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For the holidays we gave our eight-year-old daughter a set of indoor monkey bars. That meant I spent a day with my arms above my head, screwing eye bolts into her bedroom ceiling. She can now get from the doorway to her bed without setting foot on the floor, which is useful because she tells me it’s made out of molten lava.
At bedtime I reached out to turn on a faucet and suddenly my mid-back locked up. It was incredibly painful and I felt unable to move without worsening it. I made the mistake of bending down to touch my toes, thinking it would help, but was then frozen in that position.
I’ve treated this same condition in countless patients. Often this type of back spasm is crippling for at least a few days – meaning missed work or travel – followed by a lingering stiffness and pain for a week or more. Frequently the locked area, even as it begins to release, is prone to getting retriggered if we move or sleep the wrong way.
Luckily, I knew what to do. I started locating and massaging effective acupuncture points on my hands and arms that began to release the locked up muscles. Meanwhile, I used certain visualizations and breathing techniques that facilitated the loosening of my back. Eventually I could move enough to lie on a small ball to put pressure on the muscle spasm while continuing with the breathing, visualization, and self-acupressure. I went to bed about an hour later than I intended, but with my back feeling 80% better. The next day I released the rest of the tension.
Several times throughout the process I thought, “This would be so much worse if I didn’t know how to do this.” I would have to find a practitioner and wait for an appointment. But what kind of practitioner, and which one? What if they weren’t available during the holidays? Would I have to be immobile during our holiday party? Would I be reliant on pharmaceutical painkillers? Would I be in a daze? Would I find it hard to get off them?
This conundrum is why I created an online course called Live Pain Free. It started with the advice I found myself giving hundreds of pain patients in my office over the years – and the realization that I didn’t have time to explain everything I wanted to teach them. Little by little, the course grew to include virtually all of the techniques and lifestyle modifications I have found useful for self-treatment of pain. It’s more comprehensive than anything else I’ve found.
Are there other things like it? Yes, of course. There are plenty of books and courses that teach pain relief techniques, some of them very useful. But most feature a single approach to pain, and I’ve never found a single method that works for all – or even most – pain. Even for a given individual, some things work one day and not the next. This is because there are many “ingredients” in pain, especially long-term pain – our history, psychology, lifestyle, body mechanics, etc. – so we need a blend of multiple approaches.
During the years I spent crafting this course, I discovered that beyond helping people to make their pain go away, much of what I wish to share deals with releasing ways of thinking that are restrictive and keep us trapped in discomfort. Although pain management is the issue that often leads people to look deeper, the ultimate resolution may be something so much more than mere physical relief: liberation from our resistance to life, the opportunity to accept and live in the present moment, the recognition of patterns that have held us back, and more.
The feeling of gratitude I had the other night – I want that for everyone. If you deal with frequent pain, if you would like to help a loved one with their pain, or you just like the idea of being prepared and knowing a wide range of strategies – some based in modern science others in Eastern medicine – check out Live Pain Free.
Be well,
Dr. Peter Borten
[post_title] => The Gift of Knowing How to Manage Your Own Pain
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After two years of studying plant and soil sciences, my favorite professor, Dr. Barker, offered me a job on the University of Massachusetts farm. Whereas my previous jobs had been things like bagging groceries and washing dishes, this was the first time I was getting paid to do something I was interested in, and under the supervision of someone I looked up to.
I was nervous when I showed up at Bowditch Hall on my first day. Dr. Barker, a white-haired man with a country drawl, introduced me to his assistant, Kathy. Then he handed me the keys to a faded old, blue truck and asked me, “Ever driven a three-on-the-tree?” I had never driven any kind of truck before, much less one with the gearshift on the steering column, but I learned quickly as I drove the three of us – with lots of jerking and stalling – out to the farm.
Standing at the edge of a freshly plowed field, Dr. Barker explained that we were going to use stakes and twine to mark out rows for planting seeds. Kathy and I got to work while he watched. The only trouble was, while I had stakes, a mallet, and a ball of twine, I didn’t have anything to cut the twine with. I thought maybe I had spaced out when someone explained where to find a knife or scissors. Or maybe the professor had told me to bring my own knife and I had forgotten. I was too uncomfortable to say anything.
Wondering if there was some way I could proceed with my task without a cutting tool, I pounded the first stake into the ground. I tied one end of the twine around it, walked the length of the field, pounded in another stake, wrapped the twine around that stake, pulled it taut, and then I just squatted there for a few moments. I considered trying to gnaw through it with my teeth, but dismissed the idea as totally unprofessional. Finally, at the risk of appearing unprepared, I called out to Kathy, who was a dozen paces away, “Do you have a knife?”
“Huh?” she turned around and squinted at me in the bright sun. “Oh.” She ambled over, fished around in her pocket, and passed me a pink disposable lighter.
I interpreted this unexpected response to mean, “I don’t have a knife, but I can see what you need there. You’re going to have to burn through the twine with this. At the ends of every row.” She gave me the lighter in such a matter-of-fact way that I thought it would be too weird to ask for a different explanation.
So, feeling like I didn’t have enough hands, I held the twine straight out from the stake, positioned the flame beneath it, and tried to shield it from the wind with my leg. It blew out a couple times, but I eventually managed to burn through it. Meanwhile Dr. Barker had wandered over to observe me and remarked, “That is the strangest way of doing that I have ever seen.”
“Um. I didn’t have a knife,” I said sheepishly.
“Well, I’ve got a knife you can use.”
“Me too,” offered Kathy.
And that’s how, on the first day of my first important job, I believed I must have convinced my boss that I was an absolute idiot. By the way, if you’re wondering why Kathy handed me that lighter, these were the days when smoking was still quite common. She was a smoker and must have thought I said, “Do you have a light?”
The whole thing turned out to be a good lesson for me. By avoiding an uncomfortable conversation, I ended up in even more discomfort.
I resolved to speak up and break through the tension of misunderstanding in the future. I can’t say I’ve always done this, because it takes bravery, and sometimes I chose to stay in my (dis-)comfort zone. But I can say that I’ve never regretted it. Usually there’s an immediate diffusion of tension, and even when there isn’t, at least the truth is out and there’s an opening for resolution. This is especially true when we bring an attitude of curiosity and aim to understand the other person.
Is there anywhere in your life where you’ve left something unsaid because of your resistance to the discomfort of speaking those words and the feelings that may follow? I want to challenge you to make a communication this week that takes you a bit outside your comfort zone. Even if you have to say, “I’m really nervous about saying this” or you have to hold a friend’s hand while doing it, it’s worth it.
Be well,
Peter
[post_title] => Uncomfortable Conversations: Diffuse the Discomfort by Speaking Up
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I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way.
“Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power.
Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training.
For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E.
Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience.
Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points.
Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.)
Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything.
Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.).
In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip).
Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees.
The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians.
Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience.
While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling.
Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling.
If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive.
If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.)
If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement.
If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain.
That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist.
Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity.
Be well,
Dr. Peter Borten
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For the holidays we gave our eight-year-old daughter a set of indoor monkey bars. That meant I spent a day with my arms above my head, screwing eye bolts into her bedroom ceiling. She can now get from the doorway to her bed without setting foot on the floor, which is useful because she tells me it’s made out of molten lava.
At bedtime I reached out to turn on a faucet and suddenly my mid-back locked up. It was incredibly painful and I felt unable to move without worsening it. I made the mistake of bending down to touch my toes, thinking it would help, but was then frozen in that position.
I’ve treated this same condition in countless patients. Often this type of back spasm is crippling for at least a few days – meaning missed work or travel – followed by a lingering stiffness and pain for a week or more. Frequently the locked area, even as it begins to release, is prone to getting retriggered if we move or sleep the wrong way.
Luckily, I knew what to do. I started locating and massaging effective acupuncture points on my hands and arms that began to release the locked up muscles. Meanwhile, I used certain visualizations and breathing techniques that facilitated the loosening of my back. Eventually I could move enough to lie on a small ball to put pressure on the muscle spasm while continuing with the breathing, visualization, and self-acupressure. I went to bed about an hour later than I intended, but with my back feeling 80% better. The next day I released the rest of the tension.
Several times throughout the process I thought, “This would be so much worse if I didn’t know how to do this.” I would have to find a practitioner and wait for an appointment. But what kind of practitioner, and which one? What if they weren’t available during the holidays? Would I have to be immobile during our holiday party? Would I be reliant on pharmaceutical painkillers? Would I be in a daze? Would I find it hard to get off them?
This conundrum is why I created an online course called Live Pain Free. It started with the advice I found myself giving hundreds of pain patients in my office over the years – and the realization that I didn’t have time to explain everything I wanted to teach them. Little by little, the course grew to include virtually all of the techniques and lifestyle modifications I have found useful for self-treatment of pain. It’s more comprehensive than anything else I’ve found.
Are there other things like it? Yes, of course. There are plenty of books and courses that teach pain relief techniques, some of them very useful. But most feature a single approach to pain, and I’ve never found a single method that works for all – or even most – pain. Even for a given individual, some things work one day and not the next. This is because there are many “ingredients” in pain, especially long-term pain – our history, psychology, lifestyle, body mechanics, etc. – so we need a blend of multiple approaches.
During the years I spent crafting this course, I discovered that beyond helping people to make their pain go away, much of what I wish to share deals with releasing ways of thinking that are restrictive and keep us trapped in discomfort. Although pain management is the issue that often leads people to look deeper, the ultimate resolution may be something so much more than mere physical relief: liberation from our resistance to life, the opportunity to accept and live in the present moment, the recognition of patterns that have held us back, and more.
The feeling of gratitude I had the other night – I want that for everyone. If you deal with frequent pain, if you would like to help a loved one with their pain, or you just like the idea of being prepared and knowing a wide range of strategies – some based in modern science others in Eastern medicine – check out Live Pain Free.
Be well,
Dr. Peter Borten
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