Four Case Histories
To a National Board Certified Myofascial Trigger Point Therapist, Myofascial Trigger Point Therapy (or, as it is sometimes mistakenly called, myofascial release) is not just a treatment modality, but an entire treatment protocol. The first step of that protocol is an in-depth history of all relevant traumas experienced by a person’s body. To what degree is trauma relevant? Briefly, I’ll cite an example.
Physical Therapist, John, suffered with chronic right knee pain. In taking an initial history, John insisted he never suffered any trauma to the right knee. I persisted. Later, as he lay on my treatment table visibly perturbed by my persistence, he explained that when he was 12 years old, he fell off his bicycle and landed on his right knee. “But that was over thirty years ago. What’s that got to do with my knee pain?”
A very close examination of the texture of the skin over the patella revealed a tiny scar approximately 1/8 of an inch in diameter. With the leg fully extended, I began to test the mobility of the patella. I found that it moved about an axis whose center was that tiny scar. As I held the patella superior to the knee joint, I had him slide his heel towards his buttocks. With knee flexion at approximately 20°, a loud “click” was heard.
The adhesion that was created when John fell on his knee at 12 years old had caused his patella to track incorrectly for these many years. His knee pain was significantly decreased after one or two treatments to inactivate trigger points laid down in the quadriceps due to a dysfunctional patella. In the case histories that follow, the “mysteries of the histories” were not always revealed until after much client/therapist interaction had taken place.
After an in-depth history is taken, a charting of the patient’s pain is completed. Pain, referred by an active myofascial trigger point in a muscle, is the “signature” or pain pattern of an affected muscle. Based on analysis of the history and careful review of pain patterns, ROM testing is employed to locate restriction in a muscle or muscle group. This restriction is further verification of myofascial trigger point activity. Another objective sign is observed when palpation of a myofascial trigger point in a taut band of muscle elicits a local twitch response.
Treatment involves a variety of techniques that include, but are not limited to, ischemic compression and Fluori-Methane Spray and Stretch. A home exercise program is prescribed, including stretching and appropriate strengthening, to maintain functional release achieved during treatment. During each treatment, continuous inquiries by the therapist begin to uncover perpetuating factors such as inappropriate ergonomics, poor nutrition, inadequate water intake, activities of daily living, and more.
Myofascial Trigger Point Therapy is not a cure for all pain. However, the authors of Myofascial Pain and Dysfunction, The Trigger Point Manual, Dr. Janet Travell and Dr. David Simons, report that “voluntary skeletal muscle is the largest single organ of the human body and accounts for 40% or more of body mass.” They go on to say that there are “347 paired and 2 unpaired muscles for a total of 696 muscles” in the human body. Further, they state “any one of these muscles can develop myofascial trigger points that refer pain and other distressing symptoms usually to a remote location.” In spite of this, ”the muscles receive little attention in modern medical school teaching and medical textbooks.”
More than 40% of the mass of the human body, consisting of muscle tissue, is capable of developing active myofascial trigger points. Myofascial trigger points, in turn, refer pain to a location other than the site of the lesion, often confounding conventional models. Is it any wonder why this treatment protocol is effective with pain patients who have had no relief from pain pills and muscle relaxers? It is my hope that the following case studies will shed light on the efficacy of Myofascial Trigger Point Therapy by a board-certified practitioner for the treatment of both acute and chronic pain.