Trigger Point Therapy

Christopher Moyer, Ph.D., is a psychologist who has done research in massage therapy and meditation. He recently began a blog on research and massage therapy and I was honored that he asked to interview me for his blog.

I first got to know Chris when I heard that he’d done a metaanalysis that overturned what a lot of us thought about massage lowering cortisol. Curious, I looked him up on the internet and sent an email asking about his paper. Shortly after, I encountered him again in online discussions and it led to a friendship that was both professional and personal as we discovered we had many common interests.

On Monday, May 6, Kathryn Merrow interviewed me for 30 minutes for Massage Talk Radio. We had a lot of fun. She asked about how I got into massage, about my training and experience, and how I've evolved to incorporate the various things I've learned over the years into my practice. We talked about how my understanding of trigger points has changed and I was particularly happy to speak about what I've learned about pain science in recent years. I appreciated the opportunity to tell my fellow massage therapists that even though learning something new that contradicts what we've believed to be true can be uncomfortable at first, it does not have to be threatening and, in fact, when we embrace understanding how the body actually works, it's exciting and liberating.

We massage therapists are taught a lot about muscles. We also study bones, joints, ligaments, tendons, fascia. We learn a little about physiology, about other systems of the body, and some lip service is paid to the role of the nervous system in the relaxation response and to how the brain mediates the changes brought about by massage. But mostly we pay attention to muscles. We talk about which muscles are tight, find “knots” in them, and “release” them by pushing into them and/or stretching them with our hands, fingers, forearms, and elbows.

A colleague on a private forum asked the following questions in response to some thoughts I posted yesterday. In particular, he wondered about the description of an experience I had with a client. His question:
 

Having effect on the nervous system by stretching skin will relieve pain?  . . . [Is] Dianna [sic] relieving trigger points in this fashion? Seriously? Sixteen years ago, I never knew what was causing my pain. Doctors didn't know either. And then I ran into a PT who did know and mentored me. Trigger Point work, as I have benefitted, is painful. Paul Ingraham and Amber Davies agree, they hurt like hell when compressed. That "painful work" is the only thing that has ever given me tempory relief. I'm just not seeing where skin work is going to effect a mechanical release of myofascial contraction knots.....

If you keep up with the world of therapeutic massage, you will eventually notice that there are some new ideas and terms going around. Evidence based massage. Evidence based practice. Evidence informed practice. Science based medicine. What does it all mean?

True to my commitment to being evidence-based, my thinking about trigger points has changed a bit since I first wrote this article. For now, I'll leave it as it was first written, but some time in the future I'll write about some new information about trigger points that challenges the ideas of Travell and Simons. As a result, my approach has altered a bit and has allowed me to work even more successfully with clients without making them sore like I did in the past! After 22 years in practice, I'm still learning and evolving. I wouldn't have it any other way.

Swedish massage. Deep tissue massage. Sports massage. Russian massage. Trigger point therapy. What are they and how are they different? If you are a client looking for a massage, how do you know what to ask for?

You don't necessarily need to know the name of a specific technique but you do want to be clear about your goal. When a new client walks into my office, I ask them what brought them in and what do they want to get out of their session? Some want to relax. Others have some sort of pain that they'd like to get rid of. Still others want to improve their performance. By understanding the client's goal, I can tailor the session to their specific needs. However, people do frequently ask the question, "What is the difference between these different kinds of massages?"

It is with great sadness that the massage community received the news that Dr. David Simons recently passed away at the age of 87. Dr. Simons co-authored Myofascial Pain and Dysfunction: The Trigger Point Manual with Dr. Janet Travell, the physician who helped President John F. Kennedy with his back pain.