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For the holidays we gave our eight-year-old daughter a set of indoor monkey bars. That meant I spent a day with my arms above my head, screwing eye bolts into her bedroom ceiling. She can now get from the doorway to her bed without setting foot on the floor, which is useful because she tells me it’s made out of molten lava.
At bedtime I reached out to turn on a faucet and suddenly my mid-back locked up. It was incredibly painful and I felt unable to move without worsening it. I made the mistake of bending down to touch my toes, thinking it would help, but was then frozen in that position.
I’ve treated this same condition in countless patients. Often this type of back spasm is crippling for at least a few days – meaning missed work or travel – followed by a lingering stiffness and pain for a week or more. Frequently the locked area, even as it begins to release, is prone to getting retriggered if we move or sleep the wrong way.
Luckily, I knew what to do. I started locating and massaging effective acupuncture points on my hands and arms that began to release the locked up muscles. Meanwhile, I used certain visualizations and breathing techniques that facilitated the loosening of my back. Eventually I could move enough to lie on a small ball to put pressure on the muscle spasm while continuing with the breathing, visualization, and self-acupressure. I went to bed about an hour later than I intended, but with my back feeling 80% better. The next day I released the rest of the tension.
Several times throughout the process I thought, “This would be so much worse if I didn’t know how to do this.” I would have to find a practitioner and wait for an appointment. But what kind of practitioner, and which one? What if they weren’t available during the holidays? Would I have to be immobile during our holiday party? Would I be reliant on pharmaceutical painkillers? Would I be in a daze? Would I find it hard to get off them?
This conundrum is why I created an online course called Live Pain Free. It started with the advice I found myself giving hundreds of pain patients in my office over the years – and the realization that I didn’t have time to explain everything I wanted to teach them. Little by little, the course grew to include virtually all of the techniques and lifestyle modifications I have found useful for self-treatment of pain. It’s more comprehensive than anything else I’ve found.
Are there other things like it? Yes, of course. There are plenty of books and courses that teach pain relief techniques, some of them very useful. But most feature a single approach to pain, and I’ve never found a single method that works for all – or even most – pain. Even for a given individual, some things work one day and not the next. This is because there are many “ingredients” in pain, especially long-term pain – our history, psychology, lifestyle, body mechanics, etc. – so we need a blend of multiple approaches.
During the years I spent crafting this course, I discovered that beyond helping people to make their pain go away, much of what I wish to share deals with releasing ways of thinking that are restrictive and keep us trapped in discomfort. Although pain management is the issue that often leads people to look deeper, the ultimate resolution may be something so much more than mere physical relief: liberation from our resistance to life, the opportunity to accept and live in the present moment, the recognition of patterns that have held us back, and more.
The feeling of gratitude I had the other night – I want that for everyone. If you deal with frequent pain, if you would like to help a loved one with their pain, or you just like the idea of being prepared and knowing a wide range of strategies – some based in modern science others in Eastern medicine – check out Live Pain Free.
Be well,
Dr. Peter Borten
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When a patient comes in to see me, I get a brief opportunity to facilitate a shift toward the positive. I might overhaul their diet, give them exercises, insert acupuncture needles, or prescribe some medicine. It’s clear that these interventions help. But when I look back at the treatments that were major turning points for people, about half the time what made the difference was something I said.
Most of what I say is pretty simple stuff. The more simple, the bigger the potential impact. All the essential truths of the great spiritual traditions are simple. But they’re underappreciated and easily forgotten. There’s so much other stuff vying for priority real estate in our minds. And in a time when we put so much value on complexity – science, for instance – simple concepts don’t get taken seriously. Someone once said, The truth is simple. If it were complicated, everyone would get it.
The nice part about profound truths being simple is that you don’t have to work so hard. Stop trying to have all the answers; just listen and remember what you already know. The simple truth I want to share with you today is one you are undoubtedly familiar with: positive thinking makes good things happen. If someone said to you, “I have the solution to most of your problems: think positive,” you might say, “I have the solution to why nobody likes you: unsolicited, crappy advice.” But I urge you to reconsider.
If you consistently had positive thoughts about your life, do you know what would happen? You would feel consistently positive about your life. And that pretty much constitutes a good life, doesn’t it? Regardless of whether or not your life is exactly the way you want it to be, if you cultivate positive thoughts, your consciousness – your experience of life – will be more positive. Isn’t that what really matters? Your perspective is more important than your circumstances. Wouldn’t you rather be poor and happy than rich and miserable? If you’re happy, you’re happy.
But it’s not just a mind trick where you fool yourself into being thrilled by a pathetic life. As you make a habit of forging positive thoughts, you become a more positive person, and then the objective circumstances of your life change. Have you ever met someone who was really successful and also super positive? Which do you think came first? I would venture to guess it was the positive part.
The tricky aspect – or so it seems to a mind that loves complication– is actually remembering to think positively. Many people feel it’s not their innate nature to be positive, or that life circumstances have made it difficult to be an optimist. But they have just made a habit of focusing on and emphasizing negative viewpoints. It’s true that the glass is both half empty and half full. Both perspectives are valid, but they are not equally meaningful observations. The optimist focuses on what is and the pessimist on what isn’t.
Like the song goes, accentuate the positive. Here’s how:
- Look and listen for good signs, positive news, beauty, and fascinating things, and then latch onto them, talk about them, share them, savor them, amplify them, run with them. Imagine you just tapped into a vein of gold in the earth, and now you want to follow that vein. Jump from one good thing to the next. Make a game out of it.
- Create more positivity in the world. This is especially important if you find it hard to arouse your own optimism. Instigate positivity in people around you, even if you feel dark inside. Create the vein of gold that you can then follow, by asking people about their lives, their kids, their dreams. You will ignite a light in someone else that will lead you in the right direction. Then keep doing it. Deliver genuine compliments. Help others to see the positive side of whatever they’re grappling with. It’s often easier to do for others than for yourself.
- Get out of the dirt. Following the gold vein is as much a matter of not choosing to veer into the dirt as it is a choice to follow the gold. Catch yourself choosing to indulge in negativity and be disciplined about shifting your attention to something else. It’s like breaking an addiction. Notice which of your acquaintances have a “this sucks” mentality and (a) hang out with them less (b) laugh internally at everything negative they say – lightly, not disparagingly (c) don’t let them throw you off your gold vein. Also, stop watching Breaking Bad. Choose your media consumption consciously.
- Tweet/post/comment responsibly. The stories and opinions you choose to share shape who you are in the world – plus who and what you attract. Are you a positive influence on your environment or a negative one? Before you click “Post,” look at what you’ve written. If it’s snarky or amounts to “Doesn’t this suck?” just delete it. You won’t feel any regret.
- Respond with humor to situations that would otherwise make you angry, irritated, or anxious. I know it’s hard, but if your habit is to relinquish the whole gold vein just because of some stupid situation, you simply cannot engage with it in an adversarial way. Be imperturbable. Go on a drama fast. Stay committed to your positivity.
- Lose the belief that finding problems and errors makes you smart or likeable. People who enjoy finding what’s wrong with everything rarely care as much about looking for solutions.
- Know what you want. Most of us spend so much time thinking about our current problems and the undesired future situations we hope to avoid that we have a clearer sense of what we don’t want than what we do want. Know with laser-like precision what kind of life you want and replace the habit of dwelling on what you don’t want with savoring the anticipation of getting what you do want.
Once you’re in the zone, let’s go have some tea together. Positive people are fun to be around. I wonder what cool thing you’ll do next.
Be well,
Peter
[post_title] => The Truth is Simple. Start Feeling Better.
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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
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For the holidays we gave our eight-year-old daughter a set of indoor monkey bars. That meant I spent a day with my arms above my head, screwing eye bolts into her bedroom ceiling. She can now get from the doorway to her bed without setting foot on the floor, which is useful because she tells me it’s made out of molten lava.
At bedtime I reached out to turn on a faucet and suddenly my mid-back locked up. It was incredibly painful and I felt unable to move without worsening it. I made the mistake of bending down to touch my toes, thinking it would help, but was then frozen in that position.
I’ve treated this same condition in countless patients. Often this type of back spasm is crippling for at least a few days – meaning missed work or travel – followed by a lingering stiffness and pain for a week or more. Frequently the locked area, even as it begins to release, is prone to getting retriggered if we move or sleep the wrong way.
Luckily, I knew what to do. I started locating and massaging effective acupuncture points on my hands and arms that began to release the locked up muscles. Meanwhile, I used certain visualizations and breathing techniques that facilitated the loosening of my back. Eventually I could move enough to lie on a small ball to put pressure on the muscle spasm while continuing with the breathing, visualization, and self-acupressure. I went to bed about an hour later than I intended, but with my back feeling 80% better. The next day I released the rest of the tension.
Several times throughout the process I thought, “This would be so much worse if I didn’t know how to do this.” I would have to find a practitioner and wait for an appointment. But what kind of practitioner, and which one? What if they weren’t available during the holidays? Would I have to be immobile during our holiday party? Would I be reliant on pharmaceutical painkillers? Would I be in a daze? Would I find it hard to get off them?
This conundrum is why I created an online course called Live Pain Free. It started with the advice I found myself giving hundreds of pain patients in my office over the years – and the realization that I didn’t have time to explain everything I wanted to teach them. Little by little, the course grew to include virtually all of the techniques and lifestyle modifications I have found useful for self-treatment of pain. It’s more comprehensive than anything else I’ve found.
Are there other things like it? Yes, of course. There are plenty of books and courses that teach pain relief techniques, some of them very useful. But most feature a single approach to pain, and I’ve never found a single method that works for all – or even most – pain. Even for a given individual, some things work one day and not the next. This is because there are many “ingredients” in pain, especially long-term pain – our history, psychology, lifestyle, body mechanics, etc. – so we need a blend of multiple approaches.
During the years I spent crafting this course, I discovered that beyond helping people to make their pain go away, much of what I wish to share deals with releasing ways of thinking that are restrictive and keep us trapped in discomfort. Although pain management is the issue that often leads people to look deeper, the ultimate resolution may be something so much more than mere physical relief: liberation from our resistance to life, the opportunity to accept and live in the present moment, the recognition of patterns that have held us back, and more.
The feeling of gratitude I had the other night – I want that for everyone. If you deal with frequent pain, if you would like to help a loved one with their pain, or you just like the idea of being prepared and knowing a wide range of strategies – some based in modern science others in Eastern medicine – check out Live Pain Free.
Be well,
Dr. Peter Borten
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(
[0] => init_query_flags
[1] => parse_tax_query
)
)