Frequently Asked Questions

WHAT IS MYOFASCIAL?

Myofascial Trigger Point Therapy is a new therapeutic modality used for the relief of pain and dysfunction originating in the muscles and connective tissue; "MYO" means muscle and "FASCIAL" refers to connective tissue.

WHAT ARE TRIGGER POINTS?

A trigger point is simply a small contraction knot in muscle. This knot feels like a pea buried deep in the muscle, and can feel as big as a thumb. It maintains a hard contraction on the muscle fibers connected to it, thus causing a tight band that can also be felt in the muscle. These trigger points in muscles and in the thin wrapping around each muscle (called ) are called myofascial trigger points, to distinguish them from trigger points which can occur in other soft tissues such as skin, ligaments and tendons, and also in scar tissue.

ARE TRIGGER POINTS COMMON?

Myofascial trigger points are among the most common (yet poorly recognized and inadequately managed) causes of musculoskeletal pain seen in medical practice. Unfortunately, many general practitioners and orthopedic surgeons do not knowabout trigger points, and as trigger points do not show on X‐rays or scans, the patient may be told there is nothing wrong with them or that there is nothing that can be done to help their pain.

ARE TRIGGER POINTS THE SAME AS A MUSCLE OR TEAR?

No, a trigger point is not the same as a muscle spasm. A spasm involves a violent contraction of the whole muscle, whereas a trigger point is a contraction in only one small part of a muscle. A tear (or strain) involves physical damage to the muscle or tendon fibers. Such damage has not been demonstrated in studies of trigger points. (However, such may predispose one to developing trigger points later on.)

WHY ARE THEY CALLED TRIGGER POINTS?

Pulling the trigger of a gun makes a noise in the gun but it also sends out a bullet that causes pain at a distant target site. Pressing firmly on myofascial trigger points hurts right where you are pressing; sometimes making you jump, wince or pull away. But, more importantly, trigger points also send "referred" painor tenderness to some other site, often quite far away. So, for example, a headache may not be caused by a problem in the head itself but may have been sent to the head from a trigger point on the side of the neck.

IS THIS MEDICALLY ACCEPTED?

Myofascial Trigger Point Therapy (MTPT) is recognized by the American Academy of Pain Management as an effective treatment of myofascial pain and dysfunction.

WHAT DOES THIS FEEL LIKE?

The referred pain caused by trigger points is usually steady, dull and aching, and often deep. It may occur at rest, or only with movement. It varies from being a low‐grade discomfort to being severe and incapacitating.

IS THIS JUST ANOTHER ?

No. Fully clothed patients sit or lie on a table as the therapist applies pressure to the bigger points of specific muscle groups. Pressure is applied while the therapist stretches the muscle, the muscle more fully as more trigger points are treated. A home exercise program is prescribed which includes stretching and the appropriate strengthening to maintain the functional release achieved during treatment.

SO HOW DID YOU KNOW WHERE TO FIND THAT SPOT?

Referred pain occurs in predictable patterns, which have been mapped out in The Trigger Point Manual by Travel and Simons. Using their maps we know which areas to search for the trigger points that characteristically send pain to the place where you are hurting. Then we feel for a tight muscle in that area, feel for tight bands within that muscle, and localize an area the band which is extremely tender: THAT spot is the trigger point. As we press or twang it, the muscle may twitch. As we keep pressure on it, it will cause your usual referred pain, thus confirming that we've got the spot. It is important to realize that the trigger points themselves do not hurt unless pressure is applied.

HOW DOES TRIGGER POINT THERAPY WORK?

• Trigger point therapy breaks through the self‐sustaining, vicious cycle that has kept the muscle contracted. • It increases the circulation, which has been restricted in the immediate area by the contracted fibers, thus enabling oxygen and nutrients to flow to the spot. • It directly stretches the trigger point's knotted muscle fibers.

WHAT OTHER SYMPTOMS MAY TRIGGER POINTS CAUSE?

Apart from pain, trigger points may cause numbness, tingling, weakness, or lack of normal range of movement. Trigger points can also cause earaches, dizziness, sinus congestion, nausea, heartburn, and false heart pain. And they may result in depression if pain has been chronic.

COULD THERE BE MORE THEN ONE TRIGGER POINT?

Yes, trigger points tend to gang together. It is common to find more than one trigger point in the tight muscle, and more than one muscle whose trigger points refer pain to the area where you are hurting. All of your trigger points need to be hunted out and treated before you'll gain full relief of your symptoms.

HOW LONG WILL IT TAKE FOR THE PAIN TO GET BETTER?

With trigger points of recent onset, significant relief of symptoms often comes in just minutes, and most acute problems can be eliminated within 2 to 10 days. Chronic conditions are more complex and often less responsive to treatment. None the less, even some of these problems can be cleared in as little as 6 weeks.

WHAT CONDITIONS ARE DUE TO REFERRED PAIN?

Trigger points are known to cause or contribute to headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, tennis , and many kinds of pain mistakenly ascribed to arthritis, tendonitis, or bursitis.

WHAT DO I DO AFTER THERAPY HAS RELIEVED THE PAIN?

After therapy, it is very important to apply a hot pack covered with a dampened flannel or towel to the treated area for a few minutes. Then gradually and gently stretch the treated muscle through its full range of movement three times, with a pause to deeply breathe and consciously relax between each cycle.

WHAT CAUSES TRIGGER POINTS TO DEVELOP?

Take a look at the grey boxes on the center section of the full‐page diagram. All of us develop tight bands in our muscles as we age, but some people have more than others, for the various reasons that are listed in the red box labeled: “predisposing factors.” Some of these tight bands go on to develop trigger points when one or more “precipitating factors” arise. For example, a trigger point may develop following an acute muscular strain such as during a car accident, a fall, a sprain or fracture, or excessive or unusual exercise, or following chronic overload of the muscles used to maintain posture because of poor sitting, working or sleeping habits, or by repetitive work tasks.

WOULD THE TRIGGER POINTS GET BETTER IF I JUST RESTED?

Yes and no. Studies have shown that with a short period of rest and the avoidance of whatever activated the trigger points, the pain symptoms may disappear over a few weeks, (see the BLUE arrow in the center box on the diagram). This makes people believe their problems have gone away. But, if you examine the muscle properly, you will find it is still tight, stiff and weak and still tender when pressed on. In other words, the trigger points are still there; they are just lying dormant (latent), and not causing referred pain at that time. The bad news is they can be very easily reactivated (see the RED arrow in the center box) to cause pain again, by acutely overloading the muscle in a new or repetitive task, working or sleeping in an awkward position, chilling the muscle, or during emotional stress, fatigue, or viral . How much it takes to reactivate a latent trigger point will depend on the degree of muscle conditioning, so keeping fit can help reduce the likelihood of this. But the only way to get rid of the trigger points for lasting relief is through actively hunting out and treating all the active and latent trigger points. Although this involves more effort, it's truly worth it in order to escape "the endless replay" of trigger point pain.

WHAT CAN I DO TO ACHIEVE LASTING RECOVERY? l) Learn respect for your muscles. They were not designed to be held for long periods in a sustained contraction or in a fixed position. Vary your tasks each day. Lift objects very carefully.

2) Slow your working pace, and take short rests frequently, especially if feeling muscle fatigue and learn relaxation techniques, (i.e. yoga. etc.)

3) Do a daily program of passive stretches that puts the affected muscles through a full range of movement, and repeat the stretches throughout the day. Be like a cat; it rarely tries to walk after a sleep without first stretching smoothly and slowly.

4) Watch your posture when sitting, reading, using the computer, car or phone. Don't stay too long in any one position.

5) Figure out what particular postures, movements and activities stir up your trigger points. If you don't have to do that activity, then don't. If you do, then modify how it’s done (i.e. use the other hand).

6) Correct any imbalances in your diet. Regularly take vitamin and mineral supplements as recommended by your health care professional.

7) Limit your caffeine intake to a maximum of 24 ounces.

WHO DISCOVERED THIS?

The techniques are the result of lifelong research by Janet Travell M.D. and David Simons M.D.. These pioneers discovered the casual relationship between and its source: trigger points. Their two‐volume text, Myofascial Pain and Dysfunction, The Trigger Point Manual forms the basis of this internationally renowned therapeutic protocol. Trigger points often refer pain to a location other than the site of the lesion. Referred pain from trigger points usually fails to follow “normal” neural pathways and may travel a considerable distance. Dr. Travell compiled maps of the most common trigger points and the areas to which they refer pain.

WHAT ABOUT EXERCISE?

Exercise should be regarded as a prescription, and the kind of exercise prescribed depends largely on how active your trigger points are at that time. When the trigger points are hyperactive and you have pain at rest, then gentle stretches and hot packs are your limit. Once the trigger points are inactivated and constant pain fades, then a carefully graded exercise program is needed to increase muscle endurance and strength. This involves muscle lengthening exercises. Post‐exercise soreness and stiffness should not last longer than 3 days or the program needs altered. Then a regular conditioning program, such as swimming or cycling is recommended, at least twice a week.

HOW MUCH DOES THERAPY COST?

Rates vary according to the length of your session. Sessions are available for 30 minutes ($35), 60 minutes ($60), 90 minutes ($85), or 120 minutes ($110).

WHAT METHOD OF PAYMENT IS ACCEPTED?

I accept cash, credit or debit cards and checks as payment.

WILL MY HEALTH INSURANCE COVER ANY OF THE COST?

No, not yet. Health insurance companies have resisted covering the costs of myofascial trigger point therapy by erroneously classifying it as a form of massage. However, Workers’ Compensation does recognize it as a therapeutic modality and if properly referred for treatment Workers’ Compensation will pay for your therapy. We will help you to get the necessary referrals and paperwork if you currently have an open Workers Compensation case.

CAN I HAVE THE COST BILLED TO ME?

No. Payment is due at the time of treatment.

MASSAGE VS TRIGGER POINT: WHAT TYPE OF SESSION DO I NEED?

On your first visit, it is a good idea to arrive 5 to 10 minutes early to complete your the patient intake form. I will ask you basic questions, such as, “Why are you here today?” and “What are your goals for the session?” We will discuss your symptoms and pain patterns to determine if massage or trigger point therapy is more appropriate to meet your needs. If both types of sessions interest you, I will combine the therapies into one session. Each session will be customized based on your symptoms to ensure maximum benefit.

WHAT IS THE DIFFERENCE BETWEEN TRIGGER POINT THERAPY AND MASSAGE?

Trigger point therapy is a pressure technique that targets specific muscles to eliminate very specific pain issues. Patients generally remain fully clothed (unless ETPS therapy is needed) and oils/creams are not used. Patients who are on their lunch break appreciate this “no oil†session, because they will generally be returning to work afterward. Sessions are typically 30 to 60 minutes.

Massage is geared towards relaxation and stress reduction. The patient would be asked to disrobe and lie under several layers of draping (the majority of the body remains covered during the session to ensure comfort and privacy. Disrobing is done behind closed doors prior to the start of the session.) Oils and creams will be used. It is important to mention and skin sensitivities, allergies or dislike of fragrances. Sessions are typically 60 to 120 minutes.

Patients who opt for a combination session will follow massage protocols, and trigger points will be addressed as needed throughout the session. Two hours is recommended for this type of session.

HOW OFTEN DO I NEED THIS THERAPY?

If you are not experiencing pain, getting a massage once or twice a month will help maintain a healthy body by improving circulation, getting rid of toxins and encouraging restful sleep. If you are in pain, I may schedule several consecutive weekly visits until we are both satisfied with your results. At that time, a maintenance schedule would be recommended.

DO I NEED TO TIP?

The short answer is no. I view trigger point therapy as a medical service. You wouldn't tip your doctor or chiropractor, so you need not feel obligated to tip me. Some of my massage patients do tip. This is completely discretionary. Industry standard suggests 15 to 20% of the service as an appropriate gratuity. Sure, tips are nice, but it won't hurt my feelings if I don't get a tip. I would rather my patients commit to a treatment plan and give no gratuity than feel like they can't come as often as they need to because of financial pressure.

WHAT SHOULD I DO AFTER MY SESSION?

Drink lots of water to flush toxins from the body. This will help you not feel sore the next day. If you have a trigger point session, stretching may be prescribed. Live life as you would normally. You may feel so relaxed that you actually get sleepy. Personally, I like to take a nap after I get a massage!

WHAT'S BETTER? OR TRIGGER POINT THERAPY?

Both therapies have their benefits, but the truth is that you will recover faster from painful injuries when you implement both chiropractic and trigger point therapy into your treatment plan. If you plan to see your chiropractor, you should schedule an appointment with me first. This will allow your muscles to relax and assist the chiropractor in adjusting you with greater ease. Spinal adjustments will last longer if the muscles are also being treated. When the muscles are relaxed, they will also allow the spine to stay aligned. If the muscles are tense, they will force the spine out of alignment. So the answer is that trigger point therapy and chiropractic care complement each other.

WHY IS THE BUSINESS CALLED BODY BY DESIGN?

While I cannot actually design a new body for you, I do believe that our bodies were created by God to function in a very masterful way. People put unnatural stress on their muscles when they perform strenuous activities, ranging from hobbies like golfing and gardening to sports like running, without properly stretching before and after. Stretching is critical to maintain healthy muscles. Other factors like poor diet, improper sleep posture and poor workplace ergonomics can be aggravating to your body. At Body By Design, I will ask you questions to provoke your thought process. Together, we will determine what factors are causing the stress on your muscles and I will provide simple “self‐care” solutions to assist you on your journey to recovery and proper body function.

MY SESSION WAS SO AWESOME! WHAT CAN I DO TO HELP GROW YOUR BUSINESS?

Tell all of your friends about your experience and pass out my business cards. Listen for people complaining about their headaches or back pain, etc...and offer to set up an appointment for them. Look for people who rub their own neck, shoulders or back. They are obviously hurting. This is a prime opportunity to share a short testimonial about how I helped you. Provide me with contact information for your contacts who may need my service. I can call or send a coupon. (If you'd like me to call, it may be best to “warm them up” to the idea first.) Buy gift certificates for your friends, family members, colleagues, clients, etc.

WHY SHOULD I SEND YOU REFERRALS?

Because you like me! (And I like you too!) Because I helped you, and I can likely help others you know. Because, YOU WILL RECEIVE A FREE SESSION FOR EVERY 3 REFERRALS YOU SEND ME!

DO YOU MAKE HOUSE CALLS?

Not typically. However, if you assemble a group of 4 or more people, I will come to your home and we can have a massage party. See Wine and Unwind Massage Party described on the home page.

WHAT ELSE DO YOU OFFER?

I am available for client and employee appreciation events. I will bring a portable massage chair to your location (for a minimum of 3 hours) and treat your guests to 10‐15 minute mini‐ massage sessions.