Tuesday, July 25, 2017

Cold Laser: Major Change in the Way I Practice Myofascial Trigger Point Therapy!

I'm very excited to announce that I have started using LLLT - Low Level Light Therapy - also known as Cold Laser Therapy.  
LOVE it, and I think you will, too.  

Cold laser technology has been around since the 1970s, it's very well tested, and it works.  I was dubious at first (as I am of anything that sounds too good to be true) but after much googling, personally both observing and experiencing cold laser treatment from a leader in this field, grilling the CEO of the laser manufacturer, and trying it out for the last few weeks on my own patients, I can confirm that it works.   It. Really. Works.  

The best part is, it works just as well as manual myofascial trigger point therapy but it doesn't hurt.

For 25 years I have somewhat apologetically explained to my patients that getting rid of trigger points requires that I press enough to cause a small amount of pain, and then I must hold it until the trigger point begins to release, marked by a diminishment of the compression pain.  Back in the 1970s and 80s, myotherapists believed we had to use a pretty substantial amount of pressure - 35 pounds per square inch! - and that treatment was necessarily a painful thing. By the 1990s we had observed enough variations in treatments and results to realize that a considerably lesser amount of pressure would do the trick, but it often still hurt a little, and on some people still a lot.  I have noticed that patient sensitivity has more to do with the pain level than amount of pressure, which I have always been careful to keep at a tolerable level.  A patient should be able to stay relaxed, talk and breathe during treatment. But now, after 25 years, it just got even easier!

Cold laser therapy does not require painful compression at all, only the contact of the laser apparatus (it looks like a big fat pen on a cord) against the skin.  Pressing it against the trigger point does not add anything to its ability to work.  It deactivates trigger points with light just as effectively as compression, and perhaps more so, if the muscles are hyper-reactive and prone to rebound spasm when insulted by compression.  The absence of strong compression also results in the absence of post-treatment soreness.  This is fantastic news for anyone with sensitivity or anxiety issues, post-treatment soreness issues, and especially fibromyalgia.  It can not burn or cut like surgical lasers, and short of pointing it directly at your eye, it is completely safe.

Now you can find out how it feels to just. stop. hurting.

Tuesday, July 18, 2017

One Man's Story

One of my patients kept a pain diary for seven years to document his ordeal.  Doctor after doctor failed to diagnose or explain his pain to him, much less find him an effective treatment.  His persistence paid off in the end, finding therapies that helped lower his pain and keep him sane until he ultimately stumbled upon The Trigger Point Therapy Workbook by Claire and Amber Davies, which led him to understand what his pain really was and then to search me out.

Excerpted from Myofascial Pain and Treatment: My Story
by S.S.

I am approaching the eighth anniversary of My Ordeal as I call this experience, which began as a feeling of slight numbness and tingling, and became progressively worse, and developed increasing, constant pain.

In the beginning, the many doctors I went to could not diagnose the pain, which I now know is myofascial, caused by a muscle knot. I had never had anything like this before in my life. I sought out both physical and non-physical alternative treatments. It is my desire that what you read is both informative and inspiring.

I experienced vertigo at work in February of 2009 that sent me to the George Washington Hospital Emergency Room. The diagnosis was benign positional vertigo, and there was no recurrence.
However, I soon after developed a burning sensation in my entire left leg, left hip area, and left rib cage area just under my arm pit. I was referred to a neurologist and had an MRI of my brain and neck with contrast. She was not able to find a cause for the burning or vertigo, and prescribed the drug Neurontin (used for seizures) which I did not fill right away. There was a breakdown of communication as I was not assertive enough to press about the cause of my condition when the Neurologist did not seem to have an explanation. My neurologist then ordered a pelvic and lumbar MRI and a motor nerve conduction test, which indicated that I had about 50 percent of sensation in my left leg versus my normal right leg. Additional blood tests were normal except for a lower level of B12. I stopped seeing the neurologist after that.

With the burning sensation being constant 24 hours per day, with the only relief being during sleep, I decided to try acupuncture. I has 11 visits from May 2 to August 22 that did not solve the issue either.
My discomfort level during between March and October 2009 varied from 5 to 8.

I couldn't do anything to decrease the burning sensation other than to avoid strenuous physical exercise - my jogging workout - which I continued to perform during the first 6 to 7 months of this ordeal. The discomfort level stayed near constant during the first seven months. It became a nearly unbearable 7 to 8 by that August. I called my neurologist to see if she had any diagnosis yet. The only thing she mentioned was that there was a slight disk hernia in the L5 area of my spine. I then tried taking the Neurontin for about a week, but I did not see any results or lessening of the discomfort so I discontinued use.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, or bumping the funny bone. I do not like to classify my sensation as pain, but more as discomfort. I guess that they are one and the same, but I prefer to think of it as discomfort.

The main area the discomfort was in was my entire left leg from toes to hip, with the main concentration in the left hamstring and thigh area. I describe it as a burning sensation since it was constant: 24 hours a day, and very steady. I kept a daily pain diary about this during my visits to various doctors during that calendar year. The sensations included burning, hitting the nerve in your funny bone, and that feeling you get when you sleep on a body part for a while and lose sensation, and then get tingling while the sensation returns. They could also be described as as having a muscle rub such as Ben Gay all over the leg and then having a heating pad on top of that, or a small ball of fire inside my left thigh/hamstring area.

I observed that the intensity seemed to spike when I performed vigorous physical exercise such as jogging or swimming. It was like having an electronic ankle bracelet that increased the pain, as though punishing me for exercising. It wasn't life-threatening, but it was lifestyle-hindering.

By September I was feeling desperate. The possible disk herniation sent me in search of a rehabilitation clinic, hoping that physical therapy and traction might help.
The physical therapist evaluated me with range of motion and reflex tests. Everything was fine. She looked at MRI films suggested traction for the slight bulge of the L5 disk. I had some relief but after two more weeks nothing much changed and the PT decided the pain was caused by a pinched nerve and not a herniated disk.

I then began my visits to the Virginia Spine Institute where I was also prescribed Naproxen and Neurontin and had further MRIs ordered. After staying on the two drugs for a month and then returning to the Rehabilitation Clinic for six more weeks of physical therapy the burning sensation did not go away, but was more tolerable at a 2.5 to 3, the best since the previous March. During that six weeks at the PT Clinic, I did lumbar stabilization exercises, received ice, heat, TENS, ultrasound and massage. Although this seemed like a good approach, it did not solve the problem.
The doctor at VSI performed a spinal injection in October 2009, thinking perhaps the nerve bundle around the tailbone was inflamed and that a steroid injection might work. Unfortunately this did not provide any relief and finally the doctor at VSI told me after several visits somewhere in mid-November 2009 that he did not know the cause and had no diagnosis.

The final doctor I saw in 2009 was a neurologist recommended by the VSI. I told gave him the entire story including all paperwork MRI films. He prescribed the drug Lyrica and ordered another extensive blood test (five or six more vials of blood and I will state here that I do not like needles). Again they were normal except for a slightly lower level of B12; I pressed him for a diagnosis and some answers as to what I had. He said that he did not know and was doing all he could, and tried prescribing the drug Nortriptyline. I took this for about a month until mid-January 2010 and then stopped. I was very disappointed canceled further appointments.

I was out of leave and did not want to take off more work in attempts to figure this out.

Over the next several months, my doctors tried me on Cyclobenzaprine, Tramadol, and Tylenol w/Codeine,, with very limited results, nothing lasting.

In July of 2010, my mother found a Reiki healer, a spiritual approach I was willing to try since Western medicine had been unable to find a source for the problem or provide any measure of relief. After receiving a Reiki treatment that did a lot of good, I decided to become a student and learn more about Reiki as a self-healing practice. Over the subsequent six years I continued to both study and receive Reiki, and my pain level gradually dropped from 7 and 8 down to 1 and 2 by the summer of 2016.

I then began to learn more about myofascial pain and its causes from two books purchased on line, “Trigger Point Therapy for Myofascial Pain” and “The Trigger Point Therapy Workbook.”

It turned out that I what I had been experiencing was myofascial pain caused by a muscle knot called a trigger point, which is a very contracted part of the muscle that causes spikes in my level of pain. Pain gets the flare-ups when you further contract a muscle that is already tight.

Now that I knew more about my condition, and wanting to get rid of the residual pain, I found a myofascial trigger point specialist named Michele Macomber who operates Myofascial Trigger Point Therapy of Maryland from her home office. I began treatment with her in June of 2016. She studied my posture and the condition of my upper left leg muscles and began to work on releasing all the residual trigger points or knots in the area. She also prescribed several therapeutic leg stretches and introduced me to some helpful self-treatment tools that I began to use and will continue to use.  After my first treatment my pain level became a 0.5.  Within a couple of weeks I was describing it as 0.1. As of the writing of this paper the pain level CONTINUES TO GET LOWER AND LOWER.  I know the discomfort is there, however it does not limit my movement or exercise in any way.  I am not sure if the pain will completely disappear however I do think that it will continue to diminish over time as I continue to use the tools, do the stretches and get treatment from Michele.

Tuesday, July 11, 2017

Does Your Car Fit You, or... Does This Bucket Seat Make My Butt Look Big?

Poor ergonomics in the driver's seat can lead to headaches, neck, back and hip pain, even pain or numbness in your hands! 

Do you have an ill-fitting car? Those bucket seats look comfy at the dealer, and feel pretty good to sit in long enough for the test drive. But over time with countless hours of commuting, or long road trips, what happens?  Those seats can be too short to support your whole thigh, forcing the edge of the seat into fatiguing hamstrings, especially if you have to stomp frequently and forcefully on the clutch in city driving.

Ill-designed arm and head-rests can lead to driving-related chronic pain and rotator cuff issues.

Missing or ill-placed armrests make you rest your elbow somewhere that forces your shoulder out of anatomical neutral and holds it that way for hours. Missing or ill-positioned lumbar support throws your head forward and loads up your neck muscles, and the biggest culprit, forward-jutting headrests, keeps your head from sitting atop your cervical spine, even if you add the correct lumbar support. Arms, lumbar spine and thighs all must be adequately supported, sitting up straight should feel restful, and steering wheel must be comfortably and safely held, all while your feet reach the pedals! That's quite an ergonomic juggling act, and some cars simply can not be adjusted to fit some people. When treating myofascial head, neck, back or hip pain, check your car fit for perpetuating factors that can be re-activating trigger points, and see if they can be corrected.

When purchasing a car, always be sure to try it on for an ergonomic fit that will keep you comfortable for the long haul!

Wednesday, July 5, 2017

Why I Will Never Sell You Supplements

It all started when I had terrible TMJD...

I discovered myofascial trigger point therapy in the late 1980s in the same way many of us do: by stumbling upon an MTPT by happy accident when looking for pain treatment. I had terrible TMJD, and I lucked into a dentist who made me a splint and referred me to the first myofascial trigger point therapist I ever met.

As it happened, she also represented a not-available-in-stores brand of liquid potassium supplement, and right in the initial office consultation persuaded me to purchase this product from her. I obediently bought some and used it for a few weeks. It seemed to live up to its energy-boosting claims, but it was too expensive for me as I was a public school teachers' aide at the time, and I soon gave it up in favor of buying groceries. I noticed I didn't seem significantly worse off without it.

My therapist recommended a supplement now banned by the FDA

A few months later I was back in the office of the same MTPT for a tune-up - supplement salesperson or not, she was a fantastic therapist! - and now she was promoting a very expensive powdered ephedra tea mix for weight loss. I gave that one a miss because I dislike stimulants, and thank goodness I did! It later turned out to be one of those herbal supplements linked to adverse health effects - including death! - that was ultimately banned by the FDA.

In the subsequent years, I have met many myofascial trigger point therapists as well as other doctors and therapists who promote and sell various supplements and products. Some of these products have a degree of merit, most of them are more expensive than similar products found in retail stores. Something about this always bothered me.

I felt like a cash cow, not a patient.

One day a health consultant I was trying on the strong recommendation of a friend - at $100/hour plus $50/monthly supply of a supplement she'd convinced me I needed - tried to sell me two additional products plus the one I already used, plus the session, and I found myself being asked for a check for over $300. Over $300. in a single afternoon for products and services I'd never heard of before with no visible or immediate results, that might help me over time... maybe... and... snap! I suddenly didn't trust her anymore. I still liked her personally, and thought she gave at least the impression that she knew an awful lot.  But I also thought I smelled a sales pitch and my gut told me to back away. Suddenly I felt like a cash cow, not a patient. I never went back.

I decided that for me, promoting a product to my patients undermines my integrity because it presents a conflict of interest. 

I certainly want my patients to be informed if they may have a particular vitamin deficiency related their back pain or migraines, but if I am personally selling those supplements, I appear to be profiting, not to mention using up valuable treatment time to do so. I would also be representing myself as having training that I do not. If my patients are anything like me, they may be politely smiling, and even buying the product, but inwardly they may be feeling put upon, hustled, uncomfortable, resentful, and possibly even in doubt of my motives or ethics.

I will never suggest a supplement that can not be purchased in a brick-and-mortar store.

I like to make a point of telling my patients that I am not a physician, nor am I a nutritionist, and I can neither prescribe nor diagnose. I can tell them what the studies say about the relationship between muscle pain and nutrition, and make some recommendations about which supplements they might want to discuss with their physician or a licensed nutritionist. I will also never suggest a product that can not be purchased in an ordinary grocery or health food store or pharmacy. It is my belief that a good, known, tested product at a fair price will be available at a retail store, and should not come with a hard sell on why you must buy this product even though it is much more expensive than its competitors, or why this product has no competitors and therefore must be purchased only through this seller.

I am aware and respectful of the fact that some people see their health care professionals in an authoritative light. I know that I certainly like to think that my doctors and therapists always know what they are talking about! This can make it easy to persuade people that they Really Need Something if a doctor or therapist says so. No one should ever take advantage of that to make a profit. In my experience, a supplement side-line subtracts integrity from my practice, which means it can never add value, no matter what the profit.