Update on Trigger Points

All credit for this text goes to +Sigurd Mikkelsen (@sigmik) as he posted this over at FB earlier this year. Needs to be shared in my G+ world as well 🙂

"Almost all of you have heard of them – the oh so notorius myofascial TRIGGER POINTS!

So what is it? First of all, "experts" do not agree on what really constitutes a trigger point (http://1.usa.gov/11OBwxs).

It shouldn't be a surprise that if practitioners don't agree on what they are looking for, that they're off for a bad start. If they don't agree on what they're looking for, how can anyone be sure of what they "find?"

But let's not be harsh. Say we play pretend that everyone agrees on a trigger point being a "tender point in a taut band" AND "recognized pain referral", then what? Well. Trigger points are still a pain in the ass to find (50/50 chance). And the next practitioner is NOT likely to find the same spot as the guy before, or even find the spot again on his/hers next attempt (http://1.usa.gov/Xe0HFf).

So what happens? Usually the practitioner just start poking on the area which the patients points out their pain. The practitioner thinks he/she delivers trigger point therapy and the patients thinks they get good bang for the buck.

But to quote Phd Nikolai Bogduk; "If the diagnostic criteria for a trigger point are relaxed to consist only of tenderness, the reliability increase, but the increase of reliability is at the expense of validity of the diagnosis, for tenderness alone does not constitute a diagnosis of trigger point syndrome, or any other condition; it is simply tenderness."

What usually hurts more than having a so-called trigger point, is to hear that it is simply tenderness (say hello to cognitive dissonance). So why does it hurt to hear the truth? Because treating "trigger points" has become an industry full of "experts" just aching to relieve you from pain (and money), based on false premises.

Now, hear this – the trigger point hypothesis has guided a huge amount of (good & bad) research about what "tenderness" really is, but it still hasn't led to a reliable way to get rid of tenderness (http://bit.ly/Zkfi4Q). It is absolutely not hard, good, definite science, as many hyperbole claims about treatment of "trigger points" want you to believe.

Phd @NeilOConnell tweeted "What if trigger points are just a case of medicalising the normal? Ghost phenomena that exist primarily through confirmation bias alone?" I think he triggers a good point.

If you still think "trigger point therapy" is worthy your attention, do read what Dr. Frederick Wolf has to say about it (http://bit.ly/YpZuZB).

Dr. Wolf was the guy who defined the diagnostic guidelines for fibromyalgia, but also later regretted it.

"In 1992, we performed a study of trigger points. A group of four myofascial pain experts, selected by Simons and including Simons, blindly examined four patients with MFP. The examiners were allowed to take as much time as they needed; they could examine but not interview the patients. As we had mixed MFP patients with those who had fibromyalgia, it was a blinded experiment. These MFP experts were no ordinary examiners. THEY WERE THE BEST They wrote the book, they did the lectures. But, in the end, they could not find or agree on the trigger points. It was a disaster."

Another guy who has a LOT to say about trigger points (and about everything else mythical in the bodyworkers' world) is Paul Ingraham. Check out one of his his many excellent posts – "Trigger Point Doubts": http://bit.ly/12Wdi3B

So what to do about tender spots? First of all, DO SOMETHING! Rub it, touch it, move it, stretch it, soothe it, talk to it, cuddle it, change the circumstances and context of onset and duration, be creative, but don't hurt it – monitor everything about it – ANYTHING can potentially decrease the sore spot. And you can achieve this WITHOUT the trigger point paradigm…

#lt #MT  

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