CNHC update: March 2014
Trigger Happy! The art and science of trigger point therapy in advanced massage
Insomnia Treatment Slows Down Ageing
CAM Practitioner Gut Health Audit for Clients
CNHC update: March 2014
• CNHC Profession Specific Board elections – next round begins soon!
The third round of CNHC Profession Specific Board (PSB) member elections will begin in March 2014.
The next round of elections will be for the Alexander Technique teaching, Bowen therapy and Yoga therapy PSBs. Any registrant from these three disciplines will be able to stand for election for the relevant PSB, including those who are currently members of the PSB. The electorate will be all registrants in the relevant discipline at the time of the election.
Please note this means that only those that are CNHC registered as at Thursday 6th March 2014 will be eligible to stand for election and only those registered as at 31st March will be invited to vote.
CNHC will publish a template ‘election statement’ requiring candidates to set out in a maximum of 600 words how their background and experience meet our essential criteria. These statements will then be made available to the CNHC registered practitioners of each discipline in the Resources section of My CNHC. The elections will be held electronically before the end of April 2014.
We will be emailing all CNHC registered Alexander Technique teachers, Bowen therapists and Yoga therapists in early March 2014 setting out the full details and inviting registrants to stand for election.
• Interested in helping to build the body of evidence for complementary therapies?
You can attend an RCCM workshop on writing case reports
On Friday 28th March the Research Council for Complementary Medicine (RCCM) will be holding a workshop between 1.45-4.45pm on writing case reports. This workshop will be held at London South Bank University and will focus on the importance of case reports in practice and for research. Speakers include: Dr Clare Relton, Sheffield University, Dr Marie Polley, Westminster University and Professor Nicola Robinson, London South Bank University.
Register your interest early as this workshop is likely to be oversubscribed and places are limited. The workshop will be £50 with a 15% discount for RCCM Friends and RCCM Corporate members (reduction available for 2 places). For further information and to register contact Mary O’Meara at camrn@rccm.org.uk. For more information about the RCCM, visit: www.rccm.org
For further information about the CNHC and how to register or renew call 020 3178 2199, email info@cnhc.org.uk or visit www.cnhc.org.uk
Trigger Happy! The art and science of trigger point therapy in advanced massage
Sally, 36, came to me complaining of chronic low back pain and a nagging persistent pain between her shoulderblades. The pain made it difficult to sleep and Sally had seen a chiropractor, osteopath, and received epidural injections. None of these treatments had any lasting results. She told me she felt helpless and resigned to a life of constant pain.
John, 40, came into my clinic complaining of a sharp pain in his low back which was worse with movement. The pain had arisen the day before when he had suddenly turned quickly in his chair at work. He was desparate for my help as he was due to play in a big golf tournament that weekend.
Christine, 36, complained of a searing pain down her neck and arm which “made her feel sick” and unable to eat due to the pain.
Samantha, 23, had suffered from chronic migraine headaches since childhood; since the age of 4 she had been having at least one migraine a week causing her to have time off work and spend countless days in bed.
Do you know people like those above? Chances are that you do- they are members of your family, neighbours, work colleagues or perhaps you yourself. Maybe as a massage therapist, these people have come into your clinic and your heart has sank at the expectation to “cure”, to move them out of pain – you really want to help but you just don’t know how. Your qualifying course just taught you to be afraid of people in pain, to stay away from herniated discs and mysterious aches. So you just give these clients a general relaxation massage avoiding the area of pain, refer them on to your local osteopath or send them back to their GP for X-rays, MRIs and usually no answers.
Yet all of the clients at the beginning of this article are real and came into my massage clinic seeking help. Using a combination of trigger point therapy, fascial work and advanced stretching techniques, all of these clients experienced a decrease in their pain after just one treatment and were all 90% or more pain free within 6 weekly treatments. They now all come to me for regular maintenance sessions and between them have referred approximately 30 more clients.
Do I have any special magical powers as a massage therapist? The answer is no; just a knowledge of advanced bodywork techniques – in particular the amazing power of precise trigger point therapy. The good news is that as a bodyworker you can learn to bring all of the above clients out of pain quickly, effectively and permanantly, within 1-6 weekly treatments using trigger point skills.
Trigger point therapy is a highly effective technique that can be easily incorporated into your existing massage work and will astound you and your clients with the power of the results. As one of our students said “ I don’t know who was more surprised- me or my clients- when they came back the next week reporting dramatic relief from long standing problems”
Excitingly, the students who have learned these techniques with us have also reported:
o Increased clientele (and therefore more money!) without the need for formal marketing due to the new effectiveness of their treatments.
o Increased confidence in their ability to treat pain conditions.
o Less need to refer clients on to osteopaths or other professionals.
o A renewed enthusiasm and zest for their work.
All sound a bit good to be true? Then read on!
PLANET JANET!
Dr Janet Travell- the founder of trigger point techniques
“Concerning your professional goals, the basic objective is: BE YOURSELF. Do not compare yourself with anyone else. No two people in the world have the same thumb print, not even identical twins. You are unique”
“It’s better to wear out than to rust out,”
“Take care of your muscles and they will take care of you.”
(favourite sayings of Janet Travell quoted on the memorial website set up by her daughters -www.janettravellmd.com)
Thanks to the work of Dr Janet Travell, we have a growing body of evidence that many pain conditions are actually caused by trigger points or small contraction knots in the msucles. Studies suggest that trigger points are a component of up to 93% of the pain seen in pain clinics and the sole cause of such pain as much as 85% of the time. (Gershwin; Fishbain quoted in Travell and Simons: Myofascial Pain and Dysfunction: The trigger point manual Volume 1)
Trigger points are known to cause or contribute to low back pain, carpal tunnel symptoms, tennnis elbow, neck pain, migraines, jaw pain, and many kinds of joint pain mistakenly attributed to arthritis. They can cause sinus pain and congestion, nausea, chronic dry cough and are thought to contribute to fibromyalgia.
Trigger point theory is really ALL about Janet Travell. Seriously it really is – much of what has been theorized or written about trigger points can be directly traced back to her insights and most of the books that have been written on the subject are condensed or simplified versions of the famous trigger point volumes co-authored with David Simons. As Clair Davis, massage therapist and author of the successful trigger point therapy workbook puts it
“Among those who recognize the reality and importance of myofascial pain, Janet Travell is generally recognized as the leading pioneer in diagnosis and treatment. Few would deny that she single-handedly created this branch of medicine. . . . Her revolutionary concepts about pain have improved the lives of millions of people.”
Any brief examination of the life and character of Janet shows clearly that she was a “tour de force”; a woman of determination and will and moreover an excellent physician and healer. Balancing an intensive career with marriage and children in a pre-enlightened era, she is famous for being the first woman ever to hold the post of White House physician and Kennedy described her as a “medical genius”. Authors of the book “Trigger point therapy for myofascial pain” Steven and Donna Finando worked directly with Janet Travell on several occasions in the nineties, declaring the experience to be “the opportunity to observe a master practitioner”:
“Watching Dr. Travell treat patients was a joy. She understood what to do, where to touch, how to move, how to feel and she ultimately helped her patients. She understood what was of benefit and hypothesised about why. The concepts and approaches that she utilized simply work; they help change lives and alleviate suffering”
As massage therapists we owe a great debt to Janet Travell -as the quote above simpy states – her approaches “simply work” and I have found this true thousands of times over in my bodywork career dealing with chronic musculo-skeletal pain.
What exactly is a trigger point?
Although the term trigger point has passed into more common usage since the publication of Travell and Simons seminal works in the 80s there is still a surprising amount of mis- information about what trigger points actually are (and aren’t), not to mention the best way to treat them.
Let’s start with the universally known classic definition from Travell and Simons themselves –you will be hard pressed to read an article or book on trigger point therapy without encountering the classic soundbite below:
According to the “the source”, a trigger point is:
“A hyper irritable locus within a taut band of skeletal muscle, located in the muscular tissue and/or its associated fascia. The spot is painful on compression and can evoke characteristic referred and autonomic phenomena”
As this definition tends to make a large percentage of the population glaze over, most of your clients are likely to understand trigger points as “muscle knots” ie: lumps and bumps in their muscles that are responsible for their pain. Although the muscle has definitely not tied itself into a knot, clearly the average massage therapist is well aware that clients will be seeking help for relief from these pesky “muscle knots” .
Clearly the knot analogy is a pervasive image and we all instinctively feel the urge to poke around our own bodies when we are in pain to try and find these “hot spots”.
So if trigger points are not actually knots what are they? The key points about trigger points as drawn out from this definition are:
• They “feel” like knots in muscle but are in fact small areas of tightly contracted muscle (NOT the same as a whole muscle spasm)
• They are usually found within a taut band of skeletal muscle which can be palpated
• If you press on the trigger point it hurts
• This is the most exciting point to therapists- the pain has a characteristic referred pain pattern. This means that the pain from trigger points often causes pain in other parts of the body distant from the trigger point itself. A good example is trigger points in the SCM muscle which can commonly cause headaches or jaw pain. Or trigger points in the piriformis muscle that can cause a pain down the leg commonly confused with sciatica. Or trigger points in the quadratus lumborum that cause pain around the sacrum that can feel like sacro-iliac pain.
• There is also a lesser known mysterious part to the definition– trigger points can also cause “autonomic referred phenomenen”. In other words trigger points can also cause symptoms you would never guess were coming from your muscles- for example ringing in the ears or dizziness can be caused by trigger points in the SCM
The concept of referred pain is an important one as it means that the source of the pain can often be in a different location than where the client is feeling their discomfort. This is critical to what we do as massage therapists, as the theory of trigger point therapy suggests that if we are only treating the area of pain we are unlikely to achieve lasting results. It is likely that if the cause is myofascial trigger points and you are only in the area of pain, you will be wrong 75% of the time!
What are the effects of trigger points?
Pain
The bad boys of the body, trigger points are always up to no good. Travell and Simons go so far as to describe them as the “scourge of mankind”. Many researchers have corroborated the notion that trigger points are responsible for a large percentage of musculo skeletal pain, with some studies suggesting that trigger points are a component of up to 93 percent of the pain seen in pain clinics and the sole cause of such pain as much as 85 % of the time
The pain from trigger points can manifest in many different ways – it can feel dragging, stabbing, dull, tingling, burning, superficial or deep in the joint. Trigger points can also known to cause weakness in the affected muscles. Because there is a lack of awareness as to the concept of trigger points, the pain is often misdiagnosed as having a more serious or unknown cause leading to unnecessary medical tests or fear and hopelessness on the part of the client.
Compression of nerves and blood vessels
As nerves and blood vessels perforate the muscles at many places, the shortening of muscles caused by trigger points can lead to their entrapment with consequences of numbness, tingling (nerves) or oedema (blood vessels). I have had many cases of misdiagnosed carpal tunnel syndrome in my clinic that have been easily resolved through appropriate trigger point treatment of the scalenes or pectoralis minor, both of which can trap the brachial plexus (nerve bundle that runs down the arm) when shortened by trigger points.
Restricted movement
The taut bands that arise in connection with trigger points lead to shortening of the muscles – this in turn leads to reduced mobility and potentially joint dysfunction
Autonomic Effects
Autonomic effects can be found both in the area of the trigger point and in the area of referred pain. Autonomic effects include changes to skin temperature, increased sweat secretion, nausea or dizziness. Some other more bizarre cases of autonomic effects cited by Travell and Simons comprise reddening of the eyes, excessive tearing, blurred vision, a droopy eyelid, excessive salivation, persistent nasal secretion and goose bumps.
Adhesions and contractures
Persistent trigger points in muscles can lead to stiff ropy like cords in the muscle – these are caused by fascial adhesions overlying and fixing the trigger point complex. Layers of connective tissue literally stick to each other causing hard, ropy muscles that feel like they are glued together. These are known as adhesions and severe cases can even develop into a form of contracture, similar to that seen in people with paralysis. Adhesions literally “lock in” trigger points making them more difficult to treat and compounding problems of pain and movement. Contractures also affect the overall functioning of the muscle; the contracture is felt as hard, tight and fibrotic whereas the rest of the muscle becomes weak and atrophied.
The great pretenders -Misdiagnosis and myths attributed to trigger points
Because most primary health care providers are not specialists in musculo skeletal pain, the pain from trigger points can be a cause of medical misdiagnosis. Travell and Simons name a list of 23 common diagnoses where overlooked trigger points were the cause of symptoms. Looking down the list is similar to leafing through my client notes over the last 20 years – the conditions mentioned are common occurences in the average massage therapists clinic and can usually be successfully treated through trigger point therapy. Some common examples of misdiagnosis I have encoutered over the last 20 years of clinical practice include:
• Frozen shoulder
• Bursitis
• Suspected herniated cervical or lumbar disc
• Osteoarthritis
• TMJ
Causes of Trigger Points
Trigger points are very common and can develop in any of the 200 muscles in the body. No one escapes them -not even children and babies. Trigger points can be caused by a variety of events including accidents, falls, repetitive motions, poor posture, pychological stresses and inadequate diet.
How to find and treat Trigger Points
For massage therapists the most efficient way to treat trigger points is by direct sustained pressure applied directly to the point for about 8-12 seconds.
Compression of the trigger point should always be followed by stretching of the muscle. In Jing we highly recommend the approach of treating all the muscles around the joint for trigger points – this is a key concept if you really want to successfully get your clients out of pain.
So for example to treat low back pain, the therapist looks for trigger points in the erector spinae, quadratus lumborum, gluteus maximus, gluteus medius, hamstrings and psoas.
Learning Trigger Points skills to integrate into your massage work
Like many bodywork modalities, effective trigger point technique is a subtle blend of art and science. Effective treatment depends on knowing how to accurately locate the muscles involved, confidence in your approach, focussed palpation skills and the opportunity to practice under experienced supervision.
There are many great CPD courses out there in trigger point therapy and we would highly recommend you get further training in these great techniques.
Upcoming articles in Massage World will also give more practical advice on how to incorporate trigger point therapy for effective results
For now- get yourself one of the great books out there on trigger point therapy and get trigger happy! You have nothing to lose and everything to gain!
Insomnia Treatment Slows Down Ageing
Beauty sleep is not a myth. Since 2010, it has been proven scientifically that sleep is anti-ageing . Dr John Axelsson’s research in the British
Medical Journal showed that observers were more likely to rank people as attractive if they had slept well.
Adults are advised to have at least eight hours sleep every night, but modern lifestyles makes this hard to achieve. In the UK, 22% of people suffer from insomnia . This is substantially higher than in other parts of Europe and the USA.
Thankfully, relief may be found through six unique compositions comprising the Orange Grove Siesta. These are all created in the relaxing idiom of famous composer John B. Levine, providing help for insomnia that is especially popular with women, when an overly busy mind prevents sleep.
Michelle, a school community service worker, met Alphamusic composer, John Levine at one of his workshops. After enjoying his concert and Alphamusic presentation, she eventually acquired three of John’s CD titles having read a lot about his creative output on his www.silenceofmusic.com website.
Although a bit sceptical, she decided to give John Levine’s Alphamusic a try. Michelle had had sleeping problems for a long time and was unable to rest properly during the nights. She blames her sleeping difficulties on family problems. Her mother having a severe breathing setback, although coping well, suffers panic attacks. Knowing that her breathing will not improve and might even deteriorate spreads fear amongst Michelle’s family. Having heard and read so much on the web regarding the good John’s Alphamusic is doing for people around the world, Michelle decided to try it out one night. …
She wasn’t disappointed. “I have slept very well ever since using the Orange Grove Siesta. I play it just before bed time and as I drift off. This music really calms me down. In the past I have tried radio or other music to calm myself and help me get off to sleep but these have had the effect of filling up my brain instead of calming it” admits Michelle.
John Levine is both composer and pianist for his recordings. His accompanying musicians extemporize throughout the piece according to Levine’s Alphamusic principles and compositional guidelines, creating variance in timbre and phrases, enhancing the overall artistic music expression. The compositions are enriched by a variety of balanced and well-matched instruments.
John is classically trained with a Bachelor of Composition from Sydney University, and performs using a Steinway concert grand piano in an orchestral recording studio. His Alphamusic is based on his knowledge of the centuries-old European and Asian scales some of which are the Pentatonic and Lydian scales, but not only. Musical tension builds and ebbs slowly with no rush or rough discords. The “spherical” sounds have been known to bring listeners to an alpha state within 4 minutes.
The Orange Grove Siesta CD by John Levine is available from www.silenceofmusic.com, on info@silenceofmusic.com, or on 020 3239 8108.
For further information please contact John at:
info@silenceofmusic.com
www.silenceofmusic.com
T: 079 200 58 449
CAM Practitioner Gut Health Audit for Clients
As part of their CAM Services & Support Programme, Symprove are offering a limited number of nutritional therapists the chance to offer one client the opportunity to take part in a gut health audit and receive 3 months of Symprove free of charge (the retail value is just under £240). All you need to do is to complete the following information via the link below and they will be in touch with details.
Complete the questionnaire and find out more