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Trigger Point Therapy Part One

March 7, 2012 Written by JP       [Font too small?]

The November-December edition of the journal Pain Research and Management describes a sad state of affairs that many patients and physicians are frustratingly aware of: “Despite many recent advances in the past 40 years in the understanding of pain mechanisms, and in pain diagnosis and management, considerable gaps in knowledge remain, with chronic pain present in epidemic proportions in most countries.” An underutilized resource known as trigger point therapy may very well help fill some of these noted gaps. And, there’s nobody better to address this potential avenue of healing and recovery than Valerie DeLaune, LAc.

When seeking an authority on this topic, I reached out to Valerie, in part, because of her outstanding credentials – she has a Master’s Degree in Acupuncture from the Northwest Institute of Acupuncture and Oriental Medicine, a Bachelor’s of Science from the University of Washington, and certifications from the Brenneke School of Massage and Heartwood Institute. But, what’s even more impressive is that Valerie is the go to person for health professionals who want to incorporate trigger point therapy into their own practices.

JP - How does trigger point therapy differ from other forms of body work such as acupressure and massage?

Valerie - I could write a book on just that one topic, but I’ll try to keep it brief. Trigger point therapy is a protocol, not a technique. Massage is a technique that can be used to treat trigger points. Needling either with acupuncture needles or hypodermic needles is also very effective as a technique. The defining difference with treating trigger points as opposed to massage or acupressure, is that no technique (whether massage or needling), will be effective unless it is applied in the correct place.

Trigger points refer pain, and over 74% the time, they are remote to where the patient feels symptoms. Dr. Janet Travell started mapping these pain referral patterns in the 1930’s, and these maps give us a starting point of where to search for trigger points. It is important for any kind of practitioner who treats pain to add this information to their knowledge base; they need to learn to check several specific muscles for the trigger points that are the potential source of symptoms.

For example, pain felt on the outside of your lower arm may be coming from a muscle in that area (the brachioradialis), but it may also be coming from a trigger point located in a muscle higher up, such as in the front of the neck (the scalenes), underneath the collarbone (the subclavius), or the back or top of the shoulder (the infraspinatus or supraspinatus). Familiarity with referral patterns gives us a starting point of where to look for the trigger points that are actually causing the pain.

As a Traditional Chinese Medicine acupuncturist, I select acupuncture points based on the patient’s particular collection of symptoms, and if I am treating pain, I also search locally for tender points, known as “ashi” points. There is no body of knowledge in traditional Asian medicine diagnosis and treatment strategies that contains the concept or referral patterns, and tells the acupuncturist which muscles to search for “ashi” points that are remote to the area of pain. That means that about 74% of the potential trigger points would be missed using a traditional point selection protocol.  An acupuncturist who adds trigger point referral patterns to their point selection process can have an extremely high success rate.

JP - Can trigger point therapy provide pain relief in those who have failed to find adequate results with other alternative and complementary procedures?

Valerie - Absolutely, for the same reason given above. If the practitioner doesn’t know which muscles to search for trigger points, then treatments will not be anywhere near as effective. Keep in mind that many people who had some brief exposure to trigger points in school may also not understand this concept adequately, but may think that they are well-versed in trigger point treatment when in fact they are not.  This does not mean that trigger point therapy does not work; it just means that many practitioners need more training than they received in school.

JP - Which conditions and diseases are most helped by trigger point therapy? Are there certain health concerns that generally do not respond well to trigger point manipulation treatment?

Valerie - About 75% of pain is caused by trigger points. The primary symptom of trigger points is referred pain, so typically that is what I would be treating with trigger point therapy. Trigger points may also cause other symptoms, such as tinnitus, dizziness, tooth sensitivity, urinary frequency, menstrual cramps, carpal-tunnel-like symptoms, angina-like symptoms, and diarrhea (which also of course can have many other causes aside from trigger points). Most people seeing a massage therapist probably wouldn’t be coming to them for one of these conditions as their primary symptom. But it’s important that a massage therapist know what other symptoms trigger points cause besides pain, because they may help resolve a problem that up to this point has been mysterious, and also it helps the massage therapist narrow down which muscle might contain trigger points that are causing the patient’s pain. As an acupuncturist, someone might be coming to me with their primary symptom being something besides pain, so I always consider trigger points as one possibility for non-pain symptoms.

Conversely, there are conditions that cause pain that are not trigger points, such as appendicitis, cancer, spinal disc problems, and torn tendons, so you also can’t just assume all pain can be resolved with trigger point therapy. (This is called differential diagnosis – distinguishing the possible causes of pain and disease.)

Active Trigger Points Are Prevalent in Those with Chronic Shoulder Pain

Source: BMC Musculoskeletal Disorders 2011, 12:139 (link)

JP - Are there different varieties of trigger point therapy? If so, are certain forms more effective and/or safer than others?

Valerie - As noted above, there are different techniques for treating trigger points.  The practitioners most likely to have received training in trigger point therapy are physical therapists, occupational therapists, and massage therapists, and they typically would be using pressure for 8 seconds to one minute and/or repeated stroking to treat the trigger points (known as “manual techniques”). These are typically the practitioners that sign up for my continuing education trainings.

Dr. Travell and other doctors have traditionally used hypodermic needles and injected some kind of numbing agent. This is very effective, but it’s also painful, and due to the size of the needle it slices through the muscle tissue. The tissue then repairs with connective tissue, and the cut muscle fibers are no longer available for use.  There also aren’t a large number of doctors who are trained in injecting trigger points.

Acupuncture needling is as effective as hypodermic needling, is usually painless except for some occasional stinging, and the needles are so narrow that they don’t cut the muscle fibers. A greater number of trigger points can be treated in one session than can be treated with hypodermic needles, needles can treat muscles at deeper layers than massage and relax the muscles more quickly, and many of the underlying causes of the patient’s trigger points can be treated using traditional diagnostic techniques, acupuncture point selection, and herbs. The only downside is that very few acupuncturists are trained in trigger point location and perpetuating factors.

All of these techniques are safe as long as the practitioner is operating within the scope of their practice/training. The most likely potential side effects are bruising, which usually only happens with people who already tend to bruise easily, or soreness from the treatment. I tell my patients that if their soreness (from massage) lasts for more than one day, their practitioner needs to go lighter, or if they are doing self-help techniques, we need to adjust their technique.

In part two of my interview with Valerie DeLaune we’ll discuss her views about how one can self apply trigger point therapy, the scientific evidence supporting this “alternative” modality and ways to find a skilled trigger point therapist in your area. In the meantime, I encourage you to visit Valerie’s site to learn more information about natural pain management and the various products and services she offers for both health consumers and medical professionals.

Be well!

JP

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6 Comments & Updates to “Trigger Point Therapy Part One”

  1. Paul F. Says:

    Hi Jonn Paul,

    I am so trilled about your choice for this interview which can help many people to realize that they can help themselves to relieve pains originating from trigger points in a simple way, made easy to learn!

    As you know I was a mechanical engineer but five years ago, after retiring at 73 years old, I took an interest (for my own family benefit) in Physical Therapy and Exercises to attempt to prolong a good quality of life.

    My wife is trim, very active and healthy but suffers stoically from headache, back neck and upper back pains and occasionally, hip, legs pains. I wanted to help her and four years ago I discovered The Trigger Point Therapy Workbook written by Clair Davies, based on Dr Janet Travel years of research. I found Clair’s book very useful, but at times it did require quiet a bit of exertion to practice the stroking of the trigger points as a therapist. The amount of time required was at times discouraging. Clair’s approach to self therapy did not suit my wife’s inclination. However at times I was very successful at treating her.

    One week ago I discovered some new and simple protocols in the Trigger Point Therapy for Headaches and Migraines by Valerie DeLaune, L.Ac. It has given me new opportunities to perfect both my techniques and possibly provide a stimulus for self therapy for my wife. Valerie’s techniques are simple, clear and well explained. I think her treatment is thorough including pointers on nutrition and supplements too. Her books and CDs can be a valuable tool!

    I am intrigued by Valerie’s emphasis on applying pressure on the trigger points within precise intervals between 8 and 60 seconds. This technique contrasts with Clair’s emphasis on Short and Slow series of Strokes.

    I could use some guidance whether the stroking can be omitted or perhaps reduced as a follow up when necessary after the short pressure application.

    I am impressed by Valeries’s original techniques of self help and exercises such as applying pressure to the temporalis while opening the jaws illustrated in her book on page 110. It seems like in this case a little stroking is generated by moving the muscle in relation to the pressure point! This technique probably can be used on for other muscles too!

    I would appreciate if Valerie will be so kind to respond to my inquiries. Thank you in advance! Thank you for the great books!

    John Paul: Again compliments for disseminating great information. Many baby boomers will benefit! Keep up the great job!

    Paul

  2. JP Says:

    Thank you, Paul!

    I just corresponded with Valerie. Her schedule (presentations, seminars, etc.) is packed at the moment. But, I think she may be able to drop by next week to address your inquiries.

    Be well!

    JP

  3. Paul F. Says:

    Hi JP,

    I am anxious to hear Dr Valerie’s responses.

    Also if possible I would like to know if Dr Valerie has had opportunity to evaluate the usage of a percussion deep tissue massager as a practitioner and patient friendly approach to dissolve trigger points.

    Obviously the treatment will have to be followed by a thorough education of the patient to maintain the healing results through adequate exercise, avoidance of perpetuating factors, dietary and supplemental protocols.

    One of the proponents of this approach is Dr Graeme from Australia.

    He created a U-tube video where he describes the use of a hand massager he apparently developed and sells. The link is http://www.youtube.com/watch?v=sGL4wF8GHug

    I think if this approach works it could become a way to disseminate the therapy hopefully in the hands of well trained professionals, rendering their services more affordable and faster. Lengthy treatments may be discouraging patients therefore decreasing the popularity of this therapy. I hope this is a valid step in the right direction!

    Thank you, Dr Valerie for attention to these questions!

    Thank you JP for your contribution to disseminate the knowledge of this therapy that can help many people.

    Paul

  4. Paul Fanton Says:

    Hi JP,
    I am anxious to hear Dr Valerie\’s responses.
    Also if possible I would like to know if Dr Valerie has had opportunity to evaluate the usage of a percussion deep tissue massager as a practitioner and patient friendly approach do dissolve trigger points.
    Obviously the treatment will have to be followed by a thorough education of the patient to mantain the healing results through adequate exercises, avoidance of perpetuating factors, dietary and supplemental protocols.
    One of the proponents of this approach is Dr Graeme from Australia.
    He created a U-tube video where he describes the use of a hand massager he apparently developed and sells.
    The link is http://www.youtube.com/watch?v=sGL4wF8GHug
    I think if this approach works it could become a way to disseminate the theraphy hopefully in the hands of well trained professionals, rendering their services more affordable and faster.
    Lenghty treatments may be discouraging patients therefore decreasing the popularity of this theraphy.
    I hope this is a valid step in the right direction!
    Thank you, Dr Valerie for attention to these questions!
    Thank you JP for your contribution to disseminate the knowledge of
    this therapy that can help many people.

    Paul

  5. Valerie DeLaune, LAc Says:

    Hi Paul, there are many techniques that successfully treat trigger points. When I was still doing Neuromuscular Therapy, I used a combination of stroking and holding pressure. Now as an acupuncturist, I use needles. I haven’t used the device in the U-tube video, so I can’t speak from personal experience.

    Applying any technique in the correct place is the key. The self-help techniques I developed were to get the muscles in as passive a position as possible (most often by laying on balls,) and to truly allow self-help, and not require that someone else apply a technique (with the exception of the multifidi, the tibialis posterior, and the pelvic floor muscles.)

    Resolving pain definitely takes time no matter which technique you use, as there are usually many underlying factors to address. I personally hate being in pain, so for me it’s worth it to spend the time relieving it.

    Valerie

  6. Paul F. Says:

    Hi Valerie,

    I appreciate your response.Thank you.

    I am encouraged to follow your guidance.
    I agree with your views and values. I hope to be able to make progress in my modest area and will share my findings through Healthy Fellow.

    My best regards,

    Paul

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