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Myotherapy of Santa Fe
- Rose Kahn
Definition of
MYOTHERAPY
Trigger
Points & Myofascial Pain Syndromes
Myofascial
pain syndromes are characterized by the presence
of hypersensitive areas called trigger points in muscles or the
fibrous membrane (fascia) that covers them. Trigger points may
originate when muscle tissue is subjected to excessive strain
or abrupt stretching. When stimulated, these trigger points cause
a specific syndrome of pain, muscle spans, stiffness and weakness
both locally and in distant target areas. This referred pain may
occur in seemingly unrelated parts of the body, but the pattern
is consistent from person to person. The more common forms of
the referred pain syndrome have been mapped anatomically. Once
established, trigger points can be activated by often seemingly
minor physical or emotional stresses.
Trigger
points have been implicated in a variety of pain phenomena, including
muscle pain (myalgia), muscular (non-joint) manifestations of
arthritis, muscle inflammation (myositis or myofascitis), and
inflammation of the white fibrous tissue that comprises muscle
sheaths and fascial layers of the whole muscle, joint, tendon,
ligament system (fibrositis or myofibrositis). Trigger points,
particularly those found in the upper regions of the back and
shoulders, are often associated with palpable nodules of fibrous
tissue. Physiologically, they form a self sustaining cycle of
pain, more spasm, more pain. This vicious cycle may be interrupted
at the sensory (afferent) or at the motor part of the mechanism.
Trigger point compression, dry needling or injection of an anesthetic
solution will intervene at the sensory level, possibly by stimulating
brainstem production of enkephalins and endorphins. The result
is a palpable softening of tense muscle tissue, signaling muscle
relaxation and pain relief which may last for days.
Myotherapy:
The Trigger Point Compression Technique
Myotherapy, the trigger point compression technique, was developed
and reported by Bonnie
Prudden in 1980. A well known physical fitness expert, Prudden
was familiar with the trigger point injection technique long promoted
by Janet Travell, White House physician during the Kennedy administration.
Prudden made the serendipitous discovery that manual compression
of offending trigger points for a period from 5 to 7 seconds was
equally effective in bringing about muscle relaxation. This approach
had the advantage of being non-invasive, and multiple trigger
points could be “erased” at the same sitting. Prudden
then complemented the technique by including her own corrective
exercise program: First, shortened and weakened muscles are reeducated
to revert to their normal resting length, then progressive strength
training helps lead to gradual return of normal function. Compression
of trigger points is slightly painful, but as soon as the pressure
is released the pain subsides. After a group of related trigger
points has been inactivated, the muscle is gently stretched. The
sequence of trigger point compression and passive muscle stretching
continues throughout the treatment.
At
the end of the treatment, active range of motion exercises are
begun. Furthermore, because of the simplicity of the technique,
a patient’s spouse or friend can easily be taught to administer
Myotherapy to key trigger points at home in between scheduled
sessions. Hence, Myotherapy combined with the corrective exercise
program effectively interrupts the pain, spasm, pain cycle at
both the sensory and the motor levels.
The
Corrective Exercise Program: Key to Permanent Pain Relief
The corrective exercise program component seems to be the key
to long term pain relief achieved over a short period of time.
Exercise has indeed long been used for pain control. It is a known
mood elevator and allows patients to become actively involved
in their recovery. But it is also true that for many patients
with pain due to active trigger points, exercise is initially
not a viable option. However, once the pain factor is removed,
most people will find exercise enjoyable.
The
homework exercise program is tailored to the individual needs
of each patient and includes progressive range of motion exercise
(warm ups), muscle strengthening and flexibility routines. These
Bonnie Prudden exercises are easy to perform, should not elicit
any pain, and are to be done frequently throughout the day, preferably
to music. The exercises are reviewed during each session. Towards
the end of the treatment program, patients are coached to engage
in a regular physical fitness activity such as walking, swimming,
water exercises, etc., appropriate to their lifestyles. The exercise
program is thus the key feature distinguishing Myotherapy from
other pain relief methods, such as trigger point injection, application
of the TENS unit, and acupuncture, which focus mainly on modulating
sensory inputs.
Myotherapy:
A Successful Approach to the Challenge of Pain
The simplicity of Myotherapy which involves neither drugs nor
surgery is especially remarkable when the severity and disabling
nature of many of the myofascial pain syndromes is considered.
Persistent intractable pain will increasingly dominate a person’s
life, leading to depressive behavior, economic deprivation and
disruption of family dynamics. Therapeutic drugs often have undesirable
side effects, and surgery is usually unsatisfactory for long term
control of myofascial pain syndromes. In the continued search
for treatment and relief of chronic pain, the patient encounters
alternating cycles of hope and despair and eventually halts all
expectation of ever being able to lead a normal life again. Thus,
by the time Myotherapy has become a treatment option, (Myotherapists
accept patients by physician referral), considerable emotional
support may be needed to rekindle the motivation to get well.
Yet, some 85% of our patients, regardless of their presenting
problems, experience substantial pain relief over a short period
of time and are able to resume productive lives. In our patient
population, the median number of treatments is five. Most patients
fall into a range of between three to ten sessions, with a few
located at either end of the spectrum.
It
appears that the required length of treatment depends as much
on a person’s previous state of physical fitness and motivation
to perform the prescribed exercises as on the severity and duration
of the presenting problem. We also have found that certain medications,
notably antidepressants, tranquilizers, muscle relaxants, and
narcotics interfere with Myotherapy. Side effects of Myotherapy
seems to be limited to occasional bruising and residual soreness.
At this stage, Myotherapy is largely an empirical treatment modality,
but given the similarities to other sensory methods of pain control,
such as use of the TENS unit, acupuncture and trigger point injection,
similar underlying neural mechanisms may explain their pain relieving
effects. The uniqueness of the Myotherapy approach lies in the
exercise component. Since the technique is not only comprehensive
but also simple and relatively free of side effects, it is to
be hoped that Myotherapy will find its place as a first line method
for control of chronic pain syndromes. |
