Trigger points

I find myself practicing a lot of trigger point therapy these days. I hadn’t planned on specializing in this area, mind you, hadn’t planned on focusing on pain therapy in general, as far as that goes, but the results of TPT can be so dramatic and so immediate that I’m mighty glad I have it in my arsenal.

What they are

For a variety of reasons – trauma, overuse, strain, stress, and god-knows-what – muscles and their connective sheaths (called fascia) can develop localized tender-to-the-touch knots. Interestingly, and one of the challenges for diagnosis, this pain can be referred pain – i.e. show up in an area away from the site of palpitation. Sometimes trigger points announce themselves clearly and sometimes they play ventriloquist.

Treatment

After consulting with a patient and deciding that a trigger point treatment is what they need and the pain is indeed coming from a tight muscle, we get to work. Unlike most other kinds of acupuncture treatment, where patients may not even sense the presence of the needles, a direct an aggressive stimulation of the trigger point is called for. The goal is to get the muscle to twitch. Once I see this happening, I know I’m on target. If it’s a new patient I definitely go easy. After all, it may be the first time they’ve had acupuncture.

Patient responses

Here are some comments the treatment has elicited: “I have been waiting my whole life for that,” “it is like you are scratching my muscle right where it needs it” and “that feels so weird”. (OK, so the last one doesn’t come across so well out of context. But I guarantee he was smiling at the time.)

Patients look forward to trigger point treatments, and some experience such relief they beg me to release more muscles.

My thoughts

I think of TPT as restarting the muscle’s metabolism, reminding it how to function normally. It seems the most common places to hold stress in the body are the neck and shoulders, lower back and hips, and the stomach. No TPT for the stomach, though. But don’t worry. If that’s where the problem lies, we have other therapies to bring to bear. Maybe that’s a topic for next time.

Acknowledgments

I want to thank Matt Callison (at the AcuSport Health Center in San Diego) and William Duarte (OCOM here in Portland) for getting me started on this path.

PS

Western medicine treats myofascial pain with trigger points of its own, and pain specialist Dr. Peter Dorsher of the Mayo Clinic published an interesting article earlier this year comparing them with those of acupuncture.

Another case of East meets West.

The Olympic Games

I had hoped that the news coverage of this year’s Olympic Games in Beijing would yield some insightful stories about health, athletes, and Traditional Chinese Medicine. Unfortunately, a man with 205 needles in his head, each with a flag representing an attending nation, isn’t what I had in mind. Groan.

Beijing and health

The news out of Beijing is dominated by concern over the high levels of air pollution. And even though the Chinese government is desperate to do something about it, there is widespread fear that Beijing’s air will be so bad that it will imperil both athletes and spectators. What a mess.

Asthma

The athletes most likely to be affected by air pollution are those who have asthma. And among those with asthma, the ones most at risk are long-distance competitors. So imagine the plight of Paula Radcliffe, the world record-holder for the marathon, who just happens to have asthma. I don’t know if the Chinese hosts will offer acupuncture to the athletes, but if she were my patient I would first determine if her breathing problems were tied to kidney or lung deficiency and then try to fortify her body in a way that would lessen the impact of pollutants. But the exact treatment would depend on knowing a lot more than I know now, so all I can say here is that I wish her well and hope the dietary regime she has adopted will help.

Exercise-induced asthma

Breathing problems can be brought on by exercise, even for athletes not diagnosed with asthma. Changes in humidity and temperature – as happens when aerobic exercise leads to breathing through the mouth — can trigger EIA. And one would have to assume that irritants in the air would make things worse. I just hope that the athletes have been taking good care of themselves for the past year to ensure their bodies are ready for what they are about to be up against.

The Games

OK, let the Games begin, along with the hourly updates on the quality of the air.

And maybe, just maybe, a glimpse of how Chinese medicine is being brought to bear on the health challenges in Beijing.

On vacation!

Oh my gosh, where does the time go? After an invigorating and exciting beginning of 2008, July has arrived! And I’m ready for some relaxing and goofing around time with my family. For the next few weeks I’ll be a slacker. Well, as much of a slacker as one can be with a family that includes a one-year-old. But that one-year-old needs time to connect with more than one generation of family, so here we come! I’ll be back soon.

As Garrison Keillor puts it, Be well, do good work, and stay in touch.

Pregnancy

OK, this one’s for the women out there who are pregnant or considering becoming pregnant.

Choosing your health team

First, choose an OB who you are comfortable with – i.e you can talk with easily and who listens to what you say. There are many other things to consider, and good advice abounds on the web, so have a look around. WebMD and the March of Dimes are two sites that I recommend. And speaking of recommendations, a local OB that I highly respect is Lisa Johnson at the Women’s Clinic P. C. here in Portland.

Who else should you recruit for your support team? Every mother and every pregnancy is different, so there is no standard answer to this question. Some mothers enlist the help of a doula. Some a massage therapist. Some a midwife. Some an acupuncturist.

Acupuncture and my pregnancy

What does acupuncture have to offer? To start with, and speaking from personal experience, an acupuncture session can be about the most relaxing experience you can imagine. I looked forward to my regular appointments so much! Luckily, I didn’t have many specific symptoms that needed treatment, but the fatigue and stress of daily life are somehow intensified by pregnancy. Finding someone to help me with these was really important. Thanks, Emily; thanks, Brandon (now in Wisconsin – how is the badger state?).

My practice

In my practice I have treated patients for just about every pregnancy-related condition you can imagine, from morning sickness and lower back pain to nasal congestion and numbness in the hands (due to edema, temporary carpal tunnel syndrome can arise.) I recommend early treatment to help with nausea – the sooner it is treated, the better. And, I’ve found that although ginger is helpful for some, for others it makes nausea worse. So in addition to acupuncture, I find myself sharing from the cupboard of take-home tips.

When and how often should appointments be scheduled? This depends entirely on the individual patient. Some I see weekly from the very beginning, some only when a need arises. Like maybe sleeping isn’t as easy as it should be, or leg cramps are a problem, or it’s time for the 20-week ultrasound, or, well, whatever. I’ve treated mothers whose babies were in breech position (the best time to move the baby is 34-37 weeks), and when mothers have come full term, I have helped stimulate contractions. So I’m ready to help at any point, from conception to contraction, so to speak. I used to offer birth support, too, but with my own baby at home now, my schedule isn’t as flexible as it once was. All mothers will understand that!

An unexpected delight

At some point during treatment – I can’t say exactly when – I become aware of the baby as a person. I know all along that the intention of my treatment is to help the mother and the baby, but even so, there’s this moment when I sense the baby. Its pulse can sometimes be felt hovering around the mother’s. (In case you’re new to Chinese medicine, the pulse here is something more than you’re used to thinking of.) And right away I get this sense of connection with a new human being.

Now, I don’t consider myself an overly emotional person, but I have to say that when a mother first introduces me to her newborn baby, I am overpowered by a sense of . . . of what? Connection. Joy. Wonder. Motherhood.