Ref Fascial contractility and myofascial trigger points

[Barrett Dorko]

This book, out next month, may provide us with some ideas.

[Luke Rickards]

I ordered it immediately.

[Kim LeMoon]

Originally Posted by Diane

...a book with each chapter contributed by a different person (my fave - I think we need something in hardcover as well as on the net - still so many people who don't use internet to learn) to just carrying on with the site as is..

The project lacks a clear visionary editor/project manager with the right sort of exacting scruples combined with drive. Maybe you'd like to apply for the job? (No pay and long hours.) (Maybe a share of the royalites should some ever come into existance.)

I see it as a hardcover as well. It needs the kind of press that only a book can get. I've got clear vision (now that I bought some glasses ), exacting scruples, and plenty of drive. Setting people straight on manual therapy nonsense is something I am extremely passionate about. All royalties would go into furthering education in the right direction. Our tiny monetary contributions here are not nearly adequate to cover that.

In the shower just now, I had a vision of how the book might look. Some early ideas include an introduction chapter written by Barrett, a brain and nervous system chapter written by Diane, The 10 steps chapter going into explanations of each step, and then the remaining chapters would be spent deconstructing the rubbish cube. For these, I imagined collaborative efforts from members here. For instance, Luke and I could take on MPS and trigger points, Barrett and company could write about MFR, and so many other chapters came to mind to include: ART, Network Chiro, etc.

This idea is REALLY possible. If we have one thing in common here, it's how passionate we are about speaking out against rubbish.

More later, I've got to go to work now.

[Diane]

OK, this could be the working plan. Just say what the first step is. How long/short do you want the brain and nervous system chapter to be?

[Luke Rickards]

I think this was as far as we got.

[Kim LeMoon]

First step is to write a book proposal and decide which publisher to send it to. I am up for the task, but worry that, as an unknown, the proposal would get rejected. Is Barrett the only published book author here? We might need to usher it through with known names.

I spoke with my first client of the day about the idea. She's a professor at the local university and she's going to send me a sample of a couple of book proposals she's sent out. She said that we'd likely want to target a publisher who has published similar titles. I'd love to see it under Elsevier, only because we are hoping to reach the same audience as those who are shopping for other manual therapy books. Another thought is to offer it to the publisher of the book Suckers or other skeptic-type texts.

I'll do a little more research and report back what I learn.

Elsevier publishes books in the Health Sciences. I have 1 article published, 1 in press, 1 in the review process, and 1 more I'll be submitting soon. They've been great to deal with, very efficient and professional. They might entertain a proposal from me. This is the place I think the book belongs. Anyone else have anything published by them? Luke?

Prometheus Books publishes titles on critical thinking and on science topics and allows authors to submit their own manuscripts rather than go through a literary agent. Just as I thought, previous authorship is a prerequisite. The process starts with an email letter of inquiry to which a reply is promised in 4 weeks time.

[Luke Rickards]

I have 3 published articles with Elsevier, and another one being submitted in the next few weeks. And Barrett has one with Elsevier as well.

[Javier Gonzalez]

Originally Posted by Kim LeMoon

This idea is REALLY possible. If we have one thing in common here, it's how passionate we are about speaking out against rubbish.

Kim, I like your idea very much.
It could be very interesting. If I can help you just tell me.
I have 1 article in the review process with Elsevier just now.

[Diane]

Way to go, everyone who has published or is publishing with Elsevier..


Now: Any reason we couldn't do an e-book or online version as well?

[Luke Rickards]

This idea is REALLY possible. If we have one thing in common here, it's how passionate we are about speaking out against rubbish. ....then the remaining chapters would be spent deconstructing the rubbish cube.

I see a significant problem with a text that has this as a major aim.

Debunking may be popular enough within a general population, but it isn't consumed by those being debunked. A book on manual therapy is only likely to be bought by manual therapists, many of whom will be the target of a work with such a focus. As Barrett has clearly shown us, such an approach won't create waves - of the right kind, anyway.

[Kim LeMoon]

Originally Posted by Luke Rickards

Debunking may be popular enough within a general population, but it isn't consumed by those being debunked.

Good point Luke. Do you think this idea would sell to the general public? The thing that infuriates me the most is how these therapies with flawed premises prey on people in pain. These folks get their hopes up, spend lots of money, and when the therapy is ineffective, they are left worse off than they started. Do you think we could make this accessible and readable to the average consumer? People are taking charge of their healthcare and becoming informed at a fast and furious pace.

[Luke Rickards]

Do you think we could make this accessible and readable to the average consumer?

Possibly. To be honest though, doing that wouldn't interest me.

[Barrett Dorko]

I'm with Luke. My interest would be drawn to something for our colleagues working manually. A working title and mission statement or statement of intent will help us see what it is we might do.

We can all work on that. I know I've already started.

[nari]

I think both ideas are good - writing for therapists and for the general public, though not an easy task at all. However...

Debunking can be a dodgy venture. Some will listen/read and grow with the information, but many will just feel cross about their long-held understanding being challenged. History has borne that out countless times.
Writing for the general public may even create difficulties when they attend a therapist and relate what has been written, only to find that the therapist turns around and debunks it. Barrett has pointed out many times that Butler, Shacklock, Moseley et al are not familiar names to a lot of therapists; so their credibility would be low.

It doesn't mean that I don't think the book is a good idea.

Nari

[Diane]

I can feel for Kim's line of thought, and can sense that the infuriatedness would be a huge source of energy for getting such a project launched and landed. I can also see merit in the caution of the others who speak.

I think there should be room for both.

Maybe not between the same book covers.

[BB]

Kim,

Another possibility for a consumer aimed book would be to make a collection of essays providing examples for the recently posted consensus list. It could include a section on consumer protection as well. If nothing else, I'd like to see something of this nature made here as a resource for our patients. I envision something in the model of Moseley's painful yarns.

Members of ss could submit stories/explanations for each point. The mods or another group of us could act as the editors.

[Kim LeMoon]

The book ideas continue to percolate as I work on the paper. A book for the general public was just an idea and after consideration, it is less appealing. The public doesn't know the names of the therapies employed and probably doesn't care if the theories behind them are flawed. They just want to be out of pain.

Maybe there's a way to explain the mechanisms behind some of the better known therapies in an exciting enlightening way, rather than spending time discrediting. Most of the modalities have some therapeutic value. If we focused on those elements and offered nervous system explanations, there might be some interest among therapists to learn. Maybe.

This topic is overlapping concerns about my paper. I have chosen to not only describe why my hypothesis was wrong, but to point to compelling evidence that MPS is neither a disorder of the muscles nor the fascia, but is the result of central hypersensitivity with peripheral manifestations. As the editor has been one of the most prolific authors on the topics of MPS and NMT, I wonder if this paper will get published after all.

Yesterday, I went back to the TrP manual (1999) to review what was mentioned about other hypotheses, specifically looking for neurogenic explanations. I got really fired up when I realized that although several alternative hypotheses were addressed, there was a conspicuous omission of Quintner and Cohen's theory (1994). I searched to see if Travell or Simons had ever published a response to the Q & C paper and couldn't find any. It seems that they quietly ignored the paper, hoping it would go away. In other words, they must have known that their hypothesis had been logically challenged, yet they perpetuated the fallacy anyway.

No amount of logical discourse is going to change the minds of those that have an invested interest in the idea.

[Diane]

I'm really enjoying your posts Kim. May I ask, where did you want to publish this paper? Which journal?

[Kim LeMoon]

This paper has an unusual background. An agreement was made between the organizers of the Fascia Research Congress and the editors of both the Journal of Bodywork and Movement Therapies and the Journal of Electromyography & Kinesiology to publish all accepted abstracts (dividing the abstracts between the 2 journals). Not surprisingly, my abstract was promised publication in JBMT. Further, there was an opportunity for all authors to expand their abstracts into full length articles if they chose to do so. The papers would still be required to go through the peer-review process, but were guaranteed publication.

That's why there was such an issue with my request to withdraw my abstract entirely. The editor was 'duty-bound' to publish it. Weird, huh?

[Luke Rickards]

As the editor has been one of the most prolific authors on the topics of MPS and NMT, I wonder if this paper will get published after all.

Just use "may" a lot, and you'll be fine.

Most of the modalities have some therapeutic value. If we focused on those elements and offered nervous system explanations, there might be some interest among therapists to learn. Maybe.

Exactly.

[Kim LeMoon]

Originally Posted by Kim LeMoon

As the editor has been one of the most prolific authors on the topics of MPS and NMT, I wonder if this paper will get published after all.

I managed to get the paper submitted in time. The editor's only comment was that he thinks the title needs to be modified to reflect the current challenge to trigger point theory (which ended up being the main focus of the paper). That means he IS going to publish it. Whew!

The title I submitted the paper under was:
Fascial contractility - an improbable factor in Myofascial Pain Syndrome

Any suggestions for a new title?

[Barrett Dorko]

Kim,

Great to hear. I've been trying to think of a better title.

There isn't one.

[Jon Newman]

I hope your new article will find its way into the SoS and maybe the Electronic Red File. Great job.

[Luke Rickards]

Hi Kim,

Since I've seen it, how about:

Myofascial pain syndrome: Re-evaluation of an alternative hypothesis and critical examination of the literature.

[Karen L]

Hi,

This is one of my favorite threads. I just started massage school when the First International Fascia Research Congress happened. I thought "great here is science to back up massage", good cause I need lots of science.

So I have a personal story about Trp's. Mar 26, I was sitting in class and my neck went into spasm on the left side (terrible chairs and massage tables as desks). So I couldn't rotate my head left or right pain at 15 degrees bi. Pain on flexion 20 degrees, side bending right no pain, left pain immediately. No pain in left or right shoulder girdle. Point tenderness over Sp of t1 and anterior 1st rib attachment to sternum. Tenderness left cervical muscles, traps hard and swollen, levator hard, post and middle scalenes hard. All very painful 7-8/10. I was having a bad day.

I figured my left scalenes got tired of it all and went on strike. No overt neurological symptoms, although the C8 dermatome on my right forearm was hyperaesthesic. In the afternoon I became aware of pain in the referred patterns for the scalenes in my left arm chest and back. Only positions of comfort standing, or lying prone with neck hyper extended and rotated right.

I went against my instinct and newfound knowledge from here and iced my traps and neck (school advise). All it did was make my neck cold and decreased my ROM more.

This morning I was very stiff. I started moving my neck as much as I could without pain to gain ROM. I used skin stretching on my neck and anywhere I could reach. I used heat in the afternoon and that was great. Only thing I regret doing was I took an analgesic late in the day for a headache and realized I needed to stop ROM on my neck in case I over did it and the headache never went away.

I know I developed trigger points in the left scalenes and they were definitely not there before the flare up. In fact I usually have them in the right posterior scalenes, rhomboids major and levator scapula. As I type I am still symptomatic but the pain is 3-4 and my ROM is very good. I was really worried I had screwed up my brachial plexus and my arms were going to fall off. But I kept my head, used the techniques I learned here and am letting my body tell me how to heal.

A thought came to mind which initially drew me to this thread. Are myofibroblasts not immune system cells. If one were to think of any insult to the organism, whether bacterial, knife wound, bad posture... the response is an immune response. Thus pain is a part of an immune response that causes a chemical gradient signaling a compliment of reactions. The nerves signal when they are impinged for myofibroblasts to come and shore up the fascia and try to keep the nerve safe never thinking they my cause an adhesion.

The trigger points - muscle fatigue or irritated facet nerve? All I know is they weren't there first.

Thanks,
Karen

[Karen L]

I'm back,

I managed to become relatively pain free by day 5. It seems driving my car (anterior rotation of right shoulder and pressure from the seat belt on the left clavicle and 1st rib) aggravates the c-spine at c7 t1. My instructor suggested it could be facet or deep intrinsics. At this point I am not thinking disc lesion. Heat helped a lot and I had a general fascial treatment by a class member today. Again the cutaneous nerve work was what really did the trick. And he also has a unique way of releasing the skin which stimulates the receptors positively adding to the treatment.

The lesson I learned by having an injury come from nowhere is... My instructor said that many people in our class and the general public have asymptomatic disc herniations. How do you get this way unless the collagen fibers of the Posterior Longitudinal Ligament are compromised. Asymptomatic could mean the person had no idea what traumatic injury caused the lesion, maybe there is no know traumatic event. So then bad posture, chronic sore neck, job biomechanics might be cited as the cause.

What about collagen degradation: [Ironically, neuropathy itself contributes to degenerative conditions (including spondylosis). Neuropathy degrades the quality of collagen, causing it to have fewer cross-links; it is, therefore, trailer than normal collagen (14). The amount of collagen in soft and skeletal tissues is also reduced. Because collagen lends strength to ligament, tendon, cartilage, and bone, neuropathy can expedite degeneration in weight-bearing and activity-stressed parts of the body, which include the spine and joints, and become a source of pain. Enthesopathic thickening in a tendon is possibly a compensation for this weakness.] Bonic ch 28.

You get a fatigued muscle and or nerve damage and your neck is sore and you have loads of Trigger Points and maybe you are subclinical for developing a Disc lesion from sitting at your computer typing too much. Makes you wonder.

School is making me think I have all these terrible pathologies. I have to stop thinking!

Best Regards
Karen

[SMEGC]

Originally Posted by Barrett Dorko

This book, out next month, may provide us with some ideas.

Sorry to interupt but this link isn't working for me. Just wondering what the book title was?

[Barrett Dorko]

SMEGC,

The book is Kluge: The Haphazard Construction of the Human Mind.

I got it yesterday from Amazon.

[Nick]

Looks interesting. I'm waiting for your review.

[Karen L]

The more I read the more I want to understand. The body gets a neural stimulus that it perceives as threatening and then moves to protect itself. Muscles can become stiff and guard a structure, i.e. the neck. Give the nerve the appropriate input; sensory or motor and the area should relax, become warm and soft and mobility will increase.

Diane any chance you'd like to teach a term of manual skills to RMT students?

Trigger Points are like Brussels sprouts nobody likes them. But they are on your plate and have to be dealt with. (I used to feed mine to the dog).

Karen

[Diane]

A term? Sounds like a long time Karen...
Email me and tell me where and what sort of committment would be involved.

[Karen L]

How far I've come in such a short time. I need to learn to slow down, I know this about myself.I've been meaning to post this article for a while now. I even had it with me in Cleveland.

I used it for a paper I wrote for a hydrotherapy class last term. Basically you have to heat collagen to a high temperature 135 F or 57.5 C for 3 minutes and then it will start to melt. Apparently a lot of this research is done for medical/surgical (laser surgery) and meat producers looking for better ways to tenderize fascia. Don't laugh; check out meat industry research on fascia.

Karen

PS on my above posts: It was all nervous system, not TrP's. I irritated mechanically or chemically nerves in my neck and found a way to move it before it got too damaged. I was on the right track but did most of the wrong things along that way. I was lucky I didn't really hurt myself treating the muscles and not the nerves. I know better now!

[bernard]

Chiropractic Management of Myofascial Trigger Points and Myofascial Pain Syndrome: A Systematic Review of the Literature

Myofascial pain syndrome (MPS) and myofascial trigger points (MTrPs) are important aspects of musculoskeletal medicine, including chiropractic. The purpose of this study was to review the most commonly used treatment procedures in chiropractic for MPS and MTrPs.

[Luke Rickards]

I'm happy to see that they came to the same conclusions as my 2006 review.

[Karen L]

How interesting that this thread surfaced today as I was ruminating on fasiculations I have encountered during DNM treatment. We understand that sustained lack of movement is not good for our body. We are signaled by nociception that there is an issue somewhere and if it becomes pain we must "go sit under the tree and heal" (from Diane's class). Could desending inhibition in the way of decreased muscle activity cause i.e. the trigger point. Then it would make sense that DNM changes the nociceptive signal to were OK there is no threat and it is ok to move. The fasculations are the release of desending inhibition system. Palpation wise it it a no brainer when the skin distractions cause the "taut band" to relax. I am combining DMN and Simple Contact as much as I can with my clients.

Just my thought for the day.
Karen

[Matt Arnold]

Hi All,
I don't know how helpful it will be, but I just want to bump the idea of a book or wiki or both. That would be the perfect answer to my conundrum of tossing myself into this whirlwind of information. There are probably many ways that the conclusions/questions arrived at here could be shared more efficiently. Two are most obvious to me; one is having a coherent, consecutively or thematically organized introduction to key concepts and applications. The other is probably suited for another thread and can be summed up by having the same compassion for stubborn learners in this realm as you all do for stubborn nervous systems in a clinical setting.

Maybe someone can point me to a thread that addresses that last point. Maybe I need to start it.

[Karen L]

Wow is it ever cringe worthy reading my first posts. I am so glad it took me about a month to go from I had a trigger point to I had mechanical deformation. Interestingly this is also two months before I flew to Cleveland to take Barrett's class.

I still can't say for sure why at that time I was so dissatisfied by the explanations for and of traditional musculoskeletal pain treatment but I am glad I continued to challenge my education and continue to do so.

Karen

[PatrickL]

Originally Posted by Kim LeMoon

Yesterday, I contemplated my illusions, reviewed what I learned from this thread, and decided to let the whole thing go. This morning I wrote to the editor and asked him not to publish my abstract in any form. Here's what I wrote:

"I have dedicated an extraordinary amount of time over the past few months in an attempt to complete my expanded abstract. The more I learn, the more I am convinced that the hypothesis I proposed is wrong. My abstract was written with very limited resources and lacked an in-depth knowledge of the structures involved. Particularly, my understanding of the contractile mechanisms of myofibroblasts was truly rudimentary. I put forth an idea, but it was not a sound one. It is not for lack of effort that I have been unable to write the paper. It is for lack of evidence."

I'm exhausted and embarrassed, but I'll get over both shortly. I thought about how much more embarrassing it would have been if the paper had been published.

Thank you all for such great support. Without any condemnation, you contributed to my learning process and let me arrive at my own conclusions.

Rather than spend another minute trying to figure out why the trigger point hypothesis and related treatments don't make sense, I'm going to put my energies into learning more about the brain and the nervous system.

If nothing else, this thread will serve as a model of the 3 tenets that I believe make a good therapist: curiosity, humility, and the willingness to let go of existing beliefs when new ones make more sense.

I realize this is from an old post but wanted to say how much I admire kim's willingness to simultaneously learn new things and unlearn old things