For many consumers, the current economy is weeding out all but the most essential products and services. If this trend is reducing your current massage volume, consider offering treatments your patients will find essential rather than just “nice to have.” Relief of muscular pain and dysfunction is one thing most patients are desperate to find at some point in their lives.
We’ve been treating muscular pain for 24 years in Chicago, Illinois, and it still astonishes us how often chronic pain falls between the cracks of modern medicine. All too often, physicians rely on the time-worn options of muscle relaxers, pain-killing drugs or, when nothing else works, surgery. A big problem is lack of awareness of “referred pain,” from muscles and methods needed to eliminate it.
Referred pain was first defined by Dr. Janet Travell and Dr. David Simons, in their groundbreaking work, Myofascial Pain and Dysfunction: the Trigger Point Manual. “Referred pain” simply means the dysfunction is in one muscle but the pain is felt in a different area of muscle, bone or skin. So when it hurts in one place, the cause of the pain is not from that same location. For example, to effectively treat symptoms associated with Pseudo-Carpal Tunnel Syndrome (pain, numbness, weakness or tingling in the thumb and fingers), it’s sometimes necessary to treat the anterior and middle scalene muscles in the neck. Or to relieve pain in the sacroiliac joint, it’s often necessary to treat the lateral soleus muscle in the calf.
The source of this referred pain is to be found in irritable tight spots in the muscles known as “trigger points.” Knowing how to locate and deactivate trigger points is one of the most reliable and effective ways to relieve chronic and acute muscular pain—and there are comparatively few practitioners with the requisite skills.
Massage therapists are, by far, the most appropriate practitioners to acquire and develop these skills. Well-trained massage therapists bring an extensive knowledge of muscular anatomy, have good hands-on skills and are good at listening to patients. These are all important prerequisites for effectively treating myofascial referred pain.
Trigger points have an even more direct relevance for massage therapists. One of the biggest problems in our profession is our own pain and dysfunction (often repetitive overuse injury sustained in treating patients). So, myofascial trigger point therapy has a double value: It can improve career longevity and increase treatment value (and price).
A full understanding of myofascial trigger point treatment protocols will give you the skills to effectively treat such disparate conditions as:
• TMJD (Temporomandibular Joint Dysfunction)
• CTS (Carpal Tunnel Syndrome and Pseudo-CTS)
• Tennis Elbow
• Mouse Arm
• Sports Injuries
• Frozen Shoulder and
• Low-Back Pain.
A complete understanding of the field will also acquaint you with structural problems that often go undiagnosed and can be the principal perpetuating factor in severe chronic pain. Such problems include small hemipelvis, short upper arms and long second toe (aka Morton’s or Rothbart’s Foot Syndrome). These are easily detected and corrected, but many people go through their entire life without being aware they have them.
If you decide to pursue this field seriously, there’s another element you’ll need to learn, one critical for both you and your patients: self-care training. Most patients with long-standing chronic pain need at least daily treatment, sometimes several times a day. And it’s not practical to expect patients to come to you daily for treatment, even if they can afford it. The way around this is to empower patients, teaching them how to use self-care tools (read “Some Commonly Used Self-Care Tools for Treating Myofascial Pain“) you can provide, which will improve and speed their recovery. And don’t worry about losing patients because you’re teaching them how to relieve their own pain—there’s plenty of pain to go around. You’ll benefit so much more from friends and relatives referred to you over the years.
If you’re willing to take the time needed to fully master the skills of myofascial trigger point therapy, you’ll be able to:
• Resolve long-standing pain problems for you and your patients,
• Teach your patients how to treat themselves, and
• Improve the value (and price) of your treatments.
We treat patients who’ve spent thousands of dollars and sometimes years searching for relief. As an example, a few years ago, a patient came in suffering from “golfer’s elbow” (chronic pain on the inside of the elbow) so severe he could not pick up his toddler. Over three years, he had consulted several respected physiatrists and physical therapists with no relief (they were mainly strengthening his rotator cuff). He was desperate when he called us. As it turned out, he had referred pain from his pectoralis major and anterior serratus muscles. The pain and dysfunction were markedly reduced after one treatment, and over the next two months, we were able to completely resolve the problem.
“I’ve personally seen countless cases in which myofascial pain turned out to be the decisive element in chronic pain syndromes, such as migraine, neuropathic pain, arthritis and disc herniation. And time after time, when the myofascial pain was treated, the presenting problem was either eliminated or very greatly eased in frequency and severity of symptoms,” said Dr. Bernard Filner.
It may seem strange, but chronic muscular pain is pretty much a black hole in the medical landscape. In these circumstances, massage therapists with sufficient training in myofascial trigger point therapy can provide solutions for millions of people who are living with chronic pain. If this field interests you, consult the web site of the National Association of Myofascial Trigger Point Therapy (www.NAMTPT.org) for training programs that may be convenient for you.
In the future, we’ll take a look at basic treatment techniques appropriate to chronic pain in different parts of the body, and in an upcoming article, we’ll discuss keys to effective treatment of low-back pain.
Sharon Sauer is a Certified Myofascial Trigger Point Therapist and licensed massage therapist, practicing in Chicago, Illinois, since 1986. From 1988 through 1994, she assisted Dr. Janet Travell, who was President Kennedy’s personal physician. Dr. Travell and Dr. David Simons co-authored Myofascial Pain and Dysfunction: The Trigger Point Manual (Volumes 1 and 2). Dr. Simons calls Sauer “a fellow pioneer in the field.” She is now writing a book on low-back and buttocks pain. Since 1994, Sauer has offered weekend seminars in Chicago, covering soft-tissue pain throughout the body over 12 months. For more information, call (773) 583-4145 or visit www.myopain.com.