Table Of ContentTrigger Point Therapy for Myofascial Pain
The Practice of Informed Touch
DONNA FINANDO, L.AC., L.M.T.
AND
STEVEN FINANDO, PH.D., L.AC.
Healing Arts Press
Rochester, Vermont
To our patients, from whom we have learned much about the nature
of pain and how to treat it. And to our students, who required us
to think about, order, and communicate what we practice.
ACKNOWLEDGMENTS
J
anet Travell, M.D., whose life work in clarifying and ordering myofascial pain
syndromes has provided the reality base that has eluded so many others. Her
work has demonstrated beyond any doubt that pain results from muscular
dysfunction. So many in the medical community have, until very recently,
disregarded the musculature as a source of pain and suffering. Through Janet
Travell’s lifelong work—her systematic efforts to identify and chart pain patterns
associated with muscular trigger points and the various means with which to
eliminate them—we have been given the basis for treatment of chronic pain
suffered by so many for so long.
Mark Seem, Ph.D., who has strived to evolve the application of Dr. Travell’s
work to the field of acupuncture. Understanding the value of acupuncture as
physical medicine in the treatment and resolution of pain, Mark has dedicated
his efforts to bringing acupuncture into the forefront of American health care.
We would also like to thank Mark for coining the phrase informed touch, which
so clearly describes what we seek to accomplish through our work.
Arya Niellsen, L.Ac., Steven Rosenblatt, M.D., and Robert Ruffalo, D.C.,
whose feedback has helped in making this book most useful for Eastern and
Western practitioners alike.
Jane Waski, whose skillful drawings demonstrate stretches that are so
beautifully rendered that we can feel and sense the stretch of the muscle as we
look at them.
Susan Bubenas and the staff at Polan and Waski, whose graphic capabilities
have been critical in the production of illustrations that so clearly identify muscle
and trigger point.
Susan Davidson of Healing Arts Press, who has helped us clarify, order, and
evolve this work. Her help, her encouragement, her careful and critical editor’s
eye, her patience, and her dedication to this project have been invaluable to the
evolution of this manual.
CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION A GATHERING OF FORCES: Toward an Era of
Interdisciplinary Cooperation in the Treatment of Pain
CHAPTER 1 THE NATURE OF MUSCLES AND TRIGGER POINTS
CHAPTER 2 QI, MOVEMENT, AND HEALTH
CHAPTER 3 INFORMED TOUCH
CHAPTER 4 DIAGNOSIS AND TREATMENT
CHAPTER 5 HOW TO USE THIS MANUAL
Muscles of the Head, Neck, and Face
STERNOCLEIDOMASTOID
SCALENES
SPLENIUS CAPITIS
SPLENIUS CERVICIS
POSTERIOR CERVICALS
TEMPORALIS
MASSETER
PTERYGOIDS
Muscles of the Shoulder Girdle
TRAPEZIUS
LEVATOR SCAPULAE
RHOMBOIDS
SERRATUS ANTERIOR
PECTORALIS MINOR
Muscles of the Upper Limb
PECTORALIS MAJOR
DELTOID
LATISSIMUS DORSI
TERES MAJOR
SUPRASPINATUS
INFRASPINATUS
TERES MINOR
SUBSCAPULARIS
BICEPS BRACHII
TRICEPS BRACHII
BRACHIALIS
BRACHIORADIALIS
HAND AND FINGER EXTENSORS
HAND AND FINGER FLEXORS
Muscles of the Torso
ERECTOR SPINAE
QUADRATUS LUMBORUM
ILIOPSOAS
RECTUS ABDOMINIS
ABDOMINALS
Muscles of the Lower Limb
GLUTEUS MAXIMUS
GLUTEUS MEDIUS
GLUTEUS MINIMUS
TENSOR FASCIAE LATAE
PIRIFORMIS
HAMSTRINGS
QUADRICEPS
ADDUCTORS
PECTINEUS
GRACILIS
SARTORIUS
POPLITEUS
GASTROCNEMIUS
SOLEUS
TIBIALIS POSTERIOR
TIBIALIS ANTERIOR
PERONEAL MUSCLES
LONG EXTENSORS OF THE TOES
LONG FLEXORS OF THE TOES
APPENDIX 1 MERIDIAN PATHWAYS
APPENDIX 2 ON CUTANEOUS ZONES
APPENDIX 3 COMMONLY USED ACUPOINTS
FOOTNOTES
BIBLIOGRAPHY
AOUT THE AUTHORS
ABOUT THE INNER TRADITIONS
BOOKS OF RELATED INTEREST
COPYRIGHT
INTRODUCTION
A G F
ATHERING OF ORCES
Toward an Era of Interdisciplinary Cooperation in the Treatment of
Pain
T
he field of pain management, specifically the treatment of myofascial pain
syndromes, has become a meeting ground for health professionals.
Acupuncturists, medical doctors, and practitioners of various manual and
physical therapies who previously had little to say to one another are now
collaborating in ways that are unprecedented in the history of American health
care. The reason for the development of such interdisciplinary communication is
the growing recognition that myofascial syndromes are the basis of a huge
segment of patient complaint, and associated allocation of resources, within our
health care system.
Patients with myofascial pain syndromes are seeking the help of family
physicians, internists, orthopedists, neurologists, rheumatologists, osteopaths,
physiatrists, psychiatrists, and anesthesiologists. Dentists, particularly specialists
in temporomandibular joint syndrome, regularly see patients presenting with
myofascial pain. In addition, acupuncturists, chiropractors, physical therapists,
occupational therapists, massage therapists, and psychotherapists are all
encountering patients in pain. Conferences on pain treatment have increasingly
become polyprofessional experiences.
It is possible that, through health professionals’ mutual interest in the
treatment of myofascial pain syndromes, true complementary medicine may
emerge as a reality in the United States. Complementary medicine here refers to
the use of conventional medical practices in conjunction with recently emerging
Oriental and other body-therapy approaches, providing a coordinated treatment
strategy that is best for the patient. This differs from the alternative medical
model, which tends toward a competitive concept of health care, ultimately
forcing a division between itself and conventional medical practices that may
not, in the long run, be of the greatest benefit to patients. At this point in our
medical history the fact is that health professionals from widely varying
disciplines are talking to each other with a newfound respect, and the result may
be the fostering of a cooperative spirit that will help millions of people who are
in pain.
This book, a field manual for any health professional dealing with myofascial
syndromes, therefore serves a vital purpose. Its aim is to simplify and order the
vast amounts of information related to the evaluation and treatment of
myofascial pain. Utilizing our many years of clinical and teaching experience,
we have endeavored to address the concerns and desires of health care providers
for a manual that can assist in evaluating a patient, defining the presenting
condition, and guiding treatment of that condition. It is assumed that the reader
has some knowledge of myology; therefore no effort is made to replicate the
extensive background and theoretical discussion found in seminal works on
myofascial pain, such as those of Janet Travell and David Simons and P. E.
Baldry.1 Instead, in addition to the technical core of the manual, introductory
chapters discuss topics that will facilitate communication among the many
professions concerned with this area of study.
We begin with a discussion on the nature of muscles and trigger points, useful
as review for those who treat primarily from this perspective and a good
introduction for those entering the field. We then examine the phenomenology of
qi, that elusive concept of “energy” that is the foundation of all Oriental medical
practices. Qi is examined from the perspective of myofascial syndromes, making
it a more accessible and useful metaphor for all health professionals. It is hoped
that an expanded view of the concept of qi will help facilitate, rather than hinder,
communication between practitioners of Eastern and Western medicine.
Since muscle-palpation skills are at the center of effective evaluation and
treatment, we next discuss the nature and process of palpation. Because a
relative few practitioners are adept in this type of palpation, some guiding
principles are offered to help those who are evolving palpation skills. A chapter
outlining the fundamental approaches to evaluation and treatment of myofascial
pain syndromes helps establish common ground among health professionals, in
the realization that there are behavioral elements in treatment that are shared,
independent of one’s particular training or orientation. Thus the acupuncturist,
neurologist, and physical therapist, while differing in perspective regarding
myofascial pain syndromes, all ultimately share similar behaviors in evaluation
and treatment. A brief overview of how to use the clinical body of the manual,
with a description of the information provided for each muscle, finishes the
introduction.
In the final analysis, since this is a manual for the health professional who
encounters patients presenting with pain on a daily basis, the approach is
pragmatic and behavioral. In the interest of expanding our scientific knowledge,
it is enticing to determine underlying mechanisms for pain that strengthen our
theoretical understanding. However, it is far more important that the practitioner
in the field ascertain what helps patients, and learns how to effect that help. This
book is about how, not why.
