fear and short-term pleasure-seeking), it blesses us with its virtues.
Let’s look at some of these virtues. I invite you to imagine each of these qualities in the form of physical fire and then feel into how you embody it as a human virtue.
Expansiveness: Fire’s nature is to expand. Not only does it expand in size as it finds more fuel to consume, but also its light expands into the darkness and its warmth expands into the cold. As the element that rules our heart, it prompts us to expand through acceptance, joy, and love.
Warmth: Warmth is more than a physical property, it’s an expression of our inner fire that engenders comfort, good humor, and connection. Warmth almost always goes along with openness. The ability to kindle genuine warmth in a difficult situation is a gift.
Lightness: With fire, lightness means two things – the quality of being luminous and the quality of being weightless. And it’s so natural that the word has been paired with the heart – lighthearted. (You don’t hear anyone being called light-stomached, do you?) The fact that this virtue can be evoked at any time, no matter how hard life gets, is something we should all remember.
Inclusivity: As the epitome of fire in our world – the Sun – denies its warmth and light to no one, another of fire’s virtues is inclusivity. Open hearts are inclusive hearts. There’s no part of our shadow that fire isn’t willing to illuminate.
Joy: Joy is more than an emotion. It’s an embodiment of truth – that what we are is essentially joyful, and that the Divine Play of life is an act of joyous exploration. The ego can easily shroud this truth; thus, living in joy is a purposeful act of service to ourselves and the world. When we choose joy we are remembering.
Unification: All manner of fuel can be fed into a fire and it’s rendered into one indivisible ash. Likewise, all of the above virtues support fire’s virtue of unification. Expansiveness reminds us that we’re one with everything. Warmth is the magic ingredient in cooking and interpersonal connection that brings different flavors together. Lightness shows us the insignificance of our differences and the undeniability of our kinship. Inclusivity is the invitation to discover our alchemy together and to integrate the fragmented parts of ourselves. And joy is the conductor of this grand reunion.
This week let’s all choose one of these virtues to cultivate. Sit with a fire and seek to understand what this virtue has to do with fire. Invite the fire in front of you to activate the fire inside you. Ask to be an effective channel for this virtue, and intend to embody it with an attitude of play and service. Then share with us in the comments section about how it went.
Love,
Peter
[post_title] => Six Virtues of Fire That Will Change Your Life for the Better
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It was my birthday party in May and before we all started eating, Briana asked if I wanted to say something to my guests. Unbeknownst to them, I had been feeling a nauseous gurgling in my guts all day, so I was trying to hold it together and was caught a bit off guard. But I looked around at this group of shining faces and said the first words that came to me: “Community is medicine. Thank you for being here.” And that was enough.
Immersion in loving community is deeply fortifying, supportive, and uplifting. Studies show that when a suffering person holds someone’s hand, their suffering is reduced. I think the same is true of metaphorically holding many hands through community engagement. And while it’s therapeutic to be seen and held in our challenges, there’s also value in the way that being oriented to our community gives us a break from self-scrutiny and self-indulgence.
Like eating green vegetables or meditating, sometimes we can forget to prioritize community when we’re busy or immersed in a personal struggle. But as some wise person once said, our community is like our muscles. Besides supporting and empowering us, they need to be engaged regularly in order to stay strong. If you neglect your muscles, they get flabby. If you neglect your community, they probably won’t turn their backs on you, but for numerous reasons they won’t be able to support you as well as they could.
From our book, The Well Life, here are some actions you can take to mindfully build your community:
- Ask people for help – whether it be in your garden, with your taxes, or finding a great preschool. Learn what gifts and wisdom those around you have and give them opportunities to share.
- Be involved. Go to local meetings. Participate. Know your community’s plans for the future – and how you fit into them.
- Know the names of people you see often – the grocery cashier, the gas station attendant, the school principal, the guy who takes the same bus as you every day. Allow them to be real people in your life.
- Make eye contact with the humans you pass on the street. Be the one who says “Hi!” first.
- Protect the green spaces.
- Fix something that’s broken – a neighbor’s fence, your niece’s bike, the librarian’s flat tire.
- Support local businesses – even if it costs a little more.
- Learn about others’ traditions and celebrate together. Look for local festivals to attend, even if they’re for an event you wouldn’t normally observe.
- Stick up for someone – a disadvantaged person or population, someone being mistreated or disrespected, or someone who’s unable to stand up for themselves.
- Be curious. Attend lectures at the library, senior center, or local university, check out a high school science fair, and – foremost – learn what cool stuff people are up to in your town. What are people building? What are they learning? Who can tell you about the history of this place?
I want everyone to have the experience of being part of a healthy, loving, supportive community. I hope you’ll engage with your community today and be reminded of how nourishing it is.
Be well,
Peter
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