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When I’m counseling clients with marital challenges, my orientation is to always try to save the relationship. Especially if the individuals are interested in growing, becoming more self-aware, and healing old wounds and patterns of dysfunction, there’s nothing like an intimate relationship to facilitate that process. Some of the main recurring themes of our conversations are commitment, intention, and integrity.
I don't mean to provoke blame or shame when I point out that nearly every relationship that ends in divorce begins with two sane and sober people making lifelong promises to each other in front of a room full of loving witnesses. Whether we realize it or not, I believe the essence of what most couples are vowing is, “I’m going to do whatever it takes to make this a healthy relationship.” Over time, we may forget our promise or rationalize breaking it because we’re not happy, we and our circumstances have changed, or the other person is annoying and smelly.
Of course, many people enter such a contract without giving it much thought. They feel in love and assume that feeling is enough. They don’t sincerely consider the inevitability of change, hardship, and annoyance. If only we could impress upon engaged couples how important it is to be completely present in this act of commitment. Forever means forever.
Yes, there are times when it’s best to part ways – especially when there’s abuse or when your partner has withdrawn and has no interest in maintaining the relationship – but most of the cases I see are salvageable; the primary issue is one of attitude. If both parties can recognize and honor the commitment they made, both parties want to save and improve the relationship, and both parties are willing to work at it, the relationship will likely survive and be all the stronger. Further, both people will inevitably grow through the process.
While it may require role modifications, improving communication, prioritizing intimacy, and other outward changes, an important starting point is being real with oneself about one’s commitment. Lifelong commitment implies not entertaining the idea of leaving unless all options for achieving a healthy relationship have been exhausted. But frequently we do think about exiting the relationship when it’s not to our liking, sometimes before we’ve tried much to improve the situation, and this can be a form of sabotage. Even if our partner doesn’t know we’re doing it, when we’re thinking this way – i.e., “I could end it” – we subtly withdraw, and the relationship suffers from it. We’re no longer all-in. The degradation can easily snowball.
When even one member of a relationship is all-in, the chances of success are good. Of course, it’s not healthy or sufficient if one person is consistently all-in and the other is chronically disengaged, but if there’s a loving recognition that the other party’s ability to participate waxes and wanes as they grapple with their own “stuff,” and we don’t take it personally, periods of imbalance are easier to repair. If, on the other hand, we respond to a partner’s deficit of engagement by pulling out in equal measure, we’re acting against the health of the relationship and our own best interests.
In truth, the staying together part is only the most superficial aspect of our commitment. I’m sure you’ve seen unhealthy relationships that were clearly causing both members to suffer, but they seemed to feel there was merit in sticking it out, even if they weren’t actively working to heal it. So, what did we actually commit to? Even if you never put words to it, it’s still possible to do so retroactively.
Whether you’re married, in a committed non-married relationship, or single but interested in a deep relationship, I encourage you to think and write about what kinds of qualities you’re committed to. If you’re currently in a relationship, what kind of attitude do you aim to have toward the relationship and your partner? What conditions tend to degrade your attitude? What helps to strengthen your commitment to show up fully and positively? We’ll explore this more next week.
Be well,
Peter
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A couple weeks ago, I wrote about the differences between acupuncture and “dry needling” to alleviate pain, and in that article I explained a bit about the phenomenon of myofascial trigger points. After I said I believe these are the cause of most of the physical pain humans experience, a number of readers asked me to explain more. For the science lovers out there, I’m going to dive deeper this week.
Besides the most common forms of pain, like lower back and headaches, I’ve had patients with digestive problems, sinus congestion, chest pain, ear ringing, numb hands, painful intercourse, acid reflux, vision changes, and other health issues that were eventually discovered to be due to myofascial trigger points. I believe everyone should know about them and how they work – it could save us a lot of time and worry.
Basically, a trigger point is a small, irritable region in a muscle (or the surrounding connective tissue – “fascia”) that stays stuck in a contracted state, making the muscle fibers taut. This can cause reduced muscle strength and range of motion, pain, numbness, itching, and other forms of dysfunction. Sometimes a trigger point feels like a palpable nodule or “knot,” but to untrained fingers they’re often tricky to find.
A unique property of trigger points is that they’re able to produce symptoms in other parts of the body – from a few inches to a couple feet away. For instance, there’s a trigger point that can form in the soleus muscle of the calf that’s capable of producing pain in the lower back. For this reason, the work of Janet Travell, MD and her colleague David Simons, MD, was groundbreaking. For each muscle in the body, they mapped where trigger points tend to form and what kinds of symptoms they cause.
If you were experiencing pain along the outside of your leg, you might assume that something was wrong with that part of your leg, perhaps with the often-tight iliotibial band (IT band). But this diagram might be helpful. The X’s show where trigger points can occur in a muscle called gluteus minimus above the hip socket. The red shading shows the potential areas of pain that can result. You might not suspect this muscle because, as you can see, there’s no pain at the site of the problem!
There are a handful of mechanisms that can promote trigger point formation, such as irritation of nerves, chronic organ problems, nutritional deficiencies, and autoimmune disorders. Most often, though, the cause is trauma to our connective tissue. When a muscle is strained by being worked too hard, too fast, or beyond its natural range, there is frequently a sort of “recoil” that occurs as segments of the muscle fibers bunch up and remain that way.
This is especially common when someone works out without warming up; when someone does a very ambitious workout after not having exercised for a long time; when someone makes a sudden movement (like reaching out to catch something or trying to stop oneself from falling); and especially when someone does any of the above when in a state of diminished resilience (e.g, when stressed, upset, sleep deprived, eating poorly, etc.).
Even more commonly, the trauma is a form of “postural stress” that’s demanding on muscles in a way that’s difficult to perceive at the time – such as doing the same relatively motionless activity (like sitting at a desk or driving) for hours, days, months, or years. One possible mechanism is known as the “Cinderella hypothesis.” During static muscle exertion – holding a position for a long time, as dentists, musicians, typists, and others engaged in precision handwork do – the body tends to engage a certain group of small muscle fibers, called Cinderella fibers because they’re put to work first and are the last to be disengaged. Even though they’re not doing heavy lifting, these muscle fibers (often in the neck, shoulders, back, and forearms) are continually activated and overworked, which makes them susceptible to trigger point formation.
Whatever the cause, the result is that eventually the muscle never completely relaxes. Muscles are composed of numerous parallel fibers that work together to shorten (contraction of the muscle) and lengthen (the return of the muscle to its relaxed state). Within each of these fibers are many end-to-end contractile units called sarcomeres, and in the case of a trigger point, a group of sarcomeres gets “stuck” in a shortened state. This makes the affected fibers taut and often “stringy” feeling.
To make matters worse, the contracted region clamps down on tiny blood vessels causing local ischemia (inadequate blood supply), reducing in-flow of fresh, oxygenated blood and out-flow of toxins. This leads to a localized hypoxic state (not enough oxygen). The tissue pH changes, local metabolism is impaired, and fluid and waste products tend to build up in the area. This combination of factors ultimately activates pain receptors – it starts to hurt – and when this happens you use the affected muscle less.
Instead, you overload “synergists” – nearby helper muscles. The body makes the surrounding musculature tense as a protective mechanism. Meanwhile, there’s a disruption of the balance between the affected muscles and their “antagonists” – those muscles that lengthen when the primary muscles shorten and vice-versa (for example, the triceps is an antagonist of the biceps). Altogether, this restricts natural movement of the original muscle, which just perpetuates the imbalance. Finally, with longstanding trigger points, the body may deposit gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
The good news is that there are now books, charts, online tools, and practitioners that can help track down likely trigger points that may be implicated in your discomfort. I have such a tool in my online pain relief course, Live Pain Free, and I teach many approaches for deactivating trigger points.
The most basic methods involve simple mechanical disruption of this holding pattern. First, drink some water if you’re not well hydrated. Second, you or a friend can methodically feel around (ideally guided by a trigger point chart) for points that are sore, and ideally that reproduce the very sensation you’ve been experiencing. Third, maintain firm pressure on the epicenter of the point (with a finger, elbow, ball, or other tool) for about half a minute, consciously breathing into the area and intending to let it go, until there’s a palpable release. Then move on to all the other nearby points that are tight and tender and do the same.
This approach is called ischemic compression. By compressing the tissue enough to block blood flow, the body responds with reflex vasodilation, meaning it opens these vessels and flushes the tissue with a dramatic increase of blood. This will usually produce a significant improvement in the pain or dysfunction, though it will typically return sooner or later. These points tend to go from being active trigger points to “latent” trigger points, which have a certain “memory” (not the good kind of muscle memory) and are capable of getting reactivated. For this reason, persistence is important. The best results come from working on a trigger point consistently – usually from one to several short sessions per day (or less frequent if the sessions are intense) – and continuing for a while even after everything seems better.
As I said, this is a most basic approach, and while it’s often effective, sometimes a more nuanced intervention is required. There are many techniques that build on compression. We can replace fixed pressure with slow, deep strokes in the direction of the muscle fiber, as if re-lengthening this segment. We can work the trigger point back and forth across the direction of the muscle fibers. We can combine pressure on the trigger point with engagement of the affected muscle or antagonistic muscles. We can combine manual work on trigger points with topical herbs and/or internal herbs and nutrients that improve circulation and reduce inflammation. We can utilize release points on the same acupuncture meridian as where the trigger point occurs - or complementary points on other parts of the body. And more.
If all of this sounds interesting and relevant to you, I encourage you to do a little research. It might well be the end of a problem you thought had no solution. And if you need more guidance, check out my online course, Live Pain Free, where I go deeper into trigger points and much, much more to help people get out of pain of all kinds.
While I said I believe trigger points are the cause of most of our physical pain, I think it’s worth mentioning there are usually even deeper causes, such as stress and withheld emotions, poor body mechanics, dehydration, and an inflammatory diet. Holistically addressing these issues will lead to a more complete resolution of the condition. Always look at the big picture.
Be well,
Dr. Peter Borten
[post_title] => The Science Behind Our Pain: Inquiring Minds Want to Know
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One of my favorite sections of our Dreambook occupies only two-thirds of a page. It’s about discovering your core values. It’s easy to skip it. I know you could go through life only rarely, if ever, giving a thought to your core values. Or you could complete this part – choosing some appealing words from our list of suggestions, such as kindness, honesty, openness and love – and then quickly forget what you chose and why.
But what if we called them needs instead? What if I said, virtually everything you do is motivated by an attempt to get one or more of these values / needs met, and the same is true for everyone else? How might your communications be different if you could perceive the core values that are driving you and others?
A lot changes when we understand the underlying needs that move us, especially when we’re in conflict. For instance, the other day I was on the phone with a company that had really under-delivered on the large sum we paid for their services. I found myself getting angry and raising my voice even though I realized that the agent I was speaking with probably had nothing to do with it.
As I tuned in to figure out the underlying need that was pushing me, I realized it was fairness. Just to name it out loud felt better. “This isn’t fair,” I said. “It was reasonable to expect your company would do . . . but you didn’t, and then you still charged us the full amount.”
When we hit upon the value at the root of some conflict, we often feel more grounded in the situation – even if the circumstances don’t change. Here are five reasons why:
First, if we’re unaware of the core need behind our upset, we’re usually run instead by our feelings and the belief that things aren’t going our way. As soon as we see the need, there’s clarity: “Ah. This is what I value. This is what’s really driving me.”
Second, when we discover the underlying need and recognize that it’s a value, it’s easy to expand from “I want this for me” to “I want this for everyone.” This gives us perspective that lifts us out of the small feelings that are often engendered by the involvement of our inner child. With regard to fairness, the inner child of course understands “no fair!” from a self-centered point of view, but the mature inner adult grasps big picture fairness in a way that goes beyond one’s personal wants.
Third, it makes us more effective at getting another person to see our point of view when we know the core value that’s inspiring us.
Fourth, we can make rational, direct requests to achieve resolution because we know what we’re aiming for.
Fifth, when we know the need, we can almost always find more than one way to get it met.
I encourage you to consider this perspective when you’re working on the Core Values section of your Dreambook. If you’re having trouble, consider something you feel strongly about and ask yourself, “What would I get out of this?” Keep asking until you get to a refined, one word answer.
If you have about a situation like mine that you feel unsettled about, ask yourself, “What could have been done to resolve this or make it better?” And then ask yourself, “Why would that be better? What would I have?”
Also look at positive motivations. For example: Why do I like running? It keeps me healthy. What else? I release stress. I feel free. I feel strong. I feel connected to my higher self. These are great ways to home in on underlying values. Besides the list of sample core values in the Dreambook, consider these others: Peace. Security. Choice. Freedom. Creativity. Organization. Loyalty. Cleanliness. Clarity. Ease. Justice.
As you go through your day, check in a few times and see if you can discern what needs/values are currently moving you. Let’s try it right now. What motivated you to read this article? What do hope to get out of it? A feeling of peace? A feeling of achievement? Learning or greater self-awareness? Better communication and relationships? Clarity? Whatever you come up with, is that the value itself, or do you need to take it a step deeper to get to the value?
I believe that when we do the work to know ourselves deeply, this not only serves us personally, our clarity also benefits the community around us.
Be well,
Peter
[post_title] => Your Core Values: They Affect Everything You Do
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When I’m counseling clients with marital challenges, my orientation is to always try to save the relationship. Especially if the individuals are interested in growing, becoming more self-aware, and healing old wounds and patterns of dysfunction, there’s nothing like an intimate relationship to facilitate that process. Some of the main recurring themes of our conversations are commitment, intention, and integrity.
I don't mean to provoke blame or shame when I point out that nearly every relationship that ends in divorce begins with two sane and sober people making lifelong promises to each other in front of a room full of loving witnesses. Whether we realize it or not, I believe the essence of what most couples are vowing is, “I’m going to do whatever it takes to make this a healthy relationship.” Over time, we may forget our promise or rationalize breaking it because we’re not happy, we and our circumstances have changed, or the other person is annoying and smelly.
Of course, many people enter such a contract without giving it much thought. They feel in love and assume that feeling is enough. They don’t sincerely consider the inevitability of change, hardship, and annoyance. If only we could impress upon engaged couples how important it is to be completely present in this act of commitment. Forever means forever.
Yes, there are times when it’s best to part ways – especially when there’s abuse or when your partner has withdrawn and has no interest in maintaining the relationship – but most of the cases I see are salvageable; the primary issue is one of attitude. If both parties can recognize and honor the commitment they made, both parties want to save and improve the relationship, and both parties are willing to work at it, the relationship will likely survive and be all the stronger. Further, both people will inevitably grow through the process.
While it may require role modifications, improving communication, prioritizing intimacy, and other outward changes, an important starting point is being real with oneself about one’s commitment. Lifelong commitment implies not entertaining the idea of leaving unless all options for achieving a healthy relationship have been exhausted. But frequently we do think about exiting the relationship when it’s not to our liking, sometimes before we’ve tried much to improve the situation, and this can be a form of sabotage. Even if our partner doesn’t know we’re doing it, when we’re thinking this way – i.e., “I could end it” – we subtly withdraw, and the relationship suffers from it. We’re no longer all-in. The degradation can easily snowball.
When even one member of a relationship is all-in, the chances of success are good. Of course, it’s not healthy or sufficient if one person is consistently all-in and the other is chronically disengaged, but if there’s a loving recognition that the other party’s ability to participate waxes and wanes as they grapple with their own “stuff,” and we don’t take it personally, periods of imbalance are easier to repair. If, on the other hand, we respond to a partner’s deficit of engagement by pulling out in equal measure, we’re acting against the health of the relationship and our own best interests.
In truth, the staying together part is only the most superficial aspect of our commitment. I’m sure you’ve seen unhealthy relationships that were clearly causing both members to suffer, but they seemed to feel there was merit in sticking it out, even if they weren’t actively working to heal it. So, what did we actually commit to? Even if you never put words to it, it’s still possible to do so retroactively.
Whether you’re married, in a committed non-married relationship, or single but interested in a deep relationship, I encourage you to think and write about what kinds of qualities you’re committed to. If you’re currently in a relationship, what kind of attitude do you aim to have toward the relationship and your partner? What conditions tend to degrade your attitude? What helps to strengthen your commitment to show up fully and positively? We’ll explore this more next week.
Be well,
Peter
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