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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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Although we weren’t thinking about it while writing it, our life planner, The Dreambook, is very much aligned with ideas of the Human Potential Movement (HPM). The movement focuses on helping people attain their full potential through numerous avenues, including self-awareness, honesty, openness, optimism, self-acceptance, mindfulness, and a willingness to be outside of one’s comfort zone. Wikipedia says a central premise of the HPM is that “people can experience a life of happiness, creativity, and fulfillment,” and that this naturally moves us to uplift our community and assist others to actualize their own potential.
Although it’s often seen as having developed from the 1960s counterculture, the seeds of the HPM were planted much earlier. Close influences were psychologists such as William James, Carl Rogers, and Abraham Maslow. In particular, Maslow’s famous Hierarchy of Needs elucidated how humans are motivated. He claimed that we have tiers of needs, and that foundational tiers – e.g., food, shelter, safety – have to be managed before we can dedicate ourselves to higher tiers such as relationships and achievement. Maslow called the top tier self-actualization, the full realization of our potential.
Well before these modern thinkers, Greek philosophers such as Socrates and Epictetus were teaching about human potential through the cultivation of virtue. Confucius, too, (500-ish years BCE) was a great champion of personal development and spoke of the relationship between one’s individual growth and the benefit to society, similarly to what is echoed above by the HPM. In The Great Learning he wrote:
In ancient times, those who wished to make bright virtue brilliant in the world first ordered their states; those who wished to order their states first aligned their households; those who wished to align their households first refined their persons; those who wished to refine their persons first balanced their minds and hearts; those who wished to balance their minds and hearts first perfected the sincerity of their intentions; those who wished to perfect the sincerity of their intentions first extended their understanding; extending one’s understanding lies in the investigation of things.
And “the investigation of things,” according to twelfth century philosopher Zhu Xi, means, “to exhaustively arrive at the principles of matters, missing no point as one reaches the ultimate.” Some would say it means to perceive the true nature of reality.
I find this view beautifully holistic: that even for worldly aims (“to make bright virtue brilliant in the world”), we start with our basic orientation to reality, then bring this forward to the “sincerity of our intentions,” the balance of our hearts and minds, then to personal refinement, the alignment of our household, and then outward to our community.
Depending on your disposition, these statements can feel inspiring or unreachably lofty. If making bright virtue brilliant in the world feels daunting, let’s look at the ideas of living to one’s potential in simpler terms.
Confucius speaks first about the investigation of things – understanding the world. Doesn’t it make sense that in order to really grasp our potential we must understand the context in which it is expressed?
This isn’t work anyone can do for us, and it requires humility, innocence, and openness. It means, in my opinion, approaching the world as a student would approach a master teacher – willing to be wrong and open to having our mind blown. If we look to cultures who live in close connection with nature (including Confucius’s culture), they’ll almost universally assert that it’s the sacred in us, interacting with the sacred of the world, that is the essence of life – not the masks and stories we’ve superimposed upon it. What is the sacred? That which can’t be depleted, exhausted, or diminished.
What about the sincerity of intention Confucius mentions? We hope to nudge our readers toward sincere intention through the exploratory questions in the Connect section of the Dreambook. Figure out what brings you joy and gratification, regardless of what others might think. What raises your vibration? What makes you feel alive? What opens your heart? What makes you feel you’re aligned with the purpose your Highest Self wants for you?
From here, establish structures to support the actualization of these intentions. Integrate them into your everyday life. Set goals, break them down into tasks, and put the tasks in your calendar. Practice integrity by honoring your agreements with yourself. Be reverent of the powerful words they are constructed from. Make sure your agreements are clear – always know what you’ve agreed to and where you stand on them. Notice what you accomplish and celebrate these achievements. Don’t complain. Be flexible. Maintain a clear inner vision of what you intend to bring into being. And routinely express gratitude.
If this sounds like a lot to remember, that’s what a planner like the Dreambook is for – to keep you on track with the actualization of that incredible potential within you. We’re honored to witness you.
Be well,
Peter
[post_title] => Are You Actually Actualizing?
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Have you had an experience of awakening to something that feels more real than ordinary reality? I remember the first time I heard Zen-inspired spiritual teacher Adyashanti refer to these moments as “gaps” in everyday awareness, when we stop focusing on our own mind and experience the world as it really is.
I’d had some of these expansive periods but felt a great letdown when I returned to ordinary reality. This is sometimes referred to as the “I get it! I lost it” phenomenon. It was relieving to hear Adyashanti describe these moments simply as windows through the dominant narrative. He explains that when we’re adamant about finding the truth, the gaps tend to get longer and more frequent. He also observes that what we find there isn’t usually what we expect it will be.
When the gaps run into each other and become our abiding reality, this is often referred to as spiritual awakening or enlightenment. It’s natural to imagine that something that sounds so grand and mystical must be a state unlike anything we’ve ever felt – maybe even a condition of perpetual ecstasy.
This makes it highly appealing to the ego, which often tries to take over the mission. It can easily turn spirituality into a competition and a source of identity and approval (“I’m woke AF!). And it may desperately hope that it’s finally found the thing that’s going to make us happy.
Happiness is a noble pursuit, but it’s not necessarily the same path that the question of “What am I really?” takes us on. Likewise, while I believe the “What am I?” path does eventually lead us to happiness – true, causeless happiness, in fact – there’s likely to be some unhappiness along the way, which is generated by the ego’s unwillingness to get out of the driver’s seat.
Spiritual awakening shrinks the ego to irrelevance, and this idea is about as scary as actually dying. The ego – the mental construct of personality, feelings, memories, and intellect that we’ve cultivated and reinforced since childhood – dominates our inner and outer experience of life, and in this way confuses us into believing that it is who we are. It’s been this way for so long that we may have forgotten what the unfiltered, egoless experiences (i.e., gaps) feel like. The ego isn’t malicious; it’s just trying to survive. But to the extent that we believe our ego is who we are, we’ll find it impossible to circumvent – because how could we get away from ourselves?
As of this writing, my ego is alive and well, and my gaps are fewer and farther between than I would prefer, but I’ve spent enough time cultivating gaps that I hope I can share something worthwhile. In my experience, though I have had moments of true ecstasy (while completely sober!), the most striking surprise is the incredible familiarity and closeness of the transcendent experience. I think this is what Adyashanti and other teachers are getting at when they say, “It’s not what the mind thinks it’s going to be.”
While we may imagine that spiritual awakening is like acquiring new powers, I believe it’s more of a remembering. It’s like having your head in one of those old-school arcade machines, gripping the joystick, munching pellets, running away from the ghosts, believing “this is what life is,” and then pulling back and taking in the true surroundings. The surroundings were always here, and so was the consciousness that the game wasn’t reality, but you were so immersed in it you forgot.
In one of these gap experiences I actually found myself saying out loud, “Ohhh! It’s THIS! It’s THIS!” The best I can explain it is that I suddenly noticed something that had always been in the background – always, always, always there for the entirety of my life, but so constant as to be disregarded. It wouldn’t call it mystical, but it was incredibly relieving.
Upon tuning in to it and recognizing it as part of myself, that “background” immediately expanded, rendering all of “Peter’s life stuff” relatively small and insignificant. In that state I remembered that I had previously been afraid that letting go of my “small self” would mean that I’d stop caring about my loved ones. But in this expanded awareness, I saw that this was just a fear my ego came up with, and if anything I was able to love people more completely than ever.
I wish I could say I stayed there forever, but my conditioning crept back in. I was able to see myself, little by little, choosing smaller points of view, picking up my phone for no good reason, and shrinking my field of awareness. But these experiences change us even if they’re not sustained forever. They give us a glimpse that’s not easily forgotten.
So, how do we remember? A good starting point is to ask yourself, What has been with me ALWAYS? Or, Who is that consciousness that has been watching my life, that has been there all along, never departing, even while my body grew and my life circumstances changed?
As Meister Eckhart wrote, “The eye through which I see God is the same eye through which God sees me; my eye and God's eye are one eye, one seeing, one knowing, one love.” What happens when you try to see the one who’s doing the seeing? What happens when, as Adyashanti says, you “turn Awareness upon itself”?
Here’s to more and longer gaps. And feel free to share about your gap experiences in the comments section.
Be well,
Peter
[post_title] => Opening Up the Gaps in Ordinary Reality
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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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