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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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I had been hearing about an impressive tai chi teacher named Gregory Fong since moving to Portland in 1997. It was about five years later that I convinced Briana to join me one evening and we drove to Chinatown to check out his class. Sifu (“master”) Fong, as everyone called him, was probably not more than about five feet tall, but there was something intimidating about him. He welcomed us warmly, then said, “I have two questions for you. First, do you like pain?”
Do I like pain? What is the appropriate answer here? I mumbled something like, “Maybe if there is a good reason.”
He smiled. “Question two. Do you like to work hard?”
Oh boy. I thought about asking him to define the word “like,” but instead responded with, “I guess?”
He chuckled. “Alright, you don’t know if you like pain or hard work. Just sit down on that chair then.” He pointed to a wooden folding chair against a wall covered with framed portraits of Chinese men. “Rest your hands on your thighs. Don’t lean back. Lift your feet off the floor just high enough for one sheet of paper to fit under them. See you later.” And he walked away for a long time. You can try that right now if you’re sitting.
Years later, having done a lot of hard work and endured much pain in his classes, I reflected that I did in fact like to work hard. I still didn’t like pain, but I had learned the difference between avoiding it versus using it and finding a way through it. And I decided that those two questions are useful preliminaries before almost any endeavor.
They came to mind as I was thinking about the upcoming launch of our Sacred Expansion course. It’s a required program for all of our life coaches, and worthwhile for anyone interested in growing beyond their self-imposed limitations and releasing blocks to having an exceptional life.
In the context of Sacred Expansion, if I were to ask, “Do you like pain?” what I mean is, are you willing to voluntarily experience discomfort as part of discovering what’s holding you back? Are you willing to experience the tension of psycho-spiritual growing pains? Are you willing to be uncomfortable in the short term in order to release the long term discomfort you’ve gotten used to? Are you willing to use your pain to initiate a breakthrough?
As for the question “Do you like to work hard?” what I mean is, are you willing to stick with the work of unraveling your inner knots even when it’s difficult? Are you willing to choose a higher purpose – for instance: freedom, peace, spiritual connection, joy, service to your species and planet – over and over and over? Are you willing to break some habits? Are you willing to challenge your own thoughts? Are you willing to explore parts of yourself you aren’t comfortable with? All of these tasks represent a certain form of work.
By liking hard work, I don’t mean that you get points for having a hard life or that there’s merit in making things unnecessarily difficult. In fact, a core principle Sifu taught was that hard work and peace aren’t mutually exclusive. We can be at ease while simultaneously working our hardest. Regardless of the form that our work takes, there’s no getting around the importance of consistent effort in the direction of our dreams if we want them to come to fruition.
If you’ve even thought, “I know I have greater potential than this” or, “I feel like I’m missing out on my superpowers” or, “If I could release all this baggage, I could finally feel free!” read more about Sacred Expansion. We’d love to have you join us.
Be well,
Peter
[post_title] => My Favorite Kind of Pain
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An old tai ji quan (tai chi) teacher of mine used to say, "Yi dao ... qi dao ... li dao," which roughly means the focus of your mind (yi dao) dictates the way your energy moves (qi dao) which dictates the expression of your power. (This utterance came mostly when he noticed that I was looking distracted.) In other words, the ability to effectively direct your power is founded in the ability to effectively focus your mind.
Mental focus, known as yi, is one of the five aspects of consciousness defined in Traditional Chinese Medicine (TCM). Each of the five is considered to be associated with a particular part of the body, and the yi corresponds with the digestive system. In a way digestion is a kind of inner focus. When food enters the body, the digestive tract focuses its attention on it – breaking it down to its elemental parts, extracting what’s useful, and absorbing it. It makes sense that we use the word “digest” to speak about processing and assimilating a new or challenging idea or experience.
Disruption of the digestive system frequently goes hand in hand with poor mental focus. The most common example is Attention Deficit (Hyperactivity) Disorder in people who have a poor diet and/or erratic food intake and/or food sensitivities and/or gut imbalances.
There are two main patterns of digestive imbalance as it relates to mental function. The first is poor assimilation of the vital nutrients in our food, leading to a state of deficiency and a “malnourished mind.” The second is the development of phlegm, which makes us cloudy-headed and may further impede the assimilation of nutrients. The Chinese medical use of the word "phlegm" here denotes a much broader concept than simple mucus. Phlegm is anything that impedes our flow or accumulates in us but serves no functional purpose, such as plaques, cysts, excess body fat, or any other similarly tenacious “gunk” in our system. It may be tangible or intangible, and it doesn't go away easily.
Phlegm can form as a byproduct of impaired digestion. Sometimes it develops when we’re exposed to foods that irritate the body – similar to how an oyster secretes pearl material when it’s irritated by a grain of sand. Other times it develops because something else disturbs the digestive process (such as trying to digest too much mental material while trying to digest food, or eating while the eating, nervous system is activated by stress), leading to incomplete assimilation of nutrients and excretion of waste.
TCM’s notion of a digestive origin for mental disturbances is shared by Ayurveda, the traditional medical system of India, which goes so far as to say that all health problems originate in the gut. Recently these millennia-old concepts have been corroborated through our emerging understanding of the gut-brain axis – the complex interplay between the gastrointestinal tract, its microbial population, and the central nervous system.
Let’s look at some ways we can improve digestion for better mental health.
- Choose nutrient-dense foods. Support high-quality thinking with high-quality nourishment: fresh vegetables, nuts and seeds, clean proteins (free range omega-3 eggs, organic grass-fed dairy products, sustainably grown oily fish, small amounts of pasture raised meat), whole fruits, and a little whole grain. Limit your intake of fried foods, sweetened foods, and flour.
- Avoid foods you’re sensitive to. One of the most common symptoms of eating a food that’s incompatible with your system is lower energy and less-sharp thinking. Keep a food journal and track of any foods you don’t thrive on. If it’s hard to determine, consider doing an elimination diet or elemental diet (powdered, hypoallergenic meal replacement) to clean out and then systematically reintroduce foods.
- Eat in a slow, relaxed, conscious way. Unlike filling up your gas tank, which you want to be as fast as possible, eating isn’t merely a “fill up” – it’s also a way to tune in, to savor, to be grateful, and to consciously nourish your mind-body. There can be a vast qualitative difference between a rushed meal you barely pay attention to versus one you enjoy to the fullest. Get media out of the eating space. Set your stresses aside. Stay connected to the act of eating.
- Stop eating before you’re full. Stop eating before you’re full. Stop eating before you’re full.
- Try bitters. Bitter digestive-stimulating herbs have the dual effect of toning the digestive tract and clearing toxins and phlegm. Bitters as cocktail mixers are experiencing a surge of popularity, so there are more blends available than ever. I recommend a mixture of pure bitters such as gentian, rhubarb root, myrrh, Peruvian bark, goldenseal, yellow dock, barberry, or Oregon grape root with some aromatic carminative spices (promoting assimilation), such as citrus peel, anise, fennel, caraway, cardamom, or ginger. Take a squirt before and/or after each meal in a little water.
- Move a little after meals. A walk is perfect. This helps promote assimilation.
- If you need extra support, consider a good digestive enzyme blend. These supplement what your pancreas produces (and won’t cause your body to produce less) and help in the breakdown of food for better absorption. There are many good products out there. Two of my favorites are DigestZymes made by Designs for Health and Digest made by Transformation Enzymes. Take some at the beginning of each meal. Sometimes they make a remarkable difference.
Interestingly, the connection between digestion and mental function works both ways. Not only can impaired digestion contribute to diminished cognitive function, mental and emotional disturbances can also contribute to poor digestion. Worry, in particular, is considered taxing to the digestive mechanisms in TCM because it habitually engages the digestive mechanisms as you “chew” on problems. If you can make mealtimes a ritual in which you always take a break from thinking about stressful things, you’ll not only enjoy your food more, you’ll also derive greater benefit from it.
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
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