March-April 2019 Newsletter

Message from the President

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Membership 'Minders

By Mary Jo Smiley, CMTPT; NAMTPT Membership Chair

Greetings members!  I bring to your attention 2 important items today.

1) The CBMTPT has not always been sending out notices alerting people when they are due to renew their Board Certification. I notice that a good many members are due in June and July each year, myself included. Please check your expiration date with this link http://www.cbmtpt.org/CBMTPT_Cert.aspx or on your certification now so you have time to collect your CE paperwork and pay the renewal fee. Everyone must have 100 CE each 5 year period to renew the Board Certification and fill out the form and pay before the expiration date.

2) After years of using PayPal as the primary way to pay membership dues and for the annual conference, we need to make a change. Wild Apricot, our host of the members part of the website and all the “back office” is making changes. A few weeks ago we got notice that they are moving to a payment product called AffiniPay and will be charging 20% more over the fee we are charged for the Wild Apricot product if we continue to use PayPal. This is a pretty big increase in our costs and after looking at AffiniPay the board has chosen to move to this payment plan. It will work seamlessly and will automatically update your membership date when you renew and also accept payment for the conference.

This change will occur around mid to late June. If you would like to pay your membership fee with PayPal, you may renew before that, even if you are renewing early. If you register early for the conference, you will also be able to use PayPal if you want. After we switch, you will pay with AffiniPay, check or Square. More info will come later.

The recurring payments will be deleted from PayPal and you will be setting up a new recurring payment with AffiniPay, if you wish, the first time you renew your membership. If you have objection to using this new payment option, you can pay by check or the option of paying with Square is still available. If you choose to use Square, you will find the tab in the Member’s Area with a link to the page that you can enter your Credit Card info to make the payment for membership or Conference. I ask you to text me (724-494-1468) to let me know that you are doing this, because it will prompt me to accept the payment and manually accept the renewal.  Thanks for your continuing support of the NAMTPT!

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~ Connective Issues ~

by Stew Wild, LMT, CNMT, CMTPT
Owner @ Myopain Solutions
Instructor @ Myopain Seminars

“Pressing Matters, Part 1”

How long do you maintain contact pressure when you’re working on your client’s trigger points? Listed below are some of the variations I’ve come across over the decades, and played around with myself:

• 7 seconds (Bonnie Prudden method)
• 5-7 seconds, then work on antagonists, come back 3 times (Nimmo method)
• 8-12 seconds, repeat (American version Neuromuscular Therapy)
• 13 ½ seconds (long running joke in Myopain Seminars training)
• Compress and contract (CoCo) with repeated active muscle engagement (Dommerholt)
• 30 seconds, high pressure (Hou)
• 60 seconds, barrier release (Simons)
• 90 seconds, low pressure (Hou)
• Up to two minutes (Osteopaths)
• 2 – 5 minutes (Stecco, although they don’t exactly address MTrPs)

In the new Travell & Simons (T&S) 3rd Edition (page 835) the various authors state that the ‘pressure release’ approach seems to be equally effective clinically and it’s not likely to produce appreciable additional ischaemia. They believe it’s bad to create more ischaemia in an already ischaemic environment. Overall, they recommend the T&S trigger point pressure can and should be tailored to the needs of the individual’s muscles, and is less uncomfortable and therefore is more likely to be preferred by the patient.

I’m going to somewhat challenge this. In my clinical experience the deeper pressure which may result in the dreaded ‘reactive hyperemia’ is actually worth it. One of my patients sums it up this way; “Stew is going to hurt you until you don’t hurt any more”. If your patients know this in advance I believe it will be psychologically acceptable. If your dentist tells you there’s going to be a small prick just before he inserts the needle it tends to be less painful.

T&S also quote Hou et al (see above) who found that low pressure (below pain threshold) for a prolonged period, 90 seconds, or high pressure (above the pain threshold) for a shorter period, 30 seconds, was equally effective for decreasing pressure pain sensitivity over trigger points. Ninety seconds is a long time to press. Thirty seconds goes by three times faster! Maybe you can treat three times the number of trigger points.

In April 2017 a Japanese study was published in Frontiers in Neuroscience entitled ‘Compression At Myofascial Trigger Point On Chronic Neck Pain Provides Pain Relief Through The Prefrontal Cortex And Autonomic Nervous System: A Pilot Study’ (Morikawa et al). In the study the depth of pressure used was halfway between the Pressure Pain Threshold (PPT) and the Maximal Tolerable Pain (MTP), maintained for 30 seconds, and repeated four times. They called this pressure a ‘moderately painful average’.

Morikawa et al monitored prefrontal haemodynamic activity, heart rate variability and changes in subjective pain. The conclusions were that changes in autonomic activity were significantly correlated with changes in subjective pain and prefrontal haemodynamic activity. This suggests that trigger point compression in the neck region (UT) alters the activity of the autonomic nervous system via the prefrontal cortex to reduce subjective pain.

For now I’m going continue with my foray into an uncomfortable amount of pressure (but only with the continuous concordance of and communication with the patient), held for around 30 seconds, and repeated many times. I invite you to share with me your own preferred clinical depth and duration methods for trigger point deactivation, along with any research backing. On request I can supply the full text of the research papers.

Ciao for now,

~Stew

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                                   ~ Tools Of the Trade ~

Richard Finn, CMTPT

O2 Derm™ Relief Healing Gel – How I Use it in My Practice

I was sitting in my office minding my own business when a good friend walked in. Ron is a guy that when he speaks – I listen. We had been meeting for years at breakfast to discuss business stuff and how to market. Now he was marketing a new product and I listened.

He described a new oxygenated gel that he said was good for skin. He told me later that I looked at him like he was just plain nuts. I’m sure that I did.

I care about pain – not skin!

I agreed to try the product – after all – it was Ron and he had asked (Ron doesn’t make mistakes!). I still was not ready for what came next.

I approached a friend who had become a patient and asked her if I could but this along her upper back over the thoracic spine. She was willing. I rubbed only over the spinous processes. Her eyes got really big. She looked at me and said, “I’m breathing better!”

I certainly did not expect a reaction like that from a person with a pretty nasty spinal stenosis in the area. I tried really hard to control the expression on my face. I explained, in a very professional manner, that I wanted her husband to apply it daily over just that area for a month and to return and let me know how it went.

She did return and gave a much fuller report that I had asked for. Her body temperature went from 95 up to 97 degrees. Her fibromyalgia pain was gone. Her breathing had improved and if she had to cough it didn’t make her cry anymore! I certainly was not expecting that. I started to experiment.

I started with muscles. I’m a Myofascial Trigger Point Therapist – it’s what I do. I tested muscle length. I then applied the gel. Then I retested. Almost without fail the application of the gel was followed by an increase in muscle length. That was pretty impressive since I didn’t even press a trigger point.

What would happen if I applied it systematically? I found out that when I used it instead of compression in my pelvic stabilization protocol that it did the same thing that I usually did with my hands. That was impressive.

I then wondered if it might possibly have an effect neurologically. That was easy to do. I asked a student if I could do an experiment. She complied. I tested the ROM of all of the muscles in the upper extremity. Then I applied the gel to the lower cervical area from C5 – T1. I retested. Every motion improved as if I had applied it to each muscle!

At this point I decided that I really needed to make a video for the company so that others could see what I was doing and how to apply the gel. As I drove to the shoot I remembered that I had not yet tried it on acupuncture points. A friend of mine has a massage studio; as it was on the way I pulled in. Once inside I asked if I could conduct a therapy experiment.

A patient with some back pain volunteered. I tested her ROM for the QL and the Psoas. I then applied the gel to the points on the toes that corresponded to the low back. Her pain was gone and both muscles had improved ROM with less than a minute!

I now had something else to include in my photo shoot.

I was interviewed by Corrina Rachel, holistic health coach associated with popular wellness channel PsycheTruth. She is also known for her ASMR videos on the secondary channel ASMR Massage Psychetruth. The video is in the link below.

https://www.youtube.com/watch?v=uLL3NJFBtjY&index=3&list=PLVQQKsxi4jHI9vQz2S_1PI6yTgDl2bqST

My experience is that the muscles seem to relax faster and become more flexible. My clients often tell me that they have more pain relief. The primary effect of the gel is to put oxygen into the skin.

I believe the oxygen has a positive effect on the nerves in the skin. I have rubbed gel into the back and into painful muscles and the clients have reported these results.

To see my two videos on how to apply the gel you can click the following links:

1. A combined step by step demo of the toes, QL, and lumbar spine application –

https://www.youtube.com/watch?v=gIeywviMBzY&list=PLVQQKsxi4jHI9vQz2S_1PI6yTgDl2bqST&index=6

2. A combined step by step demo of my treatment of a man with cervical stenosis. I start with spinal application and then move on to acupuncture points on the finger tips, and finally to the muscle –

https://www.youtube.com/watch?v=WFSWLKUQZsY&list=PLVQQKsxi4jHI9vQz2S_1PI6yTgDl2bqST&index=4

How to Apply the Gel

People are always asking me how to get the best results using the O2 Derm™ Topical Gel. The first thing to do is to apply the gel liberally and allow it to sit for about 5 minutes for optimal effect. I have rubbed it in as well and saw results also but the sitting time really seems to add to the effect. There are 3 distinct methods that I have found to be useful in relieving pain.

1) Trigger Point Application

Just like your instinct tells you – rub it where you know that the trigger points are located. That is the first thing all of us do. Your patients get one of the great self-treatment books that are available and apply gel in addition to using pressure.

2) Spinal Treatment of the Associated Dermatome

The second thing that I have found useful is to rub it onto the area of the spine that controls the nerves in the skin where the pain is felt. Refer to the image shown here:

The numbered side shows where the nerves come out from on the spine. On the other side of the picture you can see where the nerves come to the skin.  Rub the gel at the level of the spine where the pain is felt in the body. I usually see an increase in flexibility when I use the gel. The increase in flexibility provides the opportunity to move. That is what I tell people to do. Movement is the key to keeping the blood moving and the body in less pain.

3) Acupuncture Points

The third area I have seen work is to use the gel on finger and toe acupuncture points. I think this works because the nerves from those areas terminate in the extremities. I have also seen this work in the back by rubbing the gel over the area where the ribs attach to the breast bone.

Hand Points

Toe Points

Really Important Concluding Thoughts

I really love the gel. It does a lot as a supportive treatment. It is not a replacement for good hands on work. It generally does not “fix” the problem. What it does is provide an opportunity for the patient to actually move. The brain gets to learn that movement is actually possible and that it feels good. Application of the gel at home and in the office should always be followed by movement.

Movement is the really big part of the treatment. Many patients have complained that the gel does not work as well when they get it home. That may be due to them not moving and expecting the gel to do the work.

Another thing that you can ask is for the patient to apply the gel in your office so that you can see what they are doing. They often get it wrong. This is just like asking them to do their stretches in your presence so that you can see what they are actually doing. Dr. Travell taught us to do that with stretches and it should apply equally to other self-care activities. This is the coaching part of our work.

I recommend trying this and seeing how it works for you! Here is a link to the company:

http://www.dermcreations.com/

~ Richard Finn

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From The Archives: Janet Travell, MD

JANET G. TRAVELL, M.D. - A Daughter's Recollection

by Janet Travell's Daughter, Virginia Street

(published in 2003 by the Journal of the Texas Heart Institute, Houston, TX, Vol. 30, No. 1, p. 8)

PART ONE:

Janet G. Travell, my mother, was born on 17 December 1901, in her parent's home in a fashionable section of lower New York City. She decided to study medicine at an early age; in this she was inspired by her father, Willard Travell, MD, who was at first a general practitioner. Willard Travell soon became interested in the relief of pain through physical medicine and x-ray therapy, fields in which he is recognized as an early pioneer. (1) Janet Travell's mother, Janet Davidson Travell, was beautiful and talented. She played the piano, sang lullabies to her 2 daughters, and entertained artists, writers, and musicians in her evenings-at-home. My mother's older sister, Ginny, also studied medicine. She became Virginia T. Weeks, MD, a respected pediatrician who practiced most of her life in Brooklyn Heights.

My mother was nicknamed "Bobby" because her sister couldn't say "baby." She was a tom boy who climbed trees and hit tennis balls against a fence in the back yard at 27 East 11th Street. The back yard was home to a great-horned hoot owl, a partridge, an eel, baby chickens, and a snapping turtle. These were animals that the Travells had brought back to Manhattan from their summer home, 120 acres of farmland with an old Colonial house and outbuildings in the Berkshire hills of Massachusetts. The farm remained in the family for about ninety years.

After graduating from the Brearley School, my mother attended Wellesley College, the alma mater of her mother and sister, where she majored in inorganic chemistry. In her junior year, she was elected to the Phi Beta Kappa society and, at her graduation in 1922, she was named a Durant Scholar. She was also the winner of several college singles tennis championship and many doubles titles with Ginny. In 1926, she received her M.D. degree from the Cornell University Medical College in New York City, where she graduated at the head of her class. That summer and fall, Janet took an extensive tour of Europe "to attain some perspective" on herself. (1) Then, from January 1927 through December 1928, she interned at the Cornell Medical Division of the New York Hospital, where she was "the only woman doctor on its staff." (2)

The Travells moved from 11th Street to 40 Fifth Avenue, and then on to 9 West 16th Street, a 5-story brownstone situated conveniently catty-corner across the street from the old New York Hospital where my mother was house physician for the last 6 months of her internship. My grandmother, Janet Davidson Travell, supervised the remodeling of the family's new home. The front stoop was removed and an elevator was added shortly before my grandmother died of a myocardial infarction in the fall of 1928. My parents were married less than a year later, in June 1929.

Bobby Travell had been introduced to her future husband - the dashing John W.G. "Jack" Powell, a Southern gentleman, Wall Street banker, and talented college athlete - at a white-tie ball in February 1927 at the Hotel Astor. She wrote in her autobiography, Office Hours: Day and Night, published in 1968, that they "fell in love on the dance floor that night" and have "danced through life together ever since." (1) After their wedding, Jack Powell moved into 9 West 16th Street with his wife and widowed father-in-law. Willard Travell began to practice medicine in a suite of offices on the ground floor, and my mother soon joined him.

My mother had planned to be a cardiologist. On 1 January 1929, she became "a Fellow on a collaborative clinical research project to attempt to answer the controversial question: What value has digitalis in the treatment of lobar pneumonia?" The study, which "was conducted by three university medical services - Cornell, New York University, and Columbia," - on wards at Bellevue Hospital, combined Janet's "basic interests in pharmacology and cardiology - in science and people." (1) A year and a half later, in "recognition of the importance of this research," she was awarded an instructorship at the Cornell University Medical College, where she remained for 30 years, "achieving the rank of associate professor of pharmacology in 1952." (2)

After my sister, Janet, and I were born in 1933 and 1935 respectively, we lived at 9 West 16th Street for about 10 years. We attended the Friends Seminary nearby. I remember how the waiting room on the ground floor at 9 West 16th Street, next to the family medical offices, was always filled with patients who told me how wonderful my grandfather and mother were to take away their pain.

(to be continued in the next newsletter ... )

References:

1. Travell J., M.D., Office Hours: Day and Night: The Autobiography of Janet Travell, M.D., New York, World Publishing Co., 1968.

2. Current Biography Yearbook 1961, New York, H.W. Wilson Co., 1961, pp. 37 - 38.

For the complete article, please see:

https://www.janettravellmd.com/

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