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[post_content] => A patient last week told me a story I’ve heard many times in many forms. She started experiencing chest pain that radiated down her left arm. She went to the hospital. There was nothing wrong with her that any test could reveal. She wasn’t having panic attacks and her heart was fine. She went from practitioner to practitioner before someone finally figured it out: it was muscular. In other forms of this story the symptom is abdominal pain, or diarrhea, or sinus congestion, or painful intercourse, or ear ringing, or acid reflux, but the common thread is that multiple doctors failed to consider that the origin was structural.
Often, these mystery symptoms – along with most cases of muscle pain – are caused by a phenomenon known as “myofascial trigger points,” and I believe everyone should know what they are and how they work. I’ve written about trigger points in the past, but I feel moved to explain some of the basics again because this concept remains largely unknown to both practitioners and laypeople. It’s not exactly a fringe idea either – it was developed primarily by President Kennedy’s personal doctor, Janet Travell (the first female White House physician, by the way), whom he credited with saving his political career after she cured his back pain. Her first journal article on the subject was published over 60 years ago.
What exactly is a “myofascial trigger point” anyway? 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 and can produce pain, other sensory changes, tightness, and dysfunction. 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. One of the most valuable contributions of Travell’s work was to map out hundreds common locations of trigger points and their referral patterns – i.e., where they produce symptoms.
If you know where to look for trigger points that could be implicated in an issue, it’s usually pretty quick and straightforward to determine if this is the cause. And if so, you can often fix them yourself.
How do trigger points form?
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. More 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 common in people who work out without warming up, or who suddenly do a very ambitious workout after having not exercised for a year. 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.
A muscle contracts through the action of nerve impulses – electrical signals that deliver the command to shorten. These impulses stream into the muscle for as long as we wish to hold this contraction. The impulses aren’t distributed throughout the muscle in an even way, though, and the muscle “belly” (the bulky contractile part) becomes slightly twisted during each contraction.
This isn’t usually a problem if we’re doing repeated isotonic contractions. Isotonic contractions are where the muscle causes movement and it alternately shortens and lengthens, working and relaxing. The issue lies more in prolonged isometric contraction or “static” contraction. That’s where a muscle stays contracted without movement – like the way you hold your arms up for hours while typing or driving. The muscle is under constant pressure and the continuous stream of nerve impulses produces a sustained deformation of the muscle belly.
I need a little more science to explain what happens next, so get ready. Over time, the ongoing tension and twisting of the muscle fibers causes an elevation in the resting muscle tone – that is, eventually, the muscle never completely relaxes. It’s always a bit contracted, meaning a bit shortened, and therefore a bit taut. This tightness causes local vasoconstriction – the blood vessels are constricted – and this translates to local ischemia – inadequate blood supply to the tissue (the same thing that happens to heart muscle in a heart attack). The arteries can’t bring in enough fresh blood and oxygen, the veins and lymphatic vessels can’t adequately drain waste and deoxygenated blood. The tissue pH changes, local metabolism is impaired, and fluid and waste products 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.
Over time, this situation results in the development of trigger points. A muscle is composed of numerous parallel fibers and each fiber consists of many end-to-end contractile segments called sarcomeres. When they’re working correctly, they all shorten together when you contract the muscle and then return to their resting length when you relax. But trigger points involve a collection of sarcomeres that remain in a shortened, irritable state, which makes them bulge (often causing a palpable “knot”) and causing their muscle fibers to feel taut and stringy. Finally, with longstanding trigger points, the body deposits gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
Ok, enough with the big words.
The point is, there are tons of resources in print and online to help you locate trigger points and show you the kinds of problems they can cause. As for getting rid of them, the most basic method is to simply press and hold an active trigger point when you find one. After about 30 seconds, you’ll usually feel it soften. You can also press down the trigger point (with a thumb, fingers, or a tool) and then move the tissue, as if deliberately intending to re-lengthen this shortened part of the muscle.
Acupuncture is really excellent at releasing trigger points. Dr. Travell injected various agents into trigger points to cause them to deactivate, but later in her career, she began to realize that the most effective part of this process was simply jabbing the trigger point with the end of a needle. There wasn’t a need to inject any liquid; thus, this method became known as “dry needling.” She worked with an osteopath acupuncturist named Dr. Mark Seem who developed an acupuncture-based methodology for releasing trigger points in a holistic way – that is, while supporting the body as a whole to restore balance. (If you’re interested in trying dry needling, I strongly recommend you receive it from an acupuncturist rather than a physical therapist, since acupuncturists have an exponentially greater amount of needle training and a more sophisticated understanding of how to treat the big picture.)
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.
Be well,
Dr. Peter Borten
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What do you know about hormesis? It’s the phenomenon that (kind of) explains the expression “what doesn’t kill me makes me stronger.” Technically, hormesis refers to biological processes in which a certain amount of exposure to a stress or toxin stimulates a favorable response, even when other amounts are deadly. For instance, while a high dose of radiation is often fatal, small doses have in some cases been shown to stimulate a positive adaptation leading to lower than average rates of cancer. A hormetic response to certain adverse influences sometimes leads to an evolution.
Last week I wrote about suffering and our complicated relationship with it. Perhaps we could see it as a hormetic relationship. In low to moderate doses, suffering is purely degrading. We tolerate it but it erodes our presence, our performance, and our patience. In extreme doses it kills us. But sometimes there’s a sweet spot in between where it’s bad enough that it can’t be tolerated in the usual way, something cracks open, and a breakthrough occurs.
One of the key ingredients in a favorable response to suffering is consciousness. I could never say it as well as Eckhart Tolle, so here’s a quote (slightly abridged) from his book, A New Earth:
Humanity is destined to go beyond suffering, but not in the way the ego thinks. One of the ego’s many erroneous assumptions is “I should not have to suffer.” That thought itself lies at the root of suffering. Suffering has a noble purpose: the evolution of consciousness and the burning up of the ego. As long as you resist suffering, it is a slow process. When you accept suffering, however, there is an acceleration of that process which is brought about by the fact that you suffer consciously. In the midst of conscious suffering, there is already the transmutation. The fire of suffering becomes the light of consciousness. The truth is that you need to say yes to suffering before you can transcend it.
Suffering isn’t intrinsically useful or noble. When we suffer “unconsciously” – resisting it and turning away from it – it just becomes part of the tragic degradation of life that Buddhism speaks to when it says the nature of the world is to suffer (dukkha). Bringing consciousness, acceptance, and curiosity to it makes it something entirely different.
In her book, Loving What Is, Byron Katie shares an exchange she had with a client who is incessantly angry at big corporations that pollute the planet. On examining the client’s psychology, we see that she is conducting a campaign of violence against these corporations and their faceless leaders in her mind. Katie asks the client if this suffering is necessary in order to feel that she’s doing something about the situation. Through some digging they get down to a troublesome belief at the heart of it: If I don’t suffer, I won’t care.
This is a big one for many of us. Is it true? If we didn’t suffer would we be complacent? Is it suffering that makes us care to be productive or helpful?
This is a question that can only be answered for oneself.
I believe we have a natural, transpersonal inclination toward serving, loving, and awakening. It doesn’t need to be prompted by suffering. But as we see, it’s common for humans to stifle or undermine this inclination. And so, suffering, it turns out, may sometimes be what gets us to recognize it and prioritize it.
When you meet suffering consciously, you may find that it dissolves. You may find that it’s been perpetuated by untrue beliefs, like “I should suffer for my sins,” or “I don’t deserve to be happy.” You may find that the suffering is generated by a part of you that’s just trying to get you to feel. You may find that it’s trying to draw your attention to something, to show you there’s a better, freer way to operate. You may find that the suffering is coming from the last part of you that’s afraid to embody your power, and that with trust it disappears. You may find that the suffering is the feeling that arises from being afraid of suffering. You may find that the suffering is actually an invitation to pass through a gate to a new way of being.
The only way to know is to visit with it. There's nothing in any book, no teaching from any guru that lets you bypass the need to directly encounter what's stirring in YOU.
I always love to hear what you think of these “deep” ideas, and hope that we can make such depth part of our everyday conversations and experiences.
Be well,
Peter
[post_title] => The Gift Inside Our Pain
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A few decades ago, we knew very little about the chemistry of cannabis. Most of what I encountered in college was low quality, compressed, greenish-grey material with lots of stems and seeds – commonly known as “Mexican brick weed.” It was likely to make you feel passive, immobile, and hungry – a much more benign combination than the various effects you might experience from too much beer or Mad Dog 20/20.
Of the many compounds in the plant, we only heard much about two back then – THC and CBD. At the time, our elementary knowledge could be summed up in a few words: THC is the mood-altering component (what gets you “high”) and CBD is the part that makes you relaxed. We didn’t want to be relaxed, though, so we interpreted this to mean that “good marijuana is high in THC and low in CBD” and bad marijuana is the other way around.
In the years that followed, Mexican brick weed became increasingly scarce as the American cannabis industry bred more potent plants that contained an ever-higher percentage of THC. But for many of us who had dabbled in it in our early 20’s, an intensely altered state was no longer something we desired.
As legal restrictions loosened up, specialists in botanical medicine were eventually able to gain a better understanding of cannabis chemistry (we still have a ways to go) and breeders began to develop strains that produced a more specific effect – calming, stimulating, and so on.
Furthermore, although the market for Mexican brick weed seemed to be long gone, it turned out that there was a high demand, especially among older consumers, for a product with its effects – essentially a breed with a high level of CBD and a very low quantity of THC. Something a connoisseur would have once called low quality cannabis is now sought after. And an increasing number of my patients tell me they use this - or simply CBD alone - not to “get high” but to de-stress, decrease pain, sleep better, manage neurological disorders, and more.
A patient with very stubborn idiopathic nerve pain (meaning, the cause was unknown) came in one day reporting that the pain had been remarkably better since our last visit. “I hate to break it to you, Doc,” he said with a smirk on his face, “but it wasn’t the acupuncture.” He went on to tell me that he had been using a topical CBD lotion, and that it was more effective than anything else he had tried.
Another patient, who had for years experienced an anxious tightness in her chest in social situations, told me that a small amount of oral CBD resolved it without causing any other perceptible effect. She said, “I don’t feel different in any other way. I do my work, I can think clearly. I just don’t have that anxious feeling.”
And several patients who were tired of using pharmaceuticals to treat their insomnia have told me of their success with a variety of CBD products. They generally find them just as effective as sleeping pills, but with the advantage of being natural. Also, unlike the prescription drugs, they don’t worry that the CBD could put them into such a deep slumber that they might not hear a smoke detector or other emergency.
Now, if there’s one thing that rubs me the wrong way, it’s a “cure-all” – and that’s because there aren’t any! There’s no substance out there that’s good for everything or everyone, and I’d be remiss as a healthcare practitioner if I implied otherwise. CBD isn’t going to fix your life, and some people don’t experience any noticeable benefit from it. But I can say that, for many, it’s a useful natural helper with an excellent safety profile. And I’m eager to see what more we learn about this and other remarkable plants.
Be well,
Dr. Peter Borten
P.S. Just as we were publishing this article, I discovered a new study in the journal Nature on the use of CBD in the treatment of pancreatic cancer. Pancreatic cancer has a dismal 5-year survival rate of just 5%. But in this study, mice with pancreatic cancer who were given CBD plus chemotherapy survived THREE TIMES longer than those who were treated with only chemotherapy. While we don't yet know how this will translate to treatments for humans, it's one more way in which this astounding plant is a promising tool for healing.
Click Here to Learn More About Dragontree CBD Infused Body Care Products And Get Free Shipping On Your Next Order
[post_title] => CBD vs. THC: A Tale of Two Cannabinoids
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[post_content] => A patient last week told me a story I’ve heard many times in many forms. She started experiencing chest pain that radiated down her left arm. She went to the hospital. There was nothing wrong with her that any test could reveal. She wasn’t having panic attacks and her heart was fine. She went from practitioner to practitioner before someone finally figured it out: it was muscular. In other forms of this story the symptom is abdominal pain, or diarrhea, or sinus congestion, or painful intercourse, or ear ringing, or acid reflux, but the common thread is that multiple doctors failed to consider that the origin was structural.
Often, these mystery symptoms – along with most cases of muscle pain – are caused by a phenomenon known as “myofascial trigger points,” and I believe everyone should know what they are and how they work. I’ve written about trigger points in the past, but I feel moved to explain some of the basics again because this concept remains largely unknown to both practitioners and laypeople. It’s not exactly a fringe idea either – it was developed primarily by President Kennedy’s personal doctor, Janet Travell (the first female White House physician, by the way), whom he credited with saving his political career after she cured his back pain. Her first journal article on the subject was published over 60 years ago.
What exactly is a “myofascial trigger point” anyway? 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 and can produce pain, other sensory changes, tightness, and dysfunction. 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. One of the most valuable contributions of Travell’s work was to map out hundreds common locations of trigger points and their referral patterns – i.e., where they produce symptoms.
If you know where to look for trigger points that could be implicated in an issue, it’s usually pretty quick and straightforward to determine if this is the cause. And if so, you can often fix them yourself.
How do trigger points form?
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. More 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 common in people who work out without warming up, or who suddenly do a very ambitious workout after having not exercised for a year. 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.
A muscle contracts through the action of nerve impulses – electrical signals that deliver the command to shorten. These impulses stream into the muscle for as long as we wish to hold this contraction. The impulses aren’t distributed throughout the muscle in an even way, though, and the muscle “belly” (the bulky contractile part) becomes slightly twisted during each contraction.
This isn’t usually a problem if we’re doing repeated isotonic contractions. Isotonic contractions are where the muscle causes movement and it alternately shortens and lengthens, working and relaxing. The issue lies more in prolonged isometric contraction or “static” contraction. That’s where a muscle stays contracted without movement – like the way you hold your arms up for hours while typing or driving. The muscle is under constant pressure and the continuous stream of nerve impulses produces a sustained deformation of the muscle belly.
I need a little more science to explain what happens next, so get ready. Over time, the ongoing tension and twisting of the muscle fibers causes an elevation in the resting muscle tone – that is, eventually, the muscle never completely relaxes. It’s always a bit contracted, meaning a bit shortened, and therefore a bit taut. This tightness causes local vasoconstriction – the blood vessels are constricted – and this translates to local ischemia – inadequate blood supply to the tissue (the same thing that happens to heart muscle in a heart attack). The arteries can’t bring in enough fresh blood and oxygen, the veins and lymphatic vessels can’t adequately drain waste and deoxygenated blood. The tissue pH changes, local metabolism is impaired, and fluid and waste products 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.
Over time, this situation results in the development of trigger points. A muscle is composed of numerous parallel fibers and each fiber consists of many end-to-end contractile segments called sarcomeres. When they’re working correctly, they all shorten together when you contract the muscle and then return to their resting length when you relax. But trigger points involve a collection of sarcomeres that remain in a shortened, irritable state, which makes them bulge (often causing a palpable “knot”) and causing their muscle fibers to feel taut and stringy. Finally, with longstanding trigger points, the body deposits gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
Ok, enough with the big words.
The point is, there are tons of resources in print and online to help you locate trigger points and show you the kinds of problems they can cause. As for getting rid of them, the most basic method is to simply press and hold an active trigger point when you find one. After about 30 seconds, you’ll usually feel it soften. You can also press down the trigger point (with a thumb, fingers, or a tool) and then move the tissue, as if deliberately intending to re-lengthen this shortened part of the muscle.
Acupuncture is really excellent at releasing trigger points. Dr. Travell injected various agents into trigger points to cause them to deactivate, but later in her career, she began to realize that the most effective part of this process was simply jabbing the trigger point with the end of a needle. There wasn’t a need to inject any liquid; thus, this method became known as “dry needling.” She worked with an osteopath acupuncturist named Dr. Mark Seem who developed an acupuncture-based methodology for releasing trigger points in a holistic way – that is, while supporting the body as a whole to restore balance. (If you’re interested in trying dry needling, I strongly recommend you receive it from an acupuncturist rather than a physical therapist, since acupuncturists have an exponentially greater amount of needle training and a more sophisticated understanding of how to treat the big picture.)
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.
Be well,
Dr. Peter Borten
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[is_tax] =>
[is_search] =>
[is_feed] =>
[is_comment_feed] =>
[is_trackback] =>
[is_home] =>
[is_privacy_policy] =>
[is_404] =>
[is_embed] =>
[is_paged] =>
[is_admin] =>
[is_attachment] =>
[is_singular] =>
[is_robots] =>
[is_favicon] =>
[is_posts_page] =>
[is_post_type_archive] =>
[query_vars_hash:WP_Query:private] => 6ca43ad4540a7ba772ccf8accac5e56f
[query_vars_changed:WP_Query:private] =>
[thumbnails_cached] =>
[allow_query_attachment_by_filename:protected] =>
[stopwords:WP_Query:private] =>
[compat_fields:WP_Query:private] => Array
(
[0] => query_vars_hash
[1] => query_vars_changed
)
[compat_methods:WP_Query:private] => Array
(
[0] => init_query_flags
[1] => parse_tax_query
)
)