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Last week I saw a show by a troop of comedians at a tiny theater in Montana. Though they were talented, I didn’t find myself laughing much at the recurring “battle of the sexes” theme. The men accused the women of being frigid and overly emotional. The women complained that the men need to be mothered and only care about sex. And back and forth it went. Sure, there’s comic relief in sharing about our common issues, but as I sat there seeing men and women cast somewhat bitterly in these one-dimensional ways, I couldn’t help thinking, “Are we really still doing this?”
In my previous article, we looked at the role that attitude plays in the health and sustainability of a relationship. Of course, you can’t make your partner change their attitude, but it’s worth fully exploiting the potential of your own attitude before concluding that the relationship isn’t going to work. One way to be responsible for your attitude is by abstaining from relating your partner as a stereotype.
I believe almost everyone does this to an extent. It’s difficult to banish from our minds the ideas we have about men, women, and humans in general. Even if your partner isn’t a typical male or female, your conditioning can cause you to relate to them based on ideas and experiences from the past. And even when you relate to someone simply based on your ideas about that specific person – rather than whoever they are in this very moment – this may still serve as an impediment to authentic connection.
Practice presence with them. It’s good to start with a relatively casual conversation. Let both parties be innocent – try to enter the conversation without judgment, expectations, or lenses. Who knows what might happen and how you might see the other person if you were to enter the exchange with absolute freshness.
See if you can internally choose when to talk and when to listen. When it’s your turn to listen, don’t think about what you’re going to say next. Just listen. Listen with your ears and eyes and heart. Breathe slowly and fully.
What else is involved in “your work”? Here are some examples:
To the extent that you actively work to resolve past experiences (especially traumatic ones) that infringe on your current ability to show up “cleanly” with your partner, you will benefit.
To the extent that you work to deactivate your “buttons” which cause you to make you react disproportionately to relatively benign behaviors by your partner, you will benefit.
To the extent that you choose to show up in your relationship with as much presence and enthusiasm as you can muster, you will benefit.
To the extent that you take responsibility for your baggage, attitude, communication, and interpretations, you will benefit.
To the extent that you choose to remember and honor your commitment (assuming, of course, that neither party is getting hurt by remaining together), you will benefit.
All these benefits are yours whether or not the relationship survives, and the chances of its survival are so much greater when you’re an active and responsible participant in the above ways. Further, if you’re not in a relationship but want to be, doing your work will make for a healthier relationship when the time comes, and it will also support you to make better choices of who to invite into your life. If you’re not in a romantic relationship and don’t care to be, this work will serve you in all your other relationships, including the one with yourself.
Be well,
Peter
[post_title] => Relationship Repair Part Two: Do Your Own Work
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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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Imagine if you had the opportunity to create the perfect planet. What would you come up with? Let’s brainstorm together!
To start, you’d probably want plenty of water. We all know that water is a fundamental prerequisite for life. So let’s make crystal clear water in springs and lakes and rivers for drinking and bathing and cleaning and growing plants. Then you’d probably like to have vast seas to hold more water as a source of precipitation to moisten the land. And these seas would also keep the planet cool and generate air movement. They could house infinitely fascinating creatures and would be full of mystery and beauty.
Then you’d want stable land to live on and maybe you’d cover the land with soil – a miraculous substance that would feed the creatures that live upon it and is relatively easy to dig in. It would be smart and beautiful to cover most of the soil with an incredible carpet of vegetation. There would be grasses and other low-growing plants to hold the soil together and blanket it with a lovely softness and a variety of shapes and colors. And why not also make it capable of rippling in breezes and adorning the land with flowers?
You would probably also want taller vegetation – elegant, noble trees. They would offer shade and shelter, create their own ecosystems, and support innumerable creatures. With their spreading, upright growth, they would seem to parallel the human journey, rooted in the earth and rising toward the heavens. All this plant matter would turn sunlight into biological life and provide the planet’s inhabitants with oxygen, food, lumber, clothing, paper, pigments, and nearly everything else we need.
Of course, you’d want to share the planet with a great variety of animals, each of which would be lovely in its own way. They would be fascinating and inspiring and sometimes cuddly. They would be our companions, teachers, resources, and part of a perfect, balanced web of ecology.
You would probably want to make the atmosphere just the right temperature and gas composition for all these lifeforms. It would be super smooth to breathe it. And maybe you’d choose to fill the soil with treasures – metals and minerals to fortify our bodies, and the raw materials for tools, glass, machines, jewelry, and microchips.
If it were up to you, you would make it absolutely gorgeous, right? Maybe you’d choose glorious blue skies that would make you feel free and expansive, and they’d change color in the morning and evening. You’d perhaps fill the skies with an ever-changing display of clouds that would look like swishes and dollops of paint made by a giant paint brush. And they’d provide shelter from the hot sun and would deliver water to the creatures and the land.
For interest, you’d make the land rise up in places to create chains of mountains, some of them covered with snow, and there would be lush valleys and canyons between. You would throw out the occasional rainbow as a sweet surprise. Maybe you’d create some kind of natural laser light show for people to watch at night, called aurora borealis.
Could you imagine if such a place existed?! You would look around at all of it and say, "This is perfect! It’s the greatest imaginable treasure!” And you’d feel lucky and grateful. You’d feel inspired and awestruck. You’d feel in love with the magic and majesty of it all. You’d feel honored to get to live in such a place, and reverent of the power and grace and grandeur evident in such a place. You’d feel taken care of. You’d feel home.
Let’s all remember this and treat the planet like the miracle it is.
Be well,
Peter
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Last week I saw a show by a troop of comedians at a tiny theater in Montana. Though they were talented, I didn’t find myself laughing much at the recurring “battle of the sexes” theme. The men accused the women of being frigid and overly emotional. The women complained that the men need to be mothered and only care about sex. And back and forth it went. Sure, there’s comic relief in sharing about our common issues, but as I sat there seeing men and women cast somewhat bitterly in these one-dimensional ways, I couldn’t help thinking, “Are we really still doing this?”
In my previous article, we looked at the role that attitude plays in the health and sustainability of a relationship. Of course, you can’t make your partner change their attitude, but it’s worth fully exploiting the potential of your own attitude before concluding that the relationship isn’t going to work. One way to be responsible for your attitude is by abstaining from relating your partner as a stereotype.
I believe almost everyone does this to an extent. It’s difficult to banish from our minds the ideas we have about men, women, and humans in general. Even if your partner isn’t a typical male or female, your conditioning can cause you to relate to them based on ideas and experiences from the past. And even when you relate to someone simply based on your ideas about that specific person – rather than whoever they are in this very moment – this may still serve as an impediment to authentic connection.
Practice presence with them. It’s good to start with a relatively casual conversation. Let both parties be innocent – try to enter the conversation without judgment, expectations, or lenses. Who knows what might happen and how you might see the other person if you were to enter the exchange with absolute freshness.
See if you can internally choose when to talk and when to listen. When it’s your turn to listen, don’t think about what you’re going to say next. Just listen. Listen with your ears and eyes and heart. Breathe slowly and fully.
What else is involved in “your work”? Here are some examples:
To the extent that you actively work to resolve past experiences (especially traumatic ones) that infringe on your current ability to show up “cleanly” with your partner, you will benefit.
To the extent that you work to deactivate your “buttons” which cause you to make you react disproportionately to relatively benign behaviors by your partner, you will benefit.
To the extent that you choose to show up in your relationship with as much presence and enthusiasm as you can muster, you will benefit.
To the extent that you take responsibility for your baggage, attitude, communication, and interpretations, you will benefit.
To the extent that you choose to remember and honor your commitment (assuming, of course, that neither party is getting hurt by remaining together), you will benefit.
All these benefits are yours whether or not the relationship survives, and the chances of its survival are so much greater when you’re an active and responsible participant in the above ways. Further, if you’re not in a relationship but want to be, doing your work will make for a healthier relationship when the time comes, and it will also support you to make better choices of who to invite into your life. If you’re not in a romantic relationship and don’t care to be, this work will serve you in all your other relationships, including the one with yourself.
Be well,
Peter
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