Good Pain and “Trigger Points”

A few points, before you read on:

  1. In the manual therapy world, “muscle knots”, “trigger points”, and “MTP’s” (myofascial trigger points) are synonymous terms.
  2. There is such thing as “bad/ugly” pain, and this should be avoided.  It is not uncommon for therapists to inflict this sort of pain on clients.  There are veteran therapists out there that are guilty of this…this is simply the reality of the situation.

Ingraham, PainScience:

“Good pain. In massage, there is such a thing as “good pain.” It arises from a sensory contradiction between the sensitivity to pressure and the instinctive sense that it’s also a source of relief (probably mostly due to the phenomenon of trigger points: more about this below). So pressure can be an intense sensation that just feels right somehow. It’s strong, but it’s welcome. Good pains are usually dull and aching. It is often described as a “sweet” ache. The best good pain may be such a relief that really the only bad thing about it is just that it is breathtakingly intense.”

and

“Trigger points are fairly well-defined physiologically. We know what they are, and we know where they live. They are essentially a miniature spasm, a small patch of a muscle tissue that is super-clenched. They are common, and responsible for most of the garden variety aches and pains of humanity*, ranging from mild to crippling. And we know that they can, sometimes, be relieved simply by “ironing them out” with skillful thumbs.

When you press on a trigger point, it’s going to feel painful because it’s a swampy little patch of muscle in metabolic overdrive, its sensory nerve endings bathed in junk molecules. But it’s also going to feel like a relief to have any of that problem taken away! As discussed above, relief from trigger points may occur simply through crushing and destroying the cellular machinery of it. But there are numerous other possible mechanisms, such as a tiny, localized stretching of the spasm — a miniature version of what you do when you stretch out a big leg muscle to ease a charlie horse. Another likely mechanism is that the pressure squishes stagnant tissue fluids out of the spot, allowing them to be replaced by fresh circulation.”

*When Ingraham says “garden variety aches and pains of humanity”, he simply means ordinary muscle knots

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Why A Treatment Works, and Why That Matters

A beautifully and simply written blog by Todd Hargrove, that is really worth a read to anyone that has ever received therapy and/or has questioned its explanations: Todd Hargrove Blog

Here are some of my favorite excerpts:

1. Why exactly does someone feel better after massage? Or acupuncture? Or foam rolling? Or a chiropractic adjustment, or wearing K-tape, or doing mobility drills, or a hamstring stretch?  There are some good answers to these questions, and the interesting thing I’d like to point out in this post is that quite often, the therapist doesn’t know them. Or even care about them! Or maybe the therapist has heard the good answers, but prefers alternative bad answers that are far less plausible given the current state of relevant science.

Speaking of bad explanations: Foam rolling probably doesn’t work by breaking adhesions or melting fascia. Chiropractic manipulation doesn’t put joints that are “out” back “in.” Deep tissue massage doesn’t get rid of toxins or “muscle knots.” Acupuncture doesn’t access special points or meridians – putting the needles in random places works just as well. Some sham surgeries work just as well the real thing. Motor control exercises often work to reduce pain even though motor control hasn’t changed.

None of this means that the above treatments can’t work to make someone feel better. It just means they don’t work in the manner advertised. And no this doesn’t mean that everything is just placebo (that’s a confusing word without a clear meaning.)

In general, it seems that therapists have a strong bias towards the idea they are fixing “issues in the tissues.”  And they tend to ignore issues in the more complex systems in the body – nervous, immune, autonomic – which are very sensitive to even minor inputs and have a great influence over how we move and feel. Maybe this is because these systems are less visible, or tangible, or just not what practitioners learned about when they were in school.

I was trained as a Rolfer and taught that Rolfing works by changing fascia. So when people got up from the table and said they felt taller, or looser, or had less pain, this was because their fascia had somehow changed for the better.

After doing some research about the deformability of fascia in response to manual pressure, I decided this was not a good explanation for our observations. A better explanation would involve the nervous system, which is constantly adjusting muscle tension, movement patterns, perception, and pain sensitivity in response to new sensory information, including the highly novel sensory information caused by bodywork.

Of course it’s kind of a bummer to learn that a central premise of your education is incorrect. But the good news is that this doesn’t mean people can’t be helped with your treatment. That is a completely separate issue. So my attitude was – OK, it’s not about the fascia, but that doesn’t mean I can’t help people.

2.  Imagine someone with neck pain goes to the chiropractor, is told their neck is “out”, gets cracked to put it back “in”, and then immediately feels much better. What’s the harm if they think that pain relief came from some form of realignment?

Maybe in the short term there is no harm, but false beliefs have a mischievous way of eventually causing problems in the long term.

Let’s say the neck pain comes back. The client thinks her neck must be “out” again so she needs another crack. So she overlooks other potential solutions like exercise, rest, or gentle movement. If the neck pain continues, she might eventually develop the pathological belief that her neck is fragile and unstable. This can have a nocebo effect – creating further pain and avoidance of healthy movement.

I have seen many clients with similar misconceptions, and this has cost them significant time, money, anxiety, and confusion.

And I’m not just talking about the clients of chiropractors.

I have seen yoga people who are always stretching; Pilates people always stabilizing; corrective exercisers looking for microscopic muscle imbalances; joint mobility fans perpetually mobilizing, as if their joints need a constant bath in synovial fluid, or will start knitting themselves together with some sort of fascial “fuzz” after just a few minutes of stasis. Rust never sleeps!

All these pathological behaviors ultimately stem from false beliefs about why certain therapies have worked for them in the past. These beliefs cluster around the idea that they have corrected “issues in the tissues” as opposed to temporarily adjusting the sensitivity of the nervous system.

The bottom line is that false beliefs, no matter how small, are like viruses – they multiply, get passed to others, mutate to form super bugs, and can eventually cause disease. Don’t spread them people!

Touch inhibits subcortical and cortical nociceptive responses

Very interesting study looking at the mechanisms behind the proposed analgesic (pain-reducing) effects of “touch”.

Link to study: Study in Journal Pain

Take home message for readers: “Touch induced a clear analgesic effect” – meaning that simply be touched, can have a pain-reducing effect.  Huge implications here for therapies of all sorts.

K-Tape Law Suit

At first glance, Kinesiology Tape might appear as an interesting method of decreasing musculoskeletal pain or enhancing performance, especially for athletes willing to do anything to boost their performance.  Studies indicate*, however, that this special type of tape may result in performance benefits purely as a result of the placebo effect.  Nothing wrong with that right?

The issue is the false/unwarranted claims made by K-Tape, one of the larger manufacturers of kinesiology tape.  K-Tape claims that its product treats 16 specific injuries including carpal tunnel, runner’s knee, tennis elbow, plantar fasciitis, achilles tendonitis, ankle sprains, and shin splints… despite there being no scientific evidence to support this.

K-Tape Class Action Law Suit

Quoted from the lawsuit: “This case pertains to the false representations by KT Health which have been made in a concerted and orchestrated effort to prey on consumers’ eternal hope that products exist that can quickly and effortlessly alleviate their pain.” and “KT Health has used deceptive claims regarding the purported benefits of KT tape to charge a premium approximately ten times the price of traditional athletic tape, and has achieved massive sales of KT Tape as a result.”

Sure, at the end of the day, no one really gets hurt when a company or person makes claims like this.  The consumer loses $.  No significant damage done.  However, the company/person must be willing to face the music when the time comes.

*One good example highlighting this: A study in which isokinetic (strength) testing under three taping conditions was performed, using: true facilitative kinesiology tape, sham tape, and no tape.  Participants were blinded, i.e. did not know which tape they were receiving.  There were no differences in their peak torque, total work, or time to peak torque.

Just use normal tape!

Mindfulness + Movement + “Badali Therapy” (My cousin)

A few weeks ago, I connected with a cousin of mine, Paul Badali, who is a registered Social Worker providing Psychotherapy Services in Toronto (website: badalitherapy.com).  He has been working in mental health services for close to two decades.  Paul employs a program he calls “Taming the Bull”, and has experience working with patients with:

  • Self-regulation difficulties (self-control)
  • Stress, Anxiety and Depression
  • Anger, Mood and low Motivation
  • ADHD and Learning Disabilities (LD)
  • High functioning ASD (Aspergers)
  • Other mental health-related issues

Besides all this, Paul has extensive martial arts experience, and is a Brazilian Jujitsu black-belt – if you’re not in the BJJ loop, it would be impossible for me to describe how impressive this is  (I am merely a white belt).

Paul has discovered that integrating mindfulness, exercise, and psychotherapy was very effective and beneficial to the therapeutic process.  (In layterms, he started incorporating exercise into his psychotherapy sessions, and found that this improved the psychotherapy results!).

It’s a topic that I am quite interested in.  The following paper Mindful movement: clinical and research implications discusses the neurophysiological and neuropsychological aspects of mindfulness training and movement (i.e., why doing things, as mentioned in the paper, like yoga and tai chi can have these neuro(brain)/mood-altering effects).  I’m left wondering, however, if other activities like dance, Jujitsu, and perhaps even table-tennis or golf can have these pro-neuro effects.  Perhaps any sport/physical-activity in which one has developed enough expertise and finds oneself in that state of “flow” or “in the zone” can offer such an effect.  That’s my hypothesis…

How Stress Affects Your Body

Colin Badali - TED

Fantastic video @TED – Video

Stress is more than just an emotion.  It’s a hardwired physical response.  In the short-term, stress can be advantageous. However, prolonged stress can be damaging to our bodies.

Science has suggested that prolonged elevated cortisol is implicated in atherosclerosis, aka cholesterol buildup in the lining of our arteries.  The video also cites the “brain-gut connection”, which can lead to irritable bowel syndrome.  This might affect digestion, gut bacteria (which can affect overall health – alot of research going into this subject by the way).  High levels of cortisol can also lead to the development of deep or visceral fat.

Chronic stress is also associated with shortened telomeres, which essentially translates to accelerated aging.  Chronic stress can manifest itself in: acne, hair loss, sexual dysfunction, headaches, muscle tension, fatigue, and irritability.  For my readers, I’d like to emphasize that stress is not the only thing that contributes to all of the factors mentioned so far.  For example, atherosclerosis is absolutely linked to diet + exercise as well.

Conclusion: Stress in inevitable.  Bottom line, perhaps, as suggested at the end of the video, is how we respond to stress that counts.  Perhaps finding adequate coping strategies (exercise, yoga, warm bath, massage therapy etc.) is the key.

Colin Badali, RMT, CSCS

My Alzheimer/Dementia+Exercise Presentation

On October 17th, I was lucky to be a part of AlzheimerSociety Toronto’s annual “A Changing Melody Forum” – a day of sharing and learning for people with dementia, families, friends, and professionals.  It was my second year at the event, with my role being to deliver a talk in which I presented the existing research on exercise and brain health.  Towards the end of the talk, I also facilitated a mini-workout consisting of simple mobility-type movements.  It wasn’t quite like a 90min game of Ultimate, or doing CrossFit’s “Fran” in 5 minutes, but it got some blood flowing.

The following are some point-form notes from my presentation that I elaborated on at the forum:

  1. Did you know that only a third of cognitive and physical aging can be attributed to genetics (the other two thirds being strongly linked to exercise, nutrition, mental stimulation, and stress management)?  The most compelling scientific evidence is with relation to exercise.  It would seem like all we need is any movement that gets blood flowing, i.e. your heart pumping oxygen and nutrients to your brain cells.  Your body will actually release BDNF, a protein which stimulates your neurons to grow connections and communicate more effectively, in response to this type of exercise! This info. via Dr. Gary Small, a professor of psychiatry and director of the UCLA Longevity Center.
  2. Walking may be sufficient!
  3. Experiment on rats (sidenote, rats will actually voluntarily go on treadmill, they enjoy it) – Cotman et al. – voluntary running in rats increased marker for BDNF by 20%, which was associated with better memory in same rats.
  4. Middleton et al 2010, -even those starting p.a late in life (50’s and 60’s) show less cognitive decline and lower chances of Alz
  5. Sofi et al. (2011) – over 33,000 subjects followed up to 12 years.  High level of activity – 38% reduced risk of cognitive decline!
  6. Whitmer and Yaffe – obesity leads to 3-fold increase in chances of getting Alz…

Endogenous Opioids

Here are some interesting statements:

  1. Endogenous opioids are the naturally-occurring peptides found in our bodies that are responsible for mediating pain.
  2. Massage Therapy leads to an increase in circulating endogenous opioids, including endorphins, enkephalins and dynorphins.

Factors that assist in Neurogenesis (new nerve cells in your brain)

I’ve summarized the pro-neurogenesis and anti-neurogenesis factors found within Sandrine Thuret’s work (PhD Neural Stem Cell Researcher).  Thuret studies adult neurogenesis; the process by which adult brains create new nerve cells. Neurogenesis, or lack thereof, is implicated in depression, dementia, memory, etc.

This blog entry is not meant as an offering of professional advice, but as containing some potentially very valuable information pertaining to the health of one’s brain.  Please take it with a grain of salt (but not a grain of sugar).

More information pertaining to each of these factors is presented in an easy-to-read “5 Minute Book”.  If interested, simply go to the “5 Minute Book” section above, or request a free copy by emailing me at colinbadali@gmail.com

Pro-Neurogenesis

  1. Learning
  2. Intimacy
  3. Running/Exercise
  4. Blueberries
  5. Resveratrol
  6. Omega-3 Fatty Acids
  7. Calorie Restriction
  8. Flavanoids
  9. Intermittent Fasting
  10. Folic Acid
  11. Zinc
  12. Curcumin
  13. Caffeine

Anti-Neurogenesis

  1. Aging
  2. Stress
  3. Sleep Deprivation
  4. Vitamin E Deficiency
  5. High Sugar
  6. High Saturated Fat
  7. Vitamin B Deficiency
  8. Soft Diet
  9. Vitamin A Deficiency
  10. Ethanol (Alcohol Consumption)