Trigger Point Therapy for Myofascial Pain

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My book of the month was Trigger Point Therapy for Myofascial Pain by Donna Finando and Steven Finando. It is actually more of a manual than a book to read from cover to cover, a guide to common trigger points in the body and their referral patterns.

A quick explanation of trigger points - in case you don't know what they are - is that they are specific points in muscles which are hyperirritable, found in taut bands of muscle fibre and frequently refer pain to a different area of the body. People often refer to them as 'knots' or 'lumps', and indeed they can often be easily felt within muscles.

The book divides the body into regions, further split into separate muscles. For each muscle included there is a standard format including information on how to locate the muscle, pain referral patterns, causative factors, affected organs, stretch and strengthening exercises plus a few other bits. Each muscle is accompanied by a diagram showing where, in the experience of the authors, they've found to be the most likely areas for trigger points to develop, and another showing pain referral areas. This is the useful part because a therapist can easily look at where pain is felt by the client and then go to a specific muscle to potentially find a trigger point. In practice it doesn't work this way - unless a whole treatment is set up purely to look for trigger points it is more usual to locate the trigger point within a dysfunctional muscle when we palpate it during the course of a treatment. By applying compression on the trigger point we can often replicate the pain a client feels, and with treatment erradicate them.

The introductory chapters are very useful for us as therapists to read and refresh our knowledge. Chapter 1, The Nature of Muscles and Trigger Points, has some good information on phasic and postural muscles. It talks a lot about dysfunction and the reasons that may come about due to postural stresses and physical activities which involve repeated movements. This leads on to areas prone to trigger points because of increased mechanical strain and decreased circulation.  "Our ability to operate in a physiologically optimal manner are all affected by holding patterns of muscular constriction.".

Chapter 2, Qi, Movement and Health, explores the Eastern and Western ways of treating trigger points. There are two points that stand out in this chapter. Firstly is that Eastern and Western therapists would both benefit from studying the others way of viewing the body. However each treats, we do so by seeking to remove constrictions that cause pain and trigger points. Importantly, we both do so by affecting the body on a physical level through movement and the release of contrictions. So, Finando & Finando suggest that Eastern practitioners would benefit from studying myofascial and muscular structures, and Western therapists by studying meridians.

The second point I take away from reading this chapter is related to movement. "Health requires movement, when movement ceases, life ceases." That may seem like a dramatic sentence to highlight, but it has stuck in my mind. Ultimately, without movement comes death. On a less dramatic, but very significant level, without movement your muscles become dysfunctional, pain affects your body and constrictions occur (and thus trigger points).  When the constrictions are released by a therapist the muscle can return to function and this will lead (directly and indirectly) to freedom thoughout the body, at both superficial and deeper levels. The chapter also talks about fascial lines, quoting Dr Paula Scariati on trauma or fascial changes:

Moving on, Chapter 3, Informed Touch, was a good reminder to me as a therapist about the process and thought that goes behind palpation. It's not just about hands on the client, there is so much more thought that goes into the process - from both a physical and emotional point of view. Key point from this chapter is to have a mental image of what your are palpating; know what to expect, then you can see whether there is dysfunction present. Good knowledge of anatomy is vital.

The final chapter, Diagnosis and Treatment gives an overview of what a therapist should be doing - observing the client, evolving palpation skills, listening closely, treating with precision and attention, extending treatment beyond the clinic (i.e. homecare), and allowing feedback from palpation to guide the treatment.

Although a short read, this book (or should I say manual) was good to review. I'll certainly be showing the diagrams to clients more often so they can visualise pain referral patterns, and why when they say the pain is felt in one area I might look to treat elsewhere.