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Last week I wrote about the many reasons we don’t ask for help, including what I think of the “Lone Ranger complex,” where we believe there’s great merit in doing everything by ourselves. Sure, there’s a sense of accomplishment, but we still get that feeling even when we accomplish something with the help of others.
I brought this up because enrollment is currently open for our Sacred Expansion course, which is a group-oriented approach to personal growth. Even though the internal exploration is ultimately up to each of us, we can benefit from being guided through a tried-and-true framework, discussing the experience with people on the same path, and holding hands along the way.
Why is it good to do such things with other people? I’m glad you asked. Here are a few reasons.
- We see that other people have the same stuff we do. We’re not alone in our weirdness or our struggles. It’s relieving to know that there’s little that you’ve thought, felt, or gone through that someone else out there doesn’t share.
- Further, we get to see that most people aren’t alienated by our challenges. While we may tend to fear that the world would disapprove and abandon us if it knew XYZ about us (that we’re insecure, we pick our nose, we aren’t that spiritual, we’re always sucking in our belly, we yell at our kids, we use the code for bulk conventional rice when we actually have a bag of organic rice, we snort bath salts, etc.), the truth is our friends and family are unlikely to be ruffled by any of it. More relief.
- We get the opportunity to be seen in our light and reminded of our strengths. While we may be hyper-focused on our problems and faults, others can help remind us that we’re so much more.
- We get “borrowed benefits” (to use a term coined by EFT-creator Gary Craig) from witnessing and helping others work through their problems. In the process, our own knots may begin to loosen and/or we may get insights that can be applied to our life.
- We get to be of service to others. Giving is receiving. It is as much a gift to us as it is to them.
- We learn from others’ reflections of us. The accuracy of self-reflection waxes and wanes, since we’re always seeing ourselves through a certain lens. Sometimes having someone tell us, kindly and truthfully, what they see in us can illuminate our blind spots. It can be difficult to receive this feedback, but may be instrumental in our development.
- We get to experience true connection. When operating from our default habits, we often relate to each other through many layers of mental static. What may look like a conversation between two humans could actually be … me acting out a personality I’ve constructed based on what I think is most impressive and approval-worthy, relating not to the real you, but to the mental representation I’ve made of you, based on my stereotypes, stories, and past experience of you (acting through your own filtered self). Miraculously, my true Self and your true Self can find a way to connect through all this fog. It’s therapeutic to do so. And it serves to dismantle all the crap that gets in the way.
- It helps cure us of one of the most damaging and widely held beliefs in the world: we’re all separate. The denial of our connectedness, especially combined with the belief that there isn’t enough, is a recipe for suffering. It makes us feel alone, vulnerable, judged, and in competition – rather than collaboration – with the rest of our species. But the more we let others into our life, the less we’re controlled by this belief. This is especially true when we share with others about the very issues that make us feel alone, vulnerable, judged, and in competition.
So, I heartily encourage you to find ways to grow in the company of likeminded others! Sacred Expansion is a good place to start. We created it as a preliminary course for our life coaches-in-training, but it soon became clear that it’s such an important and valuable program that we decided to make it available on its own. It’s about getting to know yourself and your place in the natural world, clearing patterns that hold you back, and reconnecting with your peaceful, trustworthy, essential Self.
Love,
Peter
[post_title] => Get By With a Little Help From Your Friends
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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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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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Last week I wrote about the many reasons we don’t ask for help, including what I think of the “Lone Ranger complex,” where we believe there’s great merit in doing everything by ourselves. Sure, there’s a sense of accomplishment, but we still get that feeling even when we accomplish something with the help of others.
I brought this up because enrollment is currently open for our Sacred Expansion course, which is a group-oriented approach to personal growth. Even though the internal exploration is ultimately up to each of us, we can benefit from being guided through a tried-and-true framework, discussing the experience with people on the same path, and holding hands along the way.
Why is it good to do such things with other people? I’m glad you asked. Here are a few reasons.
- We see that other people have the same stuff we do. We’re not alone in our weirdness or our struggles. It’s relieving to know that there’s little that you’ve thought, felt, or gone through that someone else out there doesn’t share.
- Further, we get to see that most people aren’t alienated by our challenges. While we may tend to fear that the world would disapprove and abandon us if it knew XYZ about us (that we’re insecure, we pick our nose, we aren’t that spiritual, we’re always sucking in our belly, we yell at our kids, we use the code for bulk conventional rice when we actually have a bag of organic rice, we snort bath salts, etc.), the truth is our friends and family are unlikely to be ruffled by any of it. More relief.
- We get the opportunity to be seen in our light and reminded of our strengths. While we may be hyper-focused on our problems and faults, others can help remind us that we’re so much more.
- We get “borrowed benefits” (to use a term coined by EFT-creator Gary Craig) from witnessing and helping others work through their problems. In the process, our own knots may begin to loosen and/or we may get insights that can be applied to our life.
- We get to be of service to others. Giving is receiving. It is as much a gift to us as it is to them.
- We learn from others’ reflections of us. The accuracy of self-reflection waxes and wanes, since we’re always seeing ourselves through a certain lens. Sometimes having someone tell us, kindly and truthfully, what they see in us can illuminate our blind spots. It can be difficult to receive this feedback, but may be instrumental in our development.
- We get to experience true connection. When operating from our default habits, we often relate to each other through many layers of mental static. What may look like a conversation between two humans could actually be … me acting out a personality I’ve constructed based on what I think is most impressive and approval-worthy, relating not to the real you, but to the mental representation I’ve made of you, based on my stereotypes, stories, and past experience of you (acting through your own filtered self). Miraculously, my true Self and your true Self can find a way to connect through all this fog. It’s therapeutic to do so. And it serves to dismantle all the crap that gets in the way.
- It helps cure us of one of the most damaging and widely held beliefs in the world: we’re all separate. The denial of our connectedness, especially combined with the belief that there isn’t enough, is a recipe for suffering. It makes us feel alone, vulnerable, judged, and in competition – rather than collaboration – with the rest of our species. But the more we let others into our life, the less we’re controlled by this belief. This is especially true when we share with others about the very issues that make us feel alone, vulnerable, judged, and in competition.
So, I heartily encourage you to find ways to grow in the company of likeminded others! Sacred Expansion is a good place to start. We created it as a preliminary course for our life coaches-in-training, but it soon became clear that it’s such an important and valuable program that we decided to make it available on its own. It’s about getting to know yourself and your place in the natural world, clearing patterns that hold you back, and reconnecting with your peaceful, trustworthy, essential Self.
Love,
Peter
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