from 1/31/13 Post:

Trigger Points 

Excerpts from The Trigger Point Therapy Workbook by Clair Davies, NCTMB

"Trigger points are known to cause headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis, tendinitis, bursitis, or ligament injury.  Trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow, and genital pain.  Trigger points can also cause colic in babies and bed-wetting in older children, and may be a contributing cause of scoliosis.  They are a cause of sinus pain and congestion.  They may play a part in chronic fatigue and lowered resistance to infection.  And because trigger points can be responsible for long-term pain and disability that seem to have no means of relief, they can cause depression."

"I [Davies] found that, although the physiology of a trigger point was extremely complex, a trigger point for practical purposes could be viewed as what most people call a "knot": a wad of muscle fibers staying in a hard contraction, never relaxing.  A trigger point in a muscle could be actively painful or it could manifest no pain at all unless touched.  More often, though, it would sneakily send its pain somewhere else.  I gathered that much of my pain, perhaps all of it, was probably this mysterious displaced pain, this referred pain.  It was a mistake to assume the problem was at the place that hurt!  

"Janet Travell and David Simons describe a trigger point as simply a small contraction knot in muscle tissue.  It often feels like a partly cooked piece of macaroni, or like a pea buried deep in the muscle.  A trigger point affects a muscle by keeping it both tight and weak.  At the same time, a trigger point maintains a hard contraction on the muscle fibers that it is a part of.  In turn, these taut bands of muscle fiber keep constant tension on the muscle's attachments, often producing symptoms in adjacent joints.  The constant tension in the fibers of the trigger point itself restricts circulation in its immediate area.  The resulting accumulation of the by-products of metabolism, as well as deprivation of the oxygen and nutrients needed for metabolism, can perpetuate trigger points for months or even years unless some intervention occurs.  It's this self-sustaining vicious cycle that needs to be broken (Travell and Simons 1999, 71-75).

The difficulty in treating trigger points is that they typically send pain to some other site.  Most conventional treatment of pain is based on the assumption that the cause of pain will be found at the site of the pain.  But trigger points almost always send their pain elsewhere.  This referred pain is what has always thrown everybody off, including most doctors and much of the rest of the health-care community.  According to Travell and Simons, conventional treatments for pain so often fail because they focus on the pain itself, treating the site of the pain while overlooking and failing to treat the cause, which may be some distance away."

Trigger points can develop in any of the two hundred pairs of muscles in the body, which gives them a wide territory for creating mischief (1999, 13).  Trigger points can last as long as life and can even survive in muscle tissue after death, detectable until rigor mortis sets in (1999, 68).  

An underestimated trait of trigger points is that they can exist indefinitely in a latent state, in which they don't actively refer pain.  Travell and Simons believe that the long-term effects of latent trigger points may be of even greater concern than the pain caused by active ones.  They assert that latent trigger points tend to accumulate over a lifetime and appear to be the main cause for the stiff joints and restricted range of motion of old age.  In addition, the constant muscle tension imposed by latent trigger points tends to overstress muscle attachments even in younger people, which can result in irreversible damage to the joints and may be one of the causes of osteoarthritis.  You may not suspect that you have latent trigger points, but they're very easy to find.  They're exquisitely painful when pressed on.  Latent trigger points can be activated by very little stress or strain (1999, 12-21).

Not infrequently, people think that myofascial trigger points cause only pain in the face, teeth, and jaws, getting "fascial" mixed up with "facial."  Trigger points certainly can cause face pain, but myofascial pain can occur anywhere in the body.  The prefix "myo" in myofascial (MY-oh-FAH-shul) refers to muscle.  Fascia (FAH-shuh) is the thin, translucent membrane that envelopes and separates muscles like shrink-wrap.  (A good place to see fascia is on a chicken leg.)  When you have trigger points in a muscle, the fascia covering it typically gets tight and inflexible and becomes part of the problem.  

Luckily, in troubleshooting your own myofascial pain, the trigger point's exquisite tenderness to pressure always gives it away.  Trigger points always hurt when pressed on--there's never any question.

Pharmaceutical treatments only mask the pain.  The good  news is that trigger points can be surprisingly easy to fix on your own (and especially with the aid of a good massage therapist).  Additionally, referred pain is now known to occur in predictable patterns making it easy to determine which trigger points to work on.  In the upcoming weeks, I will be posting some common trigger point issues and how you can fix them  yourself, so be on the lookout for what might be causing your pain!!!

I will continue this series every Thursday:  Next Thurs I will continue sharing excerpts from Clair Davies' wonderful book on attachment trigger points, the mystery of referred pain, trigger point symptoms and self-massage techniques.  Subsequent weeks will be on some common situations starting with shoulders.

Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by  no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good!  Clair Davies' story is amazing as is his entire book.  I am very grateful to his dedication and revelation of this subject matter!!!

For the entire Trigger Point Series Posts:
Trigger Points
Referred Pain,Trigger Point & Symptoms
Shoulder Trigger Points
Back Trigger Points
Hip & Knee Trigger Points
Final Word On Trigger Points

from 9/9/13 Post:

Knowing Achilles Tendinitis from Plantar Fasciitis 

"Pain on the back of the heel is usually Achilles tendinitis, not plantar fasciitis. While symptoms may be very similar, they are two very different conditions. The Achilles tendon is the large tendon that attaches to your heel bone right where the back of your shoe hits your ankle. This motion provides the power in the push off phase of the gait cycle. Pain in this area is related to inflammation and overuse of the Achilles tendon.

Plantar fasciitis is typically on the bottom of the heel. Pain and inflammation of plantar fasciitis is also related to overuse.

Achilles tendonitis starts after a particular activity places too much stress on the tendon. This condition usually hurts when you first get out of bed in the morning and can also be worse after heavy activity. Swelling and worsening pain occurs if the condition goes untreated. Most people tend to delay seeking treatment assuming that it will get better on its own.

If you start having Achilles tendon pain it is best to immediately modify your activities to reduce pain. Since this is an overuse injury, the best immediate treatment is to rest your foot and ankle. Anti-inflammatory medication can be helpful for both swelling and pain. If the pain continues for over a week, it is advised to seek medical attention from an orthopedic specialist.

Healing of the Achilles tendon is often slow. Initial treatment involves both immobilization and activity modification. Physical therapy is also an important part of the recovery process. For severe cases that become worse despite appropriate treatment, surgery is a consideration." ~Dr. Sandra Klein

Plantar Fasciitis

"Plantar Fasciitis - inflammation in the sole of the foot.
Who gets it? Everyone. People who are active either at work, home, or athletically are more likely to get plantar fasciitis. It is common in runners and walkers and in people who stand for prolonged periods of time.  Pain is located in the arch near the Heel. It is worse in the morning when you get out of bed as well as after prolonged sitting.  The cause of plantar fasciitis is usually related to a tight calf muscle. There is a misconception that the pain is a result of a Heel spur. A spur may form but it is as a reaction to the inflammation in the plantar fascia and is not the cause of the pain."  ~Dr. Stacy Bacon

*****

from my 5/8/12 Post on Is Tendinitis Your 'Achilles'?
    

Got pain in your heel?  Let's see if it could be Achilles Tendinitis....

Signs & Symptoms of Achilles Tendinitis are pain in your heel about 2 to 6 cm above the tendon insertion into the heel.  Usually this pain is in the morning first thing and sharp or burning pain that increases with more vigorous activity.  Weak calves can be the cause as can high arches, flat feet, poor footwear, poor flexibility, lateral ankle instability, or errors in training along with leg length discrepancies, age, or prior injuries.  Running uphill increases the load on your calves and Achilles, so if you do a lot of running be sure you are properly warming up and stretching your calves.

If you have Achilles Tendinitis you can control the pain and inflammation by "ice" (ice, compression, elevation) as well as doing calf raises and stretching.  Beyond that, be sure you are utilizing proper training techniques, proper footwear, and are at the proper weight for your height.  Know that if you do not mend and instead push through the pain you could be risking an Achilles rupture.  Just as with overtraining, overstretching is just as bad and can cause irritation to the musculotendinous unit.  Aim for restoring proper length to the calf muscles to decrease symptoms without overexertion.

Excellent calf stretches are:

*Standing lunge with the back foot heel pressed into the floor for at least 6 breaths;
*Standing lunge with the back foot heel pressed into the floor and back knee bent (this takes the stretch further into your heel) for at least 6 breaths;
*Standing on a step with one heel hanging off for at least 6 breaths.

*****

With Achilles Tendinitis strengthen the calves as well as stretch them.  With Plantar Fasciitis avoid calf strengthen moves and focus on stretching the calves. 

from 9/10/13 Post:

Knee Pain 

Patellofemoral Pain Syndrome (PFPS), Chondromalacia, and Infrapatellar Tendinitis are all knee pain culprits.  PFPS pain is primarily in the front of your knee.  Chondromalacia is primarily under the knee cap.  Infrapatellar Tendinitis is pain in the distal kneecap into the infrapatellar tendon (inflammation of the patellar tendon where it inserts in the tibia--distal part of the patella and proximal tibia).



Chondromalacia is caused by the posterior surface of the patella not properly tracking in the femoral groove and causes the cartilage under the patella to become damaged by softening or wearing it away.  Be sure to check out this video on YouTube for help with both Chondromalacia and Patellofemoral Pain:  http://youtu.be/xWC4fLSSV6E

from 6/25/12 Post on Runner's v Jumper's Knee
     

Runner's Knee or Patellofemoral Pain Syndrome (PFPS) is anterior (front) knee pain and is often confused with chondromalacia (which is a softening or wearing away of the cartilage behind the patella resulting in inflammation and pain).  PFPS can occur either with overuse, repetitive loading activities causing abnormal stress to the knee joint, or through biomechanical abnormalities altering the tracking of the patella and alignment, or muscle dysfunction and tightness.  If you have pain with running, ascending or descending stairs, squatting, or prolonged sitting, or if you have a gradual achy pain that occurs behind or underneath the patella, or knee stiffness for a prolonged period of time, then you might want to look into the possibility of PFPS and treatment.

Jumper's Knee or Infrapatellar Tendinitis is an overuse syndrome characterized by inflammation of the patellar tendon.  Typical in sports such as basketball, volleyball, jumping sports producing significant strain in the tendinous tissues.  Causes can be poor running style, overtraining, sudden changes in training surface, lower-extremity inflexibility, or muscle imbalance.  If you have pain in the distal kneecap into the infrapatellar tendon or pain when running, walking stairs, squatting, prolonged sitting and you do a lot jumping activities, you might want to look at your footwear, training techniques and frequency.

How our feet move directly impacts how the knee functions just as how tight or weak our thigh muscles and hip function directly impacts how the knee functions.  Be sure to check out the Workout Tidbits Page for help with good training/form.

Law of Facilitation  The body subscribes to the law of facilitation, meaning that the body will achieve the desired movement following the path of least resistance.  If your body has any mobility-stability compromises, you will end up with dysfunctional movement causing inevitable breakdowns at your weakest link.  This is corrected by focusing on moving correctly as opposed to just moving.  A great example is the squat and the push up.  If you just move through either of these movements regardless of incorrect movement just to say you got the move done, you are actually causing layers of damage to muscular and joint function which will impede your progress to moving correctly in those and other movements.  An excellent way to get in touch, stay in touch, as well as improve your mobility-stability issues is to STRETCH.  Yoga is an excellent way to accomplish this.  When you are stretching, regardless of what modality you use, pay attention to what is tight and what is overcompensating for your “weak links” and communicate those findings to me during our sessions.  We can work together to improve your movements so your body doesn’t have to “compromise” to move.

Do Your Best....

How Yoga Transforms Your Body

from 10/17/12 Post:

Muscle Cramps 

Great tip from Men's Health:

Make a Muscle Cramp Vanish by Bill Hartman, CSCS PT

Don't Stretch ... Cramps are caused by your muscles contracting uncontrollably, and your natural reaction when a cramp sets in is to try to stretch your way out of it.  Resist the urge to elongate the muscle.  Stretching only puts your muscle through more strain, which could lead to more pain.

Flex Instead ... Leverage the intelligent approach: reciprocal inhibition (RI).  This is a nervous-system phenomenon that you can activate yourself.  When you contract the muscle on one side of a joint hard enough, the opposing muscle--the one cramping, in this case--will stop firing, easing the cramp.  The following cramps are the most common.  The next time on strikes, put RI into action with these moves.

*Bottom of your foot cramp = Lift your toes toward your shin.
*Calf cramp = Bend your ankle, bringing your foot toward your shin.
*Hamstring cramp = Sitting or standing, fully extend your lower leg.

Why Good Posture Matters

We live in a fast paced world today with little focus on mind-body connection unless we take the time to unplug and pay attention....for real.  By the end of a day you are most likely hurting in your upper back, neck, shoulders, low back, hips, etc., and more than likely your posture throughout your day plays a big, big role in this ongoing pain cycle.

Posture is key, but it can't just be a stretch and then right back to slumped over business as usual.  A solid stretching or yoga practice helps with awareness and alignment; but in addition to stretching and awareness, you need to be sure and apply good posture practices throughout your day and including tv viewing hours.  You'll know it's become habit once it no longer "feels weird" to sit or stand with good alignment.

Why is it important?  You mean besides eliminating unnecessary aches and pains?  Poor posture not only causes grief to your muscles from either being overly contracted or overly flexed, but it pulls your skeletal alignment out of place and causes dysfunctional movement patterns and joint issues over time.  Good posture doesn't just look good, but it feels good once you put it into practice.  Added benefit is you will actually look up to 10 pounds slimmer just by standing with good form!

Stages of Understanding

from 12/29/11 Post:

Stages of Understanding 

Is life perfect?  No, and nor will your fitness (and/or weight loss) journey be perfect.  Nothing in life is about reaching perfection but about doing your perfect best every opportunity you have to do it and understanding what that means.  Your perfect best changes from moment to moment as your circumstances change....but mostly as your understanding of your journey changes.  I was reading an article some months back that said "before you can know something, you first have to learn it; that understanding is necessarily a process of steps; and that this process takes time...everyone has to progress through certain stages of understanding."  It went on to draw the analogy of learning to play the piano or knit....one starts out very crudely but with practice and ongoing understanding improves and evolves.  In other words, with each stage of understanding of any craft, profession, or journey the start is always crude and then the destination is always further the closer we get to it because not only does our ability improve and evolve and become less and less crude but also we understand that one's learning, development....journey is never at an end (as the saying goes, the more you know, the more you realize you need to learn).  So, know that however clumsily any week/effort/workout goes you can learn something from it and move on to the next, better equipped to succeed further.  As this is not about the destination but the journey itself....The destination helps us set goals, but the journey is what makes us who we are and appreciate what we have.

"Not that I speak in respect of want: for I have learned, in whatsoever state I am, therewith to be content.  I know both how to be abased, and I know how to abound: every where and in all things I am instructed both to be full and to be hungry, both to abound and to suffer need.  I can do all things through Christ Which strengtheneth me."  ~Philippians 4:11-13

from 5/23/13 Post:

Go INTERVALS Go 

from Men's Health June 2013 issue:

THREE ... the Number of weekly interval workouts that match the effectiveness of five long cardio sessions when it comes to boosting cardiovascular health.

from my 6/19/12 Post:

How Effective is HIIT?

High Intensity Interval Training (HIIT) is anaerobic training that allows you to cut cardio duration without sacrificing the cardiovascular benefits. HIIT primarily focuses on anaerobic pathways with numerous HIIT ratios that can be utilized such as a 1:1 (e.g., 30 sec of work to 30 sec of active recovery beginner Interval), a 2:1 (e.g., 20 sec of work to 10 sec of active recovery Tabata or 60 sec of work to 30 sec of active recovery intermediate Interval), or a 3:1 (e.g., 45 sec of work to 15 sec of active recovery advance Interval). The beauty of HIIT is that it not only cuts your workout duration, but in a lot of ways is way more effective than longer duration endurance cardio, especially when it comes to fat burning. But, to be effectively performing HIIT you have to be intensely working out in the "work" phase.
During exercise, higher levels of intensity cause an increase in respiration to allow larger volumes of air to move into and out of the lungs to facilitate increased delivery of oxygen and the removal of carbon dioxide. Simple, basic, you work harder resulting in you breathing harder. And as with everything, this simple process has a name...minute ventilation or Ve. There are two deflection points in the otherwise linear increase in Ve and that is VT1 and VT2. When you are exercising below VT1 you are able to carry on a conversation fairly normally. This is not very intense exercise and below VT1 is where a lot of long duration, steady state, endurance running/exercising is. At or just above VT1 is where carrying on a conversation is a little more difficult and speaking is slightly uncomfortable. Exercise just below VT2 represents the highest intensity an individual can sustain for approximately 20-30 minutes. Speaking is very broken and choppy just below VT2 and not at all at or above VT2. Intensely working at VT2 and above is where HIIT should be on the "work" phase. Active rest should be between VT1 and VT2 allowing your body to recover from the work phase without lowering your heart rate too much.

Recent research shows that the cardiovascular adaptations that occur with HIIT are similar, and in some cases superior, to those that occur with continuous endurance training (Helgerud et al. 2007; Wisloff, Ellingsen & Kemi 2009).

A Few DOs 'n' DON'Ts .....

Here are a few DOs 'n' DON'Ts to get you to where you want to go......Yes the pic is horizontal, yes I tried everything to flip it....as it appears vertical in every other medium but here and Facebook, I'm at a loss. Stretch your necks and read the DOs 'n' DON'Ts to get you to where you want to get to with your fitness and weight loss goals Come to the VEF Studio for the "vertical" version www.veryeffectivefitness.com/