by Stew Wild, LMT, CNMT, CMTPT
Owner @ Myopain Solutions
Instructor @ Myopain Seminars
Manual Trigger Point Therapy in the Emergency Department
In 2018 I twice went to teach Manual Trigger Point Therapy in Salinas, California. After an hour of beginning my first presentation one of the students asked me “you do know why you’re here, don’t you?”. Turns out all the 18 Physical Therapist students worked in the Emergency Department. Unbeknownst to me I was there to teach them techniques that they could use in an acute situation. I had never really considered my manual techniques to be used that way, so I had to wing it. A month after my first visit I contacted one of the students to ask how things were going. “Going well” she said.
Early this year my mentor, Jan Dommerholt sent me a case report that had been published in the Journal of Clinical Practice And Cases In Emergency Medicine. The case report is titled Atraumatic Back Pain Due To Quadratus Lumborum Spasm Treated By Physical Therapy With Manual Trigger Point Therapy In The Emergency Department: Grover et al 2019 (see link below).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682240/
The paper explains the step-by-step process of helping a 42 year-old woman, presenting in the Emergency Department with acute left-sided low back pain that she woke up with.
It seems from my recent research that patients with acute or chronic myofascial pain syndrome (MPS) are commonly seen in the emergency department (ED), usually complaining of pain of undetermined origin. Myofascial pain, as we all know, is pain (as well as other symptoms) from active trigger points. Very often this pain is experienced distant from its source. Many doctors in emergency departments are unaware of this. Every now and then, I’m informed, you may find an emergency physician that is trained to administer trigger point injections.
In the Community Hospital of Monterey CA the emergency medicine physicians are now using trained Physical Therapists to help identify and treat pain from myofascial sources. MPS can be diagnosed on the basis of clinical findings; in many cases, no imaging or laboratory testing is needed. More importantly, there is less need for dispensing opioids or other pain relief.
When Manual Trigger Point Therapy is applied by well-trained therapists it can provide rapid, inexpensive, non-invasive relief for acute pain situations in the Emergency Department. Feel free to use this small, well-worded case study to promote your services to skeptical patients and medical professionals.
Cheerio for now,
~ Stew Wild
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~ Tools Of the Trade ~
My first article in this series concentrated on the femoral nerve. The concept that I focused on was flossing the nerve so that the nerve would be less irritated and that the muscles it innervates would be less irritated as well. I utilize this approach often. I do it before treating the muscle.
The video I presented at that time presents an effective floss for the femoral nerve. It’s a good thing to demonstrate the ROM of the muscle both before and after that nerve floss.
Following a nerve floss and treatment of the deep paraspinals at the level of the muscles innervation, I like to treat the actual trigger point in the nerve. This is followed by a re-evaluation of the muscles ROM.
I’ve rehashed this for a purpose. At this point in treatment we often assign some type of stretch rehab as part of the home care program. I’d like to offer an alternative.
I’ve been working with movements based on the original movements in the “Swedish Movement Cure.” A number of modern authors teach that the strokes in Swedish massage are the actual movements. I’ve read a number of these texts dating from 1850 – 1920. The movements in these books are part of a pretty substantial exercise approach that was used by our ancestors in the art. Movement work was combined with massage much like Bonnie Prudden combined her exercise program with trigger point compression to create Myotherapy.
The idea in those early works was that taking a muscle through its full ROM with a pause in the middle allowed blood to pump in and out of the muscle. They recommended 4-6 reps to accomplish this. I was immediately struck by the similarity to Dr Travell’s recommendation of 3 full reps of ROM following Spray and Stretch to retrain the muscle in its normal ROM. Dr Sella’s work demonstrates that 5 reps is optimal. I recommend 5 as well.
In the following video (filmed by Sam Stanley), I demonstrate a Swedish Movement for both the psoas and the iliacus. I find this to be easy to do throughout the day. The biggest problem for most people is to get them to do it as a movement with a pause in the middle. Most people try to turn it into a stretch. Try this and see if it works for you. If so, pass it on!
https://www.youtube.com/watch?v=x7vSws8w5Zk
~ Richard Finn
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From The Archives: Janet Travell, MD
"Baby Janet Travell Creeping on a New York Sidewalk"
~ Virginia Street
In the mid-1960s, when Janet Travell began writing her autobiography, she would refresh her memory about her earlier life by rereading old letters and then working some of the information she found in them into the text of her book. The following letter to her Editor is a good example of how this worked.
3319 N Street, N.W.
Washington 7, D.C.
January 19, 1964
Dear Mr. Gutwillig;
Your letter written the day after Christmas was much appreciated. We finally got away from Washington on December 24 and spent Christmas with our family in Nashville, Tennessee. The change did me good.
President Kennedy's assassination left me in no mood for writing the book, but I am coming to life again. I am now in a better position to consider a contract. Enclosed are some brief ideas for a preface.
In meditating on my early childhood, it occurs to me that you might like to look at the old brownstone house at 27 East 11 Street where I lived for fifteen or sixteen years. When I last saw it about three years ago, the front of the house was covered to the roof by a giant wisteria vine that my mother planted about 1902. From inside, the windows were framed in green leaves and sometimes there were lavender blooms.
Under the front stoop of that house was an openwork iron grill door with perhaps six or eight inches of clearance between its bottom edge and the cement floor. At an age when I could only creep, I crawled out under this gate unobserved and made my way around the corner onto University Place. There I was recognized and brought home by the owner of a cleaning and tailoring establishment, Pomeranz and Goldfein, which our household patronized. In later years, he used to tell me about my early escapade in exploration.
In 1961, a Garden Tour of New York included the house with a note on the program that it had been my home.
I hope to be in New York on February 5 and 6, and could perhaps come by your office. If you are in Washington in the meantime, let me know. Call me at the White House.
With best wishes,
Sincerely,
Janet Travell, M.D.
* * *
The section below about crawling under a gate and down the sidewalk is what Janet Travell published a few years later about this event in her autobiography.
My birthplace was a house at 17 East 12th Street in the city of New York; the date was December 17, 1901, and the hour was 1:45 A.M. The next winter my parents moved to an old brownstone house with a high stoop at 27 East 11th Street and that was my home for fifteen or sixteen years. The front of the four-story building was eventually covered to the roof by a giant wisteria vine that my mother planted about 1902. From inside the house it framed the windows in green leaves and sometimes its lavender blooms hung against the city skyline.
Under the front stoop was an iron grill door that had six or eight inches of clearance between its bottom edge and the cement floor. At an age when I could only creep, I crawled out under this gate unobserved and inchwormed my way on the sidewalk around the corner to University Place. There I was recognized and brought home by the owner of a nearby cleaning and tailoring establishment, Pomeranz and Goldfein, which our household patronized. In later years, the tailor used to tell me about my early escapade in exploration.
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We want to promote you!
One request for this month -- we need more activity (Likes and Shares) on Facebook in order for classes to get more circulation! (These directions are best followed on your desktop/laptop):
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Thank you,
~ Sarah Ernst-Edwards
Public Relations Chair
namtpt.pr@gmail.com
National Association of Myofascial Trigger Point Therapists
www.myofascialtherapy.org
