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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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When I first delved into cognitive behavioral therapy (CBT) as a psychology major, I remember thinking, “This is an evolution for humans.” CBT focuses on examining and challenging one’s thoughts and beliefs, changing related behaviors, and building coping skills and emotional regulation.
Of course, there is a long philosophical tradition of examining the nature of human thought and behavior, but the advent of cognitive and behavioral psychology in the past couple centuries infused these concepts into mainstream culture in a profound way. It’s now common for people to talk about their thoughts as something separate from themselves, and to routinely employ behavior modification techniques in all areas of life.
I had a mentor in my early 20s who was a big advocate of CBT, and at the time I told her I had been exploring methods for healing the memories of traumatic events. I felt both rebuffed and inspired when she said, “You’re wasting your time. We don’t need to go back and relive our childhood or spend the rest of our life lying on some shrink’s couch analyzing everything that ever happened to us! All that matters is, right now, are you going to be at the mercy of your thoughts and automatic behaviors, or are you going to manage whatever comes up in a conscious, intentional way?”
I’ve thought a lot about this in the decades since. My mentor was of the mind that we don’t need to figure out why these painful or dysfunctional patterns keep coming up, we just need to change our response to them, and eventually we’ll transform our psychological makeup in a permanent way. I believe there is real value to this approach, and also . . . sometimes I think we need to go back.
When it comes to our healing and growth, here are three good reasons to revisit your past:
(1) If you’re constantly managing your response to a recurrent pattern, it might be more efficient to get to the root of the pattern and dismantle it (or at least mitigate it) so that it doesn’t come up much, if at all. Of course, you can also use cognitive and behavioral strategies if it does arise.
(2) There is potential for deeper self-awareness, insight, and growth through visiting your past and coming to understand the factors that went into making you who you are. These are opportunities to forgive, correct misunderstandings, reframe our stories, and revise or erase beliefs. While it’s totally possible for many people to be happy without going there, it’s probably not possible to be self-actualized without making peace with your past.
There are some caveats. Analyzing your past can be taken to a self-indulgent degree. It can retrigger old trauma. And most common, it can make us feel worse as we work through it (and experience it without resistance, perhaps for the first time) – though this usually gives way to greater freedom. Thus, it’s important to do this work when you’re feeling relatively stable, with a clear sense of why (what you hope to accomplish), and with the tools and/or support to do it in a way that’s likely to turn out well.
(3) Finally, some people seek total liberation from our programming, i.e., the ego. Once this urge awakens in us, it often never goes fully back to sleep. If you’re in this boat, you may find value in recapitulation.
I read about recapitulation in a Carlos Castaneda book when I was 18 and it seemed unfathomable. Castaneda, a Peruvian anthropologist-turned-apprentice of shamanism, was instructed by his teacher to write down his entire life story, from his very earliest memories, including every person he had ever met. This process, he was told, was necessary to free him from his worldly attachments. It took him years. I remember thinking, “I could never do that.”
Since then, I’ve encountered various forms of recapitulation in my other studies of shamanism, and I now feel it’s more doable than I previously believed. Could it take years? Absolutely. But you’ve got time, and it’s not an all-or-nothing proposition. Every time we release some piece of baggage, it’s like dropping a sandbag from a hot air balloon. We’re that much lighter and freer – even if we’re not “done.”
As we go through our history, we find countless moments that have a certain weight or charge. They exist in a state of incomplete resolution. Taken together they have a powerful influence on how we show up in the present. They can make us dwell in the past and fear the future. They can cause us to live within a fraction of the spectrum of what’s possible. In short, they limit our freedom. As we loosen our history’s grip on us, we thus loosen the grip of our ego, and we more readily access our true essence and potential.
I stumbled upon my own recapitulation process while doing somatic releasing practices. In a nutshell, all our history with a charge – everything that doesn’t sit neutrally in us – can be experienced through the body. There is a physical expression and felt experience to all of it. And in willingly visiting it, experiencing it without resistance, and accepting it, we promote its resolution.
If this is unfamiliar territory for you, just try this: Bring up something about your current life or your past that you wish were different. While holding this in mind, expand your awareness to include what you feel in your body. You will perceive a certain unease. As you meet it and even invite it, the unease loosens. (Sometimes this takes a little practice, especially if you’re not accustomed to feeling your feelings. If you’re interested in diving deeper into this process, check out our workbook called Freedom.)
When we do this work we inevitably find layers of holding. We release one layer and discover another layer, and so on. In my case, I began to recognize the layers faster than I could process them, so I started writing them down. Hundreds of cords, linking me to my past, pulling on me, distorting my present self. The list grew at the same rate that I crossed things off it. I’m not nearly done, but I feel much lighter.
I’m not saying a person can’t show up in a clean and authentic way until they release every conflict or resentment they’ve ever had. What I mean is that a thorough recapitulation facilitates ego liberation – something that’s beyond the scope of CBT and, frankly, not of interest to most people.
In my own process, I found that I was sometimes inspired to move my body in certain ways to assist the release of a sticky pattern, which is an integral part of some somatic therapies. Interestingly, it’s also a technique used in shamanic recapitulation. As Sandra Ingerman and Hank Wesselman explain in their book, Awakening to the Spirit World, we can facilitate the “unraveling” of a memory (or the emotional charge attached to it) by spinning. This can also be accomplished by turning the head or twisting the body from side to side, and the authors say they believe this is also why EMDR (Eye Movement Desensitization and Reprocessing) works. They recommend spinning or turning while breathing deep into the memory and its associated emotions, accepting it, and intending to release it.
I believe recapitulation also occurs to some extent automatically, especially when we’re ready for it: in dreaming; in meditation, when we are sometimes spontaneously presented with something from the past that needs to be “cleared”; in yoga and exercise; and very often under the influence of entheogenic (psychedelic) substances, especially when used intentionally as medicine. This is why psilocybin mushrooms are rapidly gaining a reputation as one of the most effective therapies for attaining peace at the end of life.
I’m curious to hear from readers about your experience with the different approaches I discussed. Have you used CBT, and did it help? Have you dug into your past to heal yourself? What methods did you use, and how did it go? Have you done a large scale recapitulation? What was the outcome? Please share.
Be well,
Peter
[post_title] => Are You Willing to Go All the Way Back?
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In my early 20s I had a boss who would ask me every morning, “How goes the battle?” I had never heard that expression before, but recognized that he meant, “How’s it going?” At the time I was learning about neuro-linguistic programming and becoming attuned to people’s word choices, so it struck me as an interesting – and loaded – phrase. Then I began to notice how common it is for people to characterize life as a fight – an ongoing series of conflicts, something we need to slog through, with a risk of imminent danger and an us-versus-them mentality.
Even if we see ourselves as winning the battle, if we hold this perspective, there’s still a chance of getting ambushed, right up to the last minute. So, we must always have our guard up, sleep with one eye open, check our drink for poison, and so on. It causes chronic stress, and we’re never entirely free.
Meanwhile, there are people who see life in a more positive light – as a game, a gift, an opportunity to explore, connect, experience, and be of service. Are they naïve? Are they less successful? Are they blindsided by the unexpected? I don’t believe so. If anything, because their perspective isn’t innately stress-inducing, they have greater resources for adapting to whatever comes.
I encourage you to examine your relationship with the world. How would you sum up your story? What kind of words do you use, both to others and yourself, when you talk and think about your challenges and ambitions? How do you feel about others aiming for the same goals as you? What sorts of bodily feelings go along with this? For extra support in re-wiring yourself, check out our workbook, Freedom, and try doing it for a month.
If you do find that you’re harboring a “battle” mentality, I wonder if it’s possible for you to symbolically wave the white flag, saying to the world (and yourself), “I’m not at war with you.” I know the stakes feel very high sometimes, but what if. . . (1) you could clearly see that being in ongoing conflict is more detrimental than it is beneficial to you, and (2) you had an unwavering link to something you could trust, an assurance that you are fundamentally okay, no matter what.
We often speak of rousing our inner warrior and the term “warrior” comes up a lot in self-help books. The warrior archetype is deep in our collective consciousness. Everyone knows it. And there’s a good side to it. Often, we evoke the warrior archetype when we wish to inspire ourselves to be clear, sharp, and disciplined, to stand up for our values, to protect those in need, to be brave, to have integrity and honor. But the other side of being a warrior is, of course, that you’re at war.
How can we embody these virtues without the sense of perpetual conflict? We live according to archetypes all the time – father, mother, husband, wife, cop, healer, good guy, bad guy, peacekeeper, curmudgeon, artist – mostly without realizing it. The first step is to become aware of the archetypes we’re subconsciously abiding by. Just making it conscious starts the process of releasing us from an archetype’s limitations.
Second, we can begin to forge a picture of something better and freer than any single archetype – our own Highest Self. Who would you be if you were clear, lighthearted, determined, loving, creative, peaceful, spiritual, purposeful, artful, present, honest, forgiving, kind, and brave?
Contrary to what your mind might say, that’s not too many virtues for one person to possess. You’re already somewhere on the spectrum of embodying every one of them. Whatever you dub this most-evolved you – Highest Self, Noble Leader, Queen/King, Divine Being, etc. – know that this is something you can freely choose at any moment.
Spend some time visualizing and feeling into this Highest Self. Imagine that she/he is just waiting for permission to step into the driver’s seat. When your small mind takes over and your habits run you, the Highest Self is nudged into the backseat. It may take some conscious surrender to let go of your default program and allow the better You to be in charge.
Another visualization you might find useful is to see yourself in the center of a circle of many different versions of yourself – all the possible ways you could be. Look around and see if you can spot the one that is the clearest, highest expression of your virtuous essence. Make a choice, and step into that Self. Try doing this every morning for a week and see what changes.
Be well,
Peter
[post_title] => Be Better Than A Warrior
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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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