Some confirmation needed: Trigger Points!

Hi!
I really needed some confirmation about the subject of trigger points (and I mean the little muscle knots and not the trigger points Sarno is talking about which actually describe the tender points).

In my head I really know (or let's better say I strongly suppose) that trigger points are TMS stuff as experiments have shown that these points are very oxygen deprived, BUT:

I still struggle a lot with this condition as my whole shoulder muscles (really everywhere) is covered with TRP's, my doctor told me he could not count them any longer, each trigger point is next to another. Due to this my shoulder/arm is nearly complete stiff and extreme painful. I had this condition about one year ago at my ellbow with the result that now my elbow joint is complete stiff because I wasn't able to bend it due to the extreme muscle stiffness. Even my doctor tried to bend it without any effect. Well, the TRP's spread up to my shoulder so that I couldn't move it any more and the doctor (who is at least rudimentary informed about TMS because I showed and explained him some TMS stuff) told me that additionally to my TMS-related muscle soreness and stiffness I now have a shrinked capusla (called "frozen shoulder"). He does several tests and movements with my arm to diagnose this. We both agreed on doing NO MRI because it's probable that something will be found and that this will be a nocebo for me.

So he told me that he will do no further diagnostic and no further therapy (what I really appreciate because with patients of my kind doctors can earn lots of money!) but that he strongly recommends some physiotherapy to get back the flexibility in my capsule.

It's really hard to give it a 100% belief as I 1) have a kind of "secondary damage" (my stiff ellbow joint) on the top of the TMS and 2) these TRP's are so "real", you can palpate them and they react positive with twitching. And I really don't want to get a stiff shoulder joint, too. It's my right arm and even brushing my teeth or eating is nearly impossible. Unfortunately massage really helps so it's hard for me not to do it. I stopped massage treatment last year when I learnt about TMS and the TRP's got worse since then.

So, if somebody was succesfull with treating these TRP's only by TMS-approach please tell me some success story, I really needed these confirmation!!!

Some of my other TMS-related conditions got a bit better, but my footpain (not due to TRP's) and my severe arm pain remained and got worse. I really really hate it to be dependend on others for pain relief (like massage, physiotherapy), I'd really like to help myself. I guess I am one of the people called "trouble healers" in SteveO's book.

I actually do guided (TMS-)meditations about one hour a day, also sometimes free meditations. I do my affirmations and I really work hard on my childhood issues and about my feelings and negative thinking patterns (in depths psychotherapy for years now, EFT and a programm recommended by one of the members here called emotional brain training to "reverse" my distorted attachment patterns).

But actually I am a bit desperate and really feel stuck.I feel that my whole sysmtem crashed due to stress a few years ago (I am diagnosed with "fibromyalgia"), also my immune system goes crazy. But the joint stiffness actually is bothering me the most.


Thanks for reading!

Kind regards from Germany sends Birdie

 

Hi Birdie
Your description of trigger points sounds very similar to what I experienced just over a year ago, including the shoulder and it traveling into the arm. I went to see a "specialist" who looked at my test results, did his own exam and proceeded to tell me about the "trigger point" injections he wanted to do while I was there. He explained the injections and what they're intended purpose was and then went on to tell me that his standard practice was to do 1 or 2 during an initial visit with a patient presenting with my issues. Then he went on to tell me that due to the "severity" of the trigger points he found he wanted to do 4 injections on me during that visit. So, he left the room for a few minutes while my husband and i discussed it. I didn't want to do it but I was a mess, physically and emotionally, and I wasn't trusting my own judgment. My husband had mixed thoughts about it as well but we finally decided to try it, I had tried pretty much everything else and it hadn't worked, and what was the point of paying for the appointment with the "specialist" if we weren't going to go ahead with the treatment from his assessment. So, I had those 4 injections and they did nothing. Same doctor's next step was going to be some sort of epidural nerve block, which he also said "may or may not work" - decided against that, it was guaranteed to have an effect financially, whether it worked or not since it was very expensive and would have been entirely out of pocket.

Massage has been very effective for me in easing the trigger points. At my worst, (before I knew anything about TMS) I was having acupuncture and massage every week. The massage therapist was concentrating all her efforts on the "painful" parts. After I learned about TMS, and the concerns about "treating the physical" I made changes to the frequency and type of massage, but I have not stopped it entirely. . Instead of going every week, or 2 and getting a deep tissue massage focused on the "sore" parts, now I go once a month and I get a full body relaxation massage from the same therapist. We talked about it when I changed the frequency and the therapist was very accommodating. Now if she comes upon trigger points (which are far fewer in number), rather than commenting about the trigger point with something like "boy is this muscle tight or I'm trying to figure out how you can even turn your head with this kind of muscle tension in your neck" she says nothing about what she's found. She works it a bit while engaging me in pleasant conversation that has nothing to do with anyone's health and then she moves on. Changing the frequency and the type helped me to change how I view it. I don't think of it as any part of a treatment program for a physical issue, I actually think of it as self compassion, part of the treatment plan for my mental well-being. Someone doing something nice for me that makes me feel relaxed, and it's me being nice to me by giving myself the gift of one hour of relaxation just for me. My tendency is to be my own worst enemy so I look at is as me making an effort to be my own friend.

 

That is awesome.

I don't know where you got the idea of having your masseuse say nothing about your muscles while she works on you, but that's exactly what Dr. Rashbaum said I should do if I chose to get massages. He said I could have them as long as they were "silent massages" where the massage therapist isn't commenting on your body. So, confirmation that you've got the right idea.

 

Hi Birdie,

I have some good news for you . I have recently recovered from some nasty trigger points in my latissimus dorsi muscle myself using TMS therapy.
I had pain in my hand, arm, and arm pit which slowly got worse over a couple of years. It was a stressful relationship breakup that really made it extra worse (although I didn't make the connection at the time.... I just thought it was from over-exercising at the time).

First I spent 6 months going to a physiotherapist, this didn't help at all. Then I found a chronic pain doctor. He found that the pain was coming from a few big trigger points in my lat dorsi muscle (he found a lump the size of a walnut!!). I was encouraged because massaging the trigger points made the pain feel better (temporarily). The doc gave me many trigger point injections, which did work, but only for a couple of weeks. I also had prolotherapy which seemed to work more then the trigger point injections. But, knowing what I know about TMS now I think they worked better because I was more scared of them (they were deeper and more painful). I had several prolo injections into my shoulder capsule as the doc thought it might have been injured in the past. I experienced a month or so pain free and thought I had been healed. However, the pain eventually came back AGAIN & so did the trigger points. So then I was telling my boss about it one day at work & he told me both him and his wife had healed from chronic pain using TMS therapy. At first I thought it was a load of crap, but eventually read Sarno's HBP. I didn't give up, i just kept reading and trying to believe it, then to my amazement ... I woke up one night with the main trigger point spasming without any pain. It spasmed mildly for about 20 hours. I was actually happy, because it had never done it for more then a few seconds before....so I knew something was changing. Then eventually all residual pain disappeared. Before I avoided exercise with my right arm (no opening bottles, holding shopping, etc). How ever now I do whatever I want.... push-ups, chin-ups, sawing, surfing, lifting heavy things and don't have any troubles.

To recover I mainly did the following:

• Read Sarno's HBP & Steve O's Great Pain Deception
• Listened to TMS podcasts and audio books
• Started doing what i feared most, exercising! Now I love it
• Stopped anticipating and fearing pain.
• Stopped obsessing over "trigger points" or possible joint damage. I used to read A LOT of trigger point therapy books, and massaged myself everyday. I now ignore all of that (but like Leslie do get massages to relax sometimes, but not for TrPs). Trigger points are real & do refer pain, but I found the underlying cause to be psychological. Remove your fear & worry, try to enjoy life & learn about TMS and they will disappear (or if they are physically still there they will do nothing). I think Sarno noted that trigger points can persist, but there is no need for them to be active at a level that causes pain or dysfunction. I don't even know if my trigger points are still there....i haven't checked and I don't care because they aren't painful anymore
• Stopped checking my progress all the time & getting stressed about recovering. Have no expectation about how long it will take to heal, as EPMD said "you gots to chill".
• Did journaling about current and past events that I think are making me angry/upset in my unconscious mind
• Made peace with myself: stopped being so self-critical, learned to forgive myself for past events, and stopped pushing myself to achieve perfection.

I still have a lot of problems in my life haha (job, relationship, and family problems), but chronic pain is not one of them now & I'm much more positive & happy now
I guess I'm 95% recovered because the pain has tried to come back as sciatica a few times now, but I'm in control & feel like a normal human again.

I might write up a proper recovery story sometime.

Good luck,
Dave

 

Hi!
Thanks very much for all this information, it was very helpful to me and brought great psychological relief and the confirmation I needed to go on with the TMS-work!
Leslie, I followed your example. Today I met a new physiotherapist for my shoulder and at the beginning I told her that I don't need to hear statements like "oh gosh is this tense and frozen!". She was very kind and understanding, told me, that she herself suffered from intense shoulder pain after an accident because she expected something must have been damaged (although all tests came out fine!). And nothing helped: neither her colleagues, nor the osteopath. All that helped was: ignoring the pain ! So she told me that she would not massage my trigger points, she'd rather like to work with me on how to move my shoulder/arm again without expecting the pain and fearing it. She never heard of Sarno but recommended Lorimer Moseley to me whose name was mentioned on the forum some months ago, don't remember the exact context. I'd never expected physiotherapists to be so open-minded, lol. That really changed my world view!
Dave, your detailed information was immense helpful to me!!! I exactly needed that to hear that somebody overcame these TRP's without physical triggerpoint-treatments! I've lots of trigger-point books and informations, too but actually don't like them because on every page there's some stuff inside like "don't do this and don't do that because you activate TRP's in the yx-muscle"! What a unnecessary fearmongering! And I am soooo tired of rolling over a tennisball, rubbing my triggerpoints until everything hurts more than before...or being desperate about the TRP's coming back after a very short time, sometimes within hours!

I am really, really looking forward to your recovery story!

 

Hi Birdie,

I too have "trigger points" in my neck and shoulders. I recovered from this pain using Sarno's approach back in 2005. I still had "trigger points" (i.e., spots that felt like knots) but they didn't cause me pain. I'm suffering a relapse now, but I'm still quite confident that this is TMS.

Here are a few helpful resources:
1) A debunking of trigger points, by the guy who once wrote a bestselling book on trigger points:
http://saveyourself.ca/articles/trigger-point-doubts.php

2) You mentioned Lorimer Moseley. I just read his book, Explain Pain. It is fantastic and very convincing - it draws on the latest neuroscience research to show that chronic pain occurs because of a malfunctioning alarm system (i.e., brain and spinal cord) rather than actual tissue damage.
http://www.noigroup.com/en/Product/EPB

Best of luck to you!

 

Did you find that the Trigger points/Knots eventually went away then? How are they now?
I'm really glad birdie made this post, as it does still sometimes play on my mind thinking about Trigger points.
So far on my journey I have found that I can reduce the amount of pain I experience from them, they then seem to go 'latent' for a while. But never seem to go completely. Any thing e.g some exercise can re-active them!

 

Guava,
I got rid of most of my trp's by not treating them. Sure, sometimes you can get some relief by treating them, but actually you are giving it attention that way. My experience that it will only give temporary relief and sometimes even will make things worse for a while. I believe that the key is to relieve the mind, the trp's will follow. I have two left, one in my butt and one or two in my lower abdomen. I see it as a sign there is still work to do.

 

These are amazing posts about TMS healing. I hope everyone reads them.

 

I explored the idea of trigger points before I found out about TMS.
I explored the idea of sensitive spots but it appears that my entire body is a sensitive spot. Some trigger point people would say that just means there are lots of triggers points active on my body but it seems a bit suspicious.
The suggestions for trigger point relief (self massage) suggest that you massage each point very firmly till you feel about a 7 on the (1-10) pain scale. A 7? [Insert favorite swear words here]
I tried it for a few days with no relief and a bruise on one of the spots. It says it might take a few weeks. But I could not bring myself to do it for that length.
I switched that to try another alternative light massage therapy that promised to heal me gently and painlessly. Yes, I like gentle and painless. I did not notice any immediate relief – it said it could take a while to heal – but it was gentle and painless.
Then I stumbled on SteveO’s book, The Great Pain Deception. One advice is to not do any therapy that reinforced the idea it is a physical problem. I was actually reluctant to give up my therapy exercises, even though they were not doing much for me. I was doing exercises to help with pain and a separate set of exercise designed to help reduce the symptoms of PMS/menopause. I am not healed yet, but I do not feel any worse after giving them up. I feel like I am getting slowly better.
I have used the time spent on therapy exercise to do regular exercise. I think that after a few months of this I will be in better physical shape as well as better mental shape.

 

The trigger points pretty much coincide with my stress/anxiety levels. I'm still not where I can actually identify my emotions but the trigger points, muscle spasms, and muscle tension serve as a barometer now. When I'm feeling more optimistic or content the trigger points are less numerous and far less discernible. When I'm feeling more pessimistic or agitated everything tightens up and there are times when it seems that all the trigger points can joint forces to turn my trapezius and rhomboid muscles into 2 big softballs just under my skin. It's frustrating and annoying, and oftentimes hard to ignore but I stopped the monthly chiro adjustments and even the "relaxation" massages back in June and when my emotions are calm I am in no better or worse condition physically than I was when I was getting those treatments.

 

A year before I discovered Dr. Sarno, I was seeing a cranio-sacral doctor (a real MD) who asked me to stop going to my chiropractor (after almost twenty years!) and that I didn't need adjustments in order to keep my atlas-occipital joint in place. Now, this is a joint at the top of the neck that would end up giving me a big lump on the right side of the cervical vertebrae - my husband could even feel it. I got terrible right-side headaches when the A-O was out of place - and I was convinced that only chiropractic adjustments could fix it.

But this cranio- doc was very convincing - so I stopped going to the chiro, cold turkey. The cranio doc was teaching me how to "talk" to the parts of my body that were causing me problems - so I talked to my A-O, and I swear to God, it stayed put. A year later, TMS theory made total sense to me (and I stopped going to the very expensive cranio doc :^)

When I am really stressed and working too hard the joint will sometime go out a bit. this happens because I fall back into old mindless patterns, so I'll be massaging it, worrying about it, letting the headache come on, etc. It's a bit frustrating how easy it is to go back to the old patterns! But, eventually, I will realize what I'm doing, so I stop doing everything, and clear my mind. Then all I do is put my hand gently on it, and visualize it moving back in place while I do some deep breathing and get back to a more mindful state. I will do this again before going to sleep. The next day, it's invariably fine.

I agree that general bodywork that is not focused on specific pathologies can be very healing. You can use massage this way, or acupuncture, to visualize the flow of qui keeping you healthy, rather than concentrating on problem areas. Practice yoga the same way. Go the gym and work out using the same visualization. The body and brain are an integrated organism, and everything is connected.

 

In my opinion trigger points are the result of TMS/anxiety and stress causing faulty bio-mechanical movements of muscles and initiation of pain and then bracing and guarding to try to reduce the pain. Considering there is a loop of feedback between the trigger points and and nerves that go to the spine then to the brain and back again, it is part of what helps build the anxiety-fear-anxiety cycle. If we believe that the pain is real, and it is, it is caused by something. Massage to help introduce a normal muscle length, in my opinion, is helpful. It was for me, but only because the medical massage therapists explained that they were the result of normal stress patterns. I was nothing special, in other words. In addition, she did a much better job of explaining muscles and referred pain and defining why I hurt where I hurt than any allopathic and "MindBody" doctor. It was just more knowledge, and knowledge is the cure. Without a proper dx, which Dr. Sarno could provide by years of clinical experience and observation, many people are left with uncertainty over what is bothering them. Dr. Sarno decided actually to "go back to the future" and question and disregard the modern imaging that so many doctors will send you to, so what seemed like a step backward by him was a leap forward. Still, Dr. Sarno and most all who prescribe cures for pain, say you have to overcome the fear. That is the hardest part, so whether a trigger point is smashed out or injected down, your fear and anxiety will cause it to return unless you understand the underlying causes of that same fear/anxiety.

 

I wonder if this is what I have? I have a very sore, but not painful, spot on the lower/mid right side of my back that won't go away. I have had it for about 6 weeks now and my GP said it was a pulled muscle. But don't pulled muscles start to heal over time not stay consistent? It feels like a pulling/tingling sensation that comes & go throughout the day but really bad at night while I try to sleep. It is just annoying! Do you think it could possibly be a trigger point? I have never had this feeling before. I still struggle with the low back pain with the electric type shocks but this is a new problem. It is just wearing me down and I want some relief. I have taken muscle relaxers, stretched, advil, tiger balm with no relief. I keep telling myself it is a new TMS spot but it is hard to accept since it won't go away. Any advice?

 

I suggest visiting your GP again for assurance it isn't anything serious. Don't break your mind over doubts what it might be. If he still says it is a muscle, you have your confirmation. You might mention your idea of a triggerpoint as a mindbody symptom and hear what he/she has to say. I found out personally that they are very interested if a patient rises the possibility of mindbody symptoms.
If you can't resist finding out yourself if it is a triggerpoint, search for charts on google or search for a pdf of "Clair Davies" or "Travell Simons". It sounds to me like the serratus posterior inferior, longissimus/iliocostalis, but it can also be other muscles like the latissimus dorsi. You see, it can be quite a puzzle... You might also consider doing a quick check by using a tennis ball between you and a wall to see if you discover whether there is one single point that gives a substantial higher pain than the surrounding soreness.

 

Guys thanks for this thread and the replys
im not saying anything right now- I think your all brilliant
A mastermind alliance- your the dream team- Go . Go. Go.
Thanks so much for all your wisdom and perseverance and
most of all your believing and courage.

 

All the human race probably has them; whether they are activated or not probably depends on what your emotional state does to areas of your body. Once the body is in a heightent state of anxiety and organs and muscles are sensitized, the "fight or flight" reflex ramps up and, in the TMS/anxious person stays ramped up. Once the TMS/anxious personality type become aware of the heightened bodily sensation, it, begins to fear it ( this second fear happens in a flash), then this trigger point or other symptom can be come hypersensitized. Then your anxious personality dwells on it, fears it, and begins to become obsessed. A conditioning is also involved here: you got to bed telling yourself, "Oh, no, the dreaded pulling/tingling sensation will start." It is your fear at work. Relief comes with the changing of thinking, or the "thinking psychologically", as Dr. Sarno puts it. What his means is rather ambigious, in my opinion. Often people have delve a little bit more into what this is supposed to mean, and often draw a blank. While it is okay to think about current stresses as that, sometimes it is helpful to know why something is a current stressor. This can take some examination into the type of person you are, going back to childhood, and applying how those learned behaviors effect sometimes the smallest things you do on a daily basis. I highly suggest that you start an investigation of this type with "Mental Health Through Will Training," by Abraham Low MD. You have to read it carefully, and more than once, but once you do you will understand a lot more how people become "nervously ill" and how they learn to retrain their thinking --and their will-- in a practical way. Here you learn that words of description make a difference and determine your thinking, how to change those words and thinking, and, most important to recognize how you sabatoge your own recoverey by words and thinking. This is not a beach read, and it was written some sixty years ago, just before the medical world went to extreme specilization and reduction of medical conditions to isolated areas of the body totally divorced from the mind. So while you might have a trigger point bothering you it is most certainly due to the "flight or fight" reflex in some way, unless you are a serious athlete and strained a muscle in training. A normal strained would gradually heal over time and you would feel the heal. When you fear a muscle sensation it will not heal and you will probably in some way brace or guard it and attach incorrect words and thoughts to it.

 

I thought I had discovered the solution to my pain a couple of years ago when I learned about trigger points. "The Trigger Point Therapy Workbook" by Clair Davies helped me a lot. It really did take a lot of my pain away to press on my muscle knots, especially the ones in my neck, shoulders, and lower back/side butt area. I had to do it every day, though, or I'd be in a lot of pain. It's still better than pain medicine and muscle relaxers, but I realize now that I was still only treating a symptom.

A few months ago I discovered Feldenkrais and Hanna Somatics. By doing the very gentle exercises in those programs (which basically teach us firsthand about our own mind/muscle connection) I realized that I was tightening up at certain times of the day, and that my pain and tightening would get worse when I was stressed.

Learning about TMS has been my "last piece of the puzzle" because it's teaching me why I'm tensing up and holding my body wrong in the first place, which is the underlying reason I've gotten the trigger points and pain. I created them myself through my emotions. In the last week since starting this program most of my trigger points are noticeably smaller and not really bothering me. One in my side, sort of under my shoulder, is completely gone and the ones in my neck are almost gone. That's a huge deal to me and I owe it all to the brave few doctors who have the courage to teach this, and to the folks here on this forum. I'm so happy and thankful for this knowledge.

(Btw, I'm still doing the Hanna Somatics "cat stretch" routine every day, not as "physical therapy", but because it's a wonderfully energizing, full-body maintenance routine. I highly recommend it for folks who enjoy exercising, although the movements involved are very small. It's easier than the easiest yoga.)

 

Great discussion, everyone!

Mousemom, and anyone else feeling stuck, here's some really good advice from our friend Alan Gordon: http://www.tmswiki.org/forum/threads/a-word-about-outcome-independence.562/

Back2it is right on to talk about brain conditioning. If you've ever studied phantom limb pain, this is what it's all about. It takes some work to reprogram those patterns. In addition to practicing Outcome Independence, also try appreciating the parts of your body that don't hurt. This is particularly effective for one-sided pain.

 

Thanks Jan and Back2-It!

While my pain is almost gone, I still have the "habit" of pain, and I still sometimes expect it to be there. I just recently described it to my mom as being similar to the concept of phantom limb pain. I keep expecting it to be there. On one hand it feels like the pain has been replaced by an intense feeling of relief, like when your stomach hurts badly for a few hours and then the pain suddenly goes away. You feel relief there instead of pain, but it takes awhile to get back to feeling normal. I see it in my mind as if all the painful spots used to be red or orange, and now they're, say, white. But the rest of my body is clear. The clear parts don't hurt and I don't expect them to hurt, or "miss" them hurting. I want my healed area to be clear, too. I'm going to start appreciating my left side more, and concentrating on the "normal" feeling over there. I think that will help a lot.