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It was my birthday party in May and before we all started eating, Briana asked if I wanted to say something to my guests. Unbeknownst to them, I had been feeling a nauseous gurgling in my guts all day, so I was trying to hold it together and was caught a bit off guard. But I looked around at this group of shining faces and said the first words that came to me: “Community is medicine. Thank you for being here.” And that was enough.
Immersion in loving community is deeply fortifying, supportive, and uplifting. Studies show that when a suffering person holds someone’s hand, their suffering is reduced. I think the same is true of metaphorically holding many hands through community engagement. And while it’s therapeutic to be seen and held in our challenges, there’s also value in the way that being oriented to our community gives us a break from self-scrutiny and self-indulgence.
Like eating green vegetables or meditating, sometimes we can forget to prioritize community when we’re busy or immersed in a personal struggle. But as some wise person once said, our community is like our muscles. Besides supporting and empowering us, they need to be engaged regularly in order to stay strong. If you neglect your muscles, they get flabby. If you neglect your community, they probably won’t turn their backs on you, but for numerous reasons they won’t be able to support you as well as they could.
From our book, The Well Life, here are some actions you can take to mindfully build your community:
- Ask people for help – whether it be in your garden, with your taxes, or finding a great preschool. Learn what gifts and wisdom those around you have and give them opportunities to share.
- Be involved. Go to local meetings. Participate. Know your community’s plans for the future – and how you fit into them.
- Know the names of people you see often – the grocery cashier, the gas station attendant, the school principal, the guy who takes the same bus as you every day. Allow them to be real people in your life.
- Make eye contact with the humans you pass on the street. Be the one who says “Hi!” first.
- Protect the green spaces.
- Fix something that’s broken – a neighbor’s fence, your niece’s bike, the librarian’s flat tire.
- Support local businesses – even if it costs a little more.
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- Stick up for someone – a disadvantaged person or population, someone being mistreated or disrespected, or someone who’s unable to stand up for themselves.
- Be curious. Attend lectures at the library, senior center, or local university, check out a high school science fair, and – foremost – learn what cool stuff people are up to in your town. What are people building? What are they learning? Who can tell you about the history of this place?
I want everyone to have the experience of being part of a healthy, loving, supportive community. I hope you’ll engage with your community today and be reminded of how nourishing it is.
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
[post_title] => The Science Behind Our Pain: Inquiring Minds Want to Know
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During a particularly hard break-up in my 20s, a friend advised me, “The more present you are during this process, the bigger the present you’ll get out of it.” And though I barely understood what that meant, I gave it a try and an odd thing happened. I saw that I was choosing the big, dramatic grieving process I was going through. And that meant it was optional.
In The Art of Presence, Eckhart Tolle says, “Through thought you cannot possibly grasp what presence is.” But he gives some clues to point us in the right direction. He says it’s there, “when you’re not thinking about the last moment, or looking to the next one.” And he uses phrases like “a state of relaxed alertness” and “a spacious stillness,” to describe it.
Thich Nhat Hanh said, “The most precious gift we can offer others is our presence.”
Our presence is tremendously rare and hugely valuable. Especially in this age of epidemic distraction, it’s increasingly difficult and uncommon to choose a voluntary time-out from technology, data, and our own mental analysis. But unlike the artificial value of a coin that accidentally got stamped with a head on both sides, our presence can do for us what nothing else can. And we can make it more abundant by simply choosing it.
Although it may not put food in our belly, most other problems disappear with presence. The need to fix or relive the past disappears. The need to avoid certain unwanted events in the future disappears. Even if we're working on something now that will benefit us in the future, with our presence, we work on it now in order to work on it now. And that’s enough.
The allure of distraction, which so often threatens our presence, dissolves when we practice being present. Do you know the word obviate? I like to write using words that almost everyone understands, but there’s only one word I can think of that means “to make unnecessary,” and that word is obviate. Learning to deepen our presence obviates the urge for distraction and mental departure from our current reality.
With presence, we perceive all kinds of intelligence and detail that we’re otherwise deaf and blind to. We know when to eat and when to stop eating. We know how to move our body in a way that doesn’t cause pain or injury. Our work becomes more interesting. Our relationships become healthier. We listen better and we feel heard.
With two kids, my presence is requested almost incessantly. I hear the word Papa at least 100 times a day. Often, I hear it ten or more times in quick succession. We all yearn for someone’s total presence with us. These are the moments of connection between what is the same in both of us. Presence uncovers what’s real in this moment. And that’s refreshing, exciting, and affirming.
When we’re all so busy that we see time as a commodity, it can seem that giving our presence to someone else is like giving away our treasure. But are we actually giving something away?
Of course not. When we “give” our presence we gain the present. To withhold our presence means both we and the other person miss out.
So, how can you learn to be more present? It takes practice. If you’re new to this, I don’t recommend making a goal like, “I’m going to be more present from now on.” I don’t want to discourage you, I just want you to be realistic about what you’re up against – a lifetime of habits and a sea of tantalizing distractions.
Try something a bit less ambitious, such as this: Once a day, as you begin some activity – whether it’s buying groceries, playing Candyland, eating a meal, and listening to a friend’s problems – select this activity as an exercise in presence. In your mind, identify what exactly you’re doing – “I’m vacuuming the floor” – and devote yourself to that. Don’t run away in the middle of the activity. This means don’t pick up your phone, don’t depart in your mind to explore other thoughts and ideas, don’t visit the past, don’t anticipate what’s next, don’t judge. Just dwell in the present. Be saturated by the present. Feel everything. Accept everything. And let each next moment come.
Over time, quicker than you might think, you’ll start regaining your attention. You’ll be able to focus on something for more than five seconds. You’ll begin to yearn for this, which will make your practice much easier. And as you start willingly selecting more and more moments to be completely present, you’ll experience an unending offering of presents.
Be well,
Dr. Peter Borten
[post_title] => A Free Pile of Presents Just for You
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It was my birthday party in May and before we all started eating, Briana asked if I wanted to say something to my guests. Unbeknownst to them, I had been feeling a nauseous gurgling in my guts all day, so I was trying to hold it together and was caught a bit off guard. But I looked around at this group of shining faces and said the first words that came to me: “Community is medicine. Thank you for being here.” And that was enough.
Immersion in loving community is deeply fortifying, supportive, and uplifting. Studies show that when a suffering person holds someone’s hand, their suffering is reduced. I think the same is true of metaphorically holding many hands through community engagement. And while it’s therapeutic to be seen and held in our challenges, there’s also value in the way that being oriented to our community gives us a break from self-scrutiny and self-indulgence.
Like eating green vegetables or meditating, sometimes we can forget to prioritize community when we’re busy or immersed in a personal struggle. But as some wise person once said, our community is like our muscles. Besides supporting and empowering us, they need to be engaged regularly in order to stay strong. If you neglect your muscles, they get flabby. If you neglect your community, they probably won’t turn their backs on you, but for numerous reasons they won’t be able to support you as well as they could.
From our book, The Well Life, here are some actions you can take to mindfully build your community:
- Ask people for help – whether it be in your garden, with your taxes, or finding a great preschool. Learn what gifts and wisdom those around you have and give them opportunities to share.
- Be involved. Go to local meetings. Participate. Know your community’s plans for the future – and how you fit into them.
- Know the names of people you see often – the grocery cashier, the gas station attendant, the school principal, the guy who takes the same bus as you every day. Allow them to be real people in your life.
- Make eye contact with the humans you pass on the street. Be the one who says “Hi!” first.
- Protect the green spaces.
- Fix something that’s broken – a neighbor’s fence, your niece’s bike, the librarian’s flat tire.
- Support local businesses – even if it costs a little more.
- Learn about others’ traditions and celebrate together. Look for local festivals to attend, even if they’re for an event you wouldn’t normally observe.
- Stick up for someone – a disadvantaged person or population, someone being mistreated or disrespected, or someone who’s unable to stand up for themselves.
- Be curious. Attend lectures at the library, senior center, or local university, check out a high school science fair, and – foremost – learn what cool stuff people are up to in your town. What are people building? What are they learning? Who can tell you about the history of this place?
I want everyone to have the experience of being part of a healthy, loving, supportive community. I hope you’ll engage with your community today and be reminded of how nourishing it is.
Be well,
Peter
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