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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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One of the earliest inspirations that prompted me to go into medicine was a book called The Science of Homeopathy by George Vithoulkas. Of all the many modalities of mainstream and alternative medicine, few are as widely used – or criticized – as homeopathy.
Most other medical systems are heteropathic or allopathic in their approach. Hetero means other or different, allo means opposite, and pathy means suffering or disease. So, both terms mean producing a condition that is incompatible with or antagonistic to the disease process. Today many people use the term “allopathic” in a negative sense to describe mainstream medicine, but if you take an anti-inflammatory herb such as turmeric for inflammation, or an antibacterial such as garlic for an infection, this is allopathic medicine.
Homeopathy is based on the idea that if a particular substance produces a certain reaction (e.g., ipecacuanha causes nausea and vomiting), minuscule quantities of that substance can treat that condition (e.g., homeopathic ipecacuanha alleviates nausea and vomiting). Homeo means like, so homeopathy means “like the disease” and it’s based on the principle that “like treats like.” Some other examples are the use of homeopathic coffee (Coffea cruda) to treat insomnia and agitation, homeopathic onion (Allium cepa) for red and watery eyes and nose, and homeopathic bee venom (Apis) for stings, swellings, and inflammation.
For what it’s worth, not all remedies work this way. In many cases, homeopathic preparations do the same thing the original substance does. The remedy Chamomilla, for instance, is homeopathic chamomile, and like the herb, it is used for digestive and emotional upset. Sometimes homeopathic versions are safer, gentler, more potent, or have a broader range of application. In the case of Chamomilla, it’s also used for teething, ear pain, and menstrual discomfort.
Homeopathic remedies are created through numerous successive dilutions of herbs, minerals, animal parts and occasionally other substances. When the original substance is diluted in ten parts of a solvent (water or alcohol), this is called an X dilution (X being the Roman numeral for ten). When the substance is diluted in one hundred parts of a solvent, this is a C dilution (C being the Roman numeral for hundred). Each time a dilution is made it is shaken in a specific way to transfer the substance to the solvent, and each successive dilution, though chemically weaker, is considered energetically more potent. I made this chart to explain the process:
Many homeopathic remedies are made from highly toxic substances, like arsenic or deadly nightshade. In these cases, the original substance is so highly diluted that the amount of toxin in a resulting pill or tincture is infinitesimal. Often, it’s unlikely that there is even a single molecule of the original substance in the resulting medicine. This is precisely why opponents of homeopathy argue that it’s worthless and call it pseudoscience.
As a scientist, I completely understand this stance, but in my opinion, what occurs in the preparation of a homeopathic remedy is something we don’t yet have the science to explain. I believe the substance leaves some kind of energetic imprint on the solvent it is diluted in. We know from Masaru Emoto’s research on water that various substances and even human intention are capable of leaving a lasting mark on water molecules that’s evidenced in the different forms of ice crystals it forms when frozen. I believe a similar process occurs through diluting and shaking a substance in water, even when the substance is eventually removed.
I must admit, my own experience with homeopathy has been hit-or-miss. I’ve taken numerous remedies that did nothing perceptible. As to whether I chose the wrong remedy or it wasn’t medicinally effective, I’ll never know. But I have also had cases in which homeopathics were remarkably effective.
This has been especially true with babies and animals, and these are cases we could assume are relatively free from the influence of the placebo effect since the recipients are presumably unaware that they’re getting medicine. In particular, I have repeatedly had the experience of giving homeopathic teething tablets to babies that were inconsolable, and within minutes they were peaceful and sleepy. As a parent, I don’t care what the mechanism is as long as it’s safe and it works.
The safety factor is significant, particularly for children, pregnant women, and elderly or frail people. Not only are homeopathics virtually free of side effects, they also tend to have zero “load” on the system. That is, they don’t make you feel like you’re on a drug. Sometimes this may come at the expense of strength (e.g., homeopathic Chamomilla doesn’t approach the potency of Xanax), but there are cases when the top priority is a clean experience. I find this to be especially true in anxiety, when making someone feel drugged can occasionally intensify the anxiety.
Have you tried homeopathy? What did you think? Share with us in the comments section. I would love to hear about your experience.
Be well,
Dr. Peter Borten
[post_title] => Homeopathy: What Is It and Does It Work?
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As a young adult living in Western Massachusetts, I had a handful of friends who attended Hampshire College. Hampshire is well known for being highly unconventional. There are no majors, no departments, and no grades. So much of the program is up to the student, including a final yearlong project. I could see why it was appealing, especially to people who didn’t seem to fit into typical academic institutions.
When I first heard these friends talk of the wonderfully freeform nature of their college experience, I was envious. In later years, as they found it increasingly challenging to keep themselves on course, I remember saying, “That kind of program wouldn’t work for me.” I realized, with no shame at all, that I needed way (way) more hand-holding. Only one of my Hampshire friends graduated. I guess they needed more hand-holding too.
There are a number of reasons we avoid getting help or taking direction:
- We’re too proud to admit we need help.
- We’re afraid of opening up, being vulnerable, or appearing weak.
- We think nobody is capable of helping us.
- We don’t want to be controlled or guided in a way we don’t like.
- We don’t want to be told what to do.
- We don’t want to be a burden.
- We don’t want to share the credit.
- We feel it’s less of an accomplishment if we get help.
- We believe we need to do things all by ourselves.
This last one is a common inherited belief, though nearly every impressive historical figure had a team of supporters. Yes, there’s a grain of truth to it: each of us is responsible for ourselves, our choices and actions. Each of us is responsible for how we show up in the world. Nobody can do the internal work for us. But it’s perfectly okay to get tons of help along the way. It doesn’t diminish the outcome. In fact, we connect and improve through the process when we let others in. This is true even when it comes to healing and spirituality. It’s time to let go of the “Lone Ranger complex.”
Guidance and mutual support are an important part of why our program, Sacred Expansion, has been so successful. We created Sacred Expansion as a prerequisite for our life coaching trainees, as we feel it’s important to “clean house” before guiding others. It was designed to help people get to know themselves more deeply, release old unhealthy patterns, and open to a state of greater intuition and trust – all within a group of others on the same journey.
It turned out to be so monumental for our early participants that we decided to make Sacred Expansion available as a stand-alone course. Enrollment is happening NOW! You’ll be lovingly led by my wife, Briana, through an exploration of yourself through the metaphors of the seasons. And you’ll come out of it with greater clarity and self-awareness, less baggage, a deeper connection to Spirit, and the tools to continue the process on your own. I encourage you to do it!
Also, I recommend you look back at that list of reasons we avoid getting help and see if there are any that ring a bell for you. If so, consider the following questions. Is this belief true? (E.g., Is it true that nobody could help me? Is it true that if I asked for help, it would compromise me in some critical way? Is it true that it’s less of an accomplishment if I get help?) And then meditate on what life might be like if you felt completely at ease and unembarrassed about asking for help and graciously receiving it?
Be well,
Peter
P.S. Early Bird pricing for Sacred Expansion is currently in progress. Sign up today and save $200! On August 17th, the price goes up, so if you want to join us, don't miss this opportunity!
Click here to enroll today!
[post_title] => Why Don't We Get The Help We Need?
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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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