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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
[post_title] => The Science Behind Wonky Body Things that Suck
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When I was in grad school for Chinese Medicine, I’d often see students hanging around campus engaged in related ancient Chinese arts, such as tai chi, qi gong, calligraphy, studying Chinese astrology or feng shui. It was also common to see a group of students hitting themselves and each other.
They were training in the toughening exercises of martial arts, which I had never witnessed before. This entailed repeatedly knocking the edges of their shins or forearms against each other, or whacking their bodies with a thick bundle of metal wires (called an “iron bundle” or tetsutaba). As I tentatively tried hitting myself with this implement, one of them told me, “You really want to feel your bones rattle when you do it.” Needless to say, they had lots of bruises.
They finished every session by taking out a jug of some pungent brown liquid and rubbing it all over the impacted parts of their bodies. As an herbalist, this was the most interesting part for me. Each guy actually had his own jug of brown stuff, and they often argued about whose was the best.
The brown stuff was called dit da jow (AKA die da jiu) which means something like “hit fall wine” and it’s sometimes just called a hit formula or training formula by martial artists. The purpose of the stuff is to help one recover faster after taking a bunch of kicks and punches. It’s made from a variety of herbs, resins, and minerals that have been soaked in alcohol for about a month. Famous teachers and martial arts schools often have their own recipes, many of which have been in continuous use for centuries and are often held in great secrecy.
Over years of begging and pleading with my fighter friends and hunting down obscure texts, I managed to procure about a dozen different recipes, then proceeded to spend more years studying them. I had hundreds of jars of my own “brown liquids,” made out of countless combinations and permutations of these formulas. Since most of my patients weren’t fighters I expanded the application to include the various ways we’re battered by modern life – athletics, poor posture, sitting for way too long at a desk, carrying kids around, using backpacks, sleeping on a crappy bed, standing on hard floors, wearing heels, etc.
By tracking people’s responses, I gradually moved toward what would eventually be our Muscle Melt liniment. It features a gigantic number of ingredients, but every one is in there for a reason. My high-performance athlete patients regularly tell me that it makes it possible for them to do a super intense workout and be back in action the next day with minimal downtime. If you’re feeling beat up by life, give it a try and tell me what you think.
Be well,
Dr. Peter Borten
[post_title] => Dit Da Jow: Healing Elixir or Ancient Myth?
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[post_content] => When my wife says I’m the only person she knows who could happily curl up in bed with a 20-pound medical text, I like to point out that I also enjoy books on philosophy. It’s been at least a decade since I’ve read a work of fiction (except to my kids), but I find nonfiction so fascinating, and it constantly challenges my worldview. I know most people find these subjects dry and heady, so I try to tackle them in our newsletters with the aim of making them more accessible and digestible.
Today I’d like to share some thoughts on one of these dry topics – the philosophy of nondualism. Wait, don’t leave! I promise I’ll make it interesting – controversial even. Just bear with me. It might even change the way you see the world.
In a nutshell, nondualism is the notion that everything is essentially one – that all the apparent differences and separation we perceive in the world are an illusion.
Nondual philosophy has many different forms; I can’t deliver a comprehensive analysis in an article this short. Instead, I’ll speak to the perspective of a single Eastern source – Tantra Illuminated by Christopher Wallis – and a single Western source – A Course in Miracles (ACIM) by Helen Schucman.
The first is a study of Tantra, a group of spiritual traditions that arose mainly between 300 and 1300 A.D. They had a significant impact on the development of yoga, Hinduism, and Buddhism. And I’m sorry to be the bearer of bad news, but “tantric sex” is the tiniest fraction of what Tantra comprises.
The second, which might be understood as nondual Christianity, was written by an American in the 1960s and 70s and is presented as a “channeled” work dictated by Jesus.
Though seemingly very different, these two traditions actually have a lot in common. And what they share is a perspective that would alleviate a lot of suffering if it were more widely known.
Both schools of thought focus on discovering the unity within all the apparent differences in the world. They say that when we see a world where some things are godly and others aren’t, where good and evil, wealth and poverty, sickness and health, virtue and sin, life and death, and a host of other “dualities” yank us around and define our experience of life, we’re wrapped up in a dream that obscures the real truth.
And that truth, they assert, is that all things are an expression of one Consciousness (God, Spirit, Universe, Divine Light, Highest Self, or whatever other word you care to use), which is synonymous with Love. These systems hold that everyone and all things are connected, equal expressions of God, and there is nothing to fear and no reason to suffer.
ACIM often pushes non-Christians’ buttons by using terms like Jesus, Christ, and Holy Spirit. For me, raised Jewish, the terminology presented some hurdles at first, but it gets easier the more I recognize that these names – as well as those of most other traditions – are all pointing to the same thing.
ACIM also pushes Christians’ buttons because much of what it teaches flies in the face of Christian dogma. It states that God isn’t outside of us or different than us. It holds that there is no duality of heaven and hell; only heaven is real and we’re either conscious of it or lost in stories of our own making. It says there is no sin – only mistakes made out of confusion. It claims that God doesn’t forgive – because God doesn’t condemn.
Despite these potential objections, I feel it’s a worthwhile study in Western nondualism. It might be a more natural leap for someone with a background in an Abrahamic religion (Judaism, Christianity, Islam are the main three) rather than adopting a completely foreign Eastern nondual tradition. However, some find the reframing of deeply entrenched Abrahamic concepts too difficult to swallow, or the terminology too loaded, making the Eastern traditions something of a clean slate in comparison.
Central to ACIM’s narrative is the idea that you sought to break apart from God, to be independent, and in so doing, you gave your power to your ego. (This might be likened to the biblical story of eating from the Tree of Knowledge, whereupon the mind was given authority and we lost the “Eden” state of consciousness.) The ego protects this idea of independence by asserting that the world is a place of separation, where everything is disconnected, where all things are in competition, and pain, suffering, and loneliness threaten us.
The perpetuation of this dream depends on the ego’s continually empowering itself by generating conflict – with the world and yourself. Meanwhile, the belief that you cut yourself off from your Highest Self (keep substituting words you like) is a source of deep self-blame, which you also project onto the world and its inhabitants.
The primary means of resolving this dilemma, the Course teaches, is forgiveness. By forgiving yourself and everyone else, conflict dissolves, the illusion of separation fades, you see that you were never actually alone or vulnerable, and the world becomes a different place.
Nondual Tantra takes a slightly different view of the origin, but presents a similar human conundrum. In its conception of reality, there is one Divine Light (again, you can call this God, Goddess, Awareness, Spirit, Dao, etc.) that expresses itself in all possible ways – including as seven billion humans – through what is called krida, the doctrine of divine play. The word “play” is used because the Source manifests an infinitely diverse world for its own sake – for the love of it – rather than for some end result.
In order to have an immersive experience as each of these facets of the world, the Divine imbues them with only a fraction of its total awareness. That is, so that you can really experience being you – believing you’re on your own, thinking you’re limited by this body, feeling the full spectrum of human emotion, triumphing over obstacles – you can’t know all along that you’re actually God acting like a human.
You have to forget, so the play feels that much more real – and so that you can later remember. It’s the ultimate game: to dive into a world where you’re blind to the connections and safety nets, where there’s so much potential to feel alone, afraid, and attacked, and yet, to find the light. To remember that it’s all You. To wake up to what you really are, with revelation, relief, and awe.
I have no agenda of convincing you to subscribe to either of these schools of thought. But knowing that our readers are open-minded people who are looking for deeper peace and an experience of connection, I thought you might find it compelling that two traditions from such different times and places offer such a similar message. (And these are just a couple examples of many.)
Both systems declare that you’re so much more connected to the world and your Highest Self than you realize, that the death of your body isn’t the end of life, and that the fundamental matrix of the universe is love. Perhaps there’s room in your worldview for a little nondualism. What do you think?
With love,
Dr. Peter Borten
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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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[guid] => http://www.thedragontree.com/?p=6641
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[post_type] => post
[post_mime_type] =>
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[filter] => raw
[webinar_id] => 0
)
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[is_single] =>
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[is_archive] => 1
[is_date] =>
[is_year] =>
[is_month] =>
[is_day] =>
[is_time] =>
[is_author] =>
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[query_vars_hash:WP_Query:private] => ec63fd8f967f6b5eb0d90a680c7e564e
[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
)
)
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