Tuesday, June 13, 2017

How Hard Does a Myofascial Trigger Point Therapist Press?

Eliminating Myofascial Pain Should Not Be Painful

How hard does a myofascial trigger point therapist press? This is how John F. Kennedy's White House physician and Trigger Point Manual author Janet G. Travell describes it:
"...clinician applies gentle, gradually increased pressure on the TrP until the fingers encounter a definite increase in the tissue resistance. At that point the patient may feel a degree of discomfort but should not experience pain. This pressure is maintained (but not increased) until the clinician senses relief of tension under the palpating finger. The palpating finger increases pressure enough to take up the tissue slack and to encounter a new barrier... the clinician again maintains only light pressure until more of the muscle tension releases."

Eliminating Muscle Pain Should Actually Be Relaxing

I like to say to my patients: “I'm going to press slowly and you're going to tell me 'when'. It should hurt a little bit, but not a lot. I want that trigger point talking to you, but not screaming at you. You should be able to talk and breathe and stay relaxed.” Just hearing this before I even begin to apply pressure goes a long way to relieving anxiety about anticipated pain, which in turn enhances the patient's total ability to relax. With the patient relaxed and confident of not being hurt, he or she can breathe into the process and aid it, at the same time learning how to do that on his or her own.

Trigger Point Myotherapists started developing their technique in the late 1970's. Different styles have evolved over the years with experience and better understanding from new research.

What About Compression on Fibromyalgia?

In the early years of my practice I used what some now consider a heavy hand - or elbow! - because that is how I was trained. The assumption was, the bigger the muscle, the heavier pressure required. The instructions were: press to the point of pain, and warn the patient what we are going to do, so they don't get a shock. It was understood that this type of treatment what necessarily if temporarily painful in order to be effective.

Then, within my first few months of practice, I got a new patient with severe fibromyalgia and I had to re-learn everything I knew about pressure and touch. I customized a combination of feather-light touch, heat, and gentle stretch that worked well for her and what do you think I discovered? Gentle compression, or if needed on a bad day, no compression at all can still be effective... at least for that patient.

On one hand, light treatment and stretch seemed to be working very well for some, but I still couldn't get stubborn trigger points out of others without some hardcore persuasion. For those people it had to be deep, sustained pressure only; any other technique was either more aggravating or ineffective.

Customizing Myofascial Trigger Point Therapy to Your Body

What I quickly realized is that all patients are different. Bodies all feel different, and people have different perceptions of pressure and different experiences of pain. They are irritated or soothed by different sensory input. Some people's muscles feel as hard as a Dunlop steel-belted radial while others' feel like they are made out mattress grade memory foam, and still others' twice-proofed sourdough. (Guess who hurts more!) Learning to touch and treat each new patient is like learning a unique new language. I get a knowledge and feel for what works best for a person, depending on the condition of their muscles and connective tissue, what feels good to them, and what technique releases their trigger points with minimal reaction and maximum results. I now know that different techniques, amounts of pressure, and even types of rehabilitative stretch are appropriate in different situations, with different patients. The real art is determining the correct match each time.

Travell and Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. 1999 Williams and Wilkins

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