the athletes guide to sports supplements by kimberly mueller

the athletes guide to sports supplements by kimberly mueller

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the athletes guide to sports supplements by kimberly muellerMyofascial pain syndrome (MPS) is a chronic pain disorder of too many trigger points. TrPs are usually described as micro-cramps, but the science is half-baked and their nature is controversial. Regardless, these sore spots are as common as pimples, often alarmingly fierce, and they seem to grow like weeds around injuries. They may be a major factor in back and neck pain, as a cause, a complication, or a bit of both. Dry needling is a popular (but dubious) method of stabbing trigger points into submission with acupuncture needles. TrP treatment is not rocket science 1 — it’s much too experimental to be so exact. But most people can learn to get at some relief safely and cheaply. It’s a plainly written guide to all the science (such as it is), the myths and controversies, with reviews of every conceivable treatment option. Some data shows that a knot may be “polluted” with waste metabolites.It’s definitely not miraculous. 2 It’s experimental and often fails. “Dry needling,” the trendiest type, bombed a good quality scientific test in 2020. 3 Good therapy is hard to find (or even define), because many (if not most) practitioners are amateurish 4 and some treatment methods are way out in left field and potentially harmful, to your wallet if nothing else. They are often barking up the wrong tree, treating so-called trigger points when there’s actually another problem. Any therapist who is highly confident about their ability to banish your sore spots should probably be fired. I get a lot of email from readers thanking me for pointing out simple treatment options for such irritating problems. Some are gobsmacked by the discovery that their chronic pain could have been treated so easily all along. You should learn more before giving up. This could give you a fighting chance of at least taking the edge off your pain, and maybe that is a bit of a miracle.http://www.duda-tech.pl/dudatech/upload/bose-al8-manual.xml

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This is the only tutorial of its kind: a book-length deep dive that isn’t just an advertisement for trigger point therapy. It’s an earnest and skeptical exploration of the biology and half-baked science of trigger points. Even if you already know about myofascial pain syndrome, you will get new ideas here. This page has been improved and updated for 21 years — no joke, it has actually been here that long. Last update: Jun 5, 2021 (jump to jump down to update log ). Scientific rigour is my top priority; pseudoscientific ideas about trigger points are debunked here. Click to make them pop up without losing your place. There are two types: more interesting extra content, 1 and boring reference stuff. 2 Try one! New Yorker cartoon by Pia Guerra, June 29, 2018. Many of actually do have interesting notes. Example citation: Acupuncture for Chronic Low Back Pain.They have had many names over the decades, 13 but myofascial trigger point ( TrP ) is the trendiest and most widely accepted label in the last 20 years. And sometimes there’s some muscle hardness or lumpiness at the site, maybe embedded in a taut band of muscle — but these abnormal textures are hard to detect reliably, and even professionals routinely mistake normal anatomy for trigger points (or other abnormalities).Its bark is much louder than its bite — these episodes will pass like a headache — but the bark can be painfully loud. It can also be a weird bark — trigger points can generate some odd and troubling sensations, and the source may not be obvious. And the story goes on: that small patch of muscle chokes off its own blood supply, which irritates it even more, a vicious cycle dubbed a “metabolic crisis.” This swampy metabolic situation is why I sometimes think of it as sick muscle syndrome. A couple major competing ideas are that it’s a more purely sensory disturbance, or the pain of slightly irritated peripheral nerves, a type of peripheral neuropathy.http://www.feynburg-uhren.de/userfiles/bose-airplay-manual.xml The TrP may be in the center of the aching, like the yolk of an egg, or the aching may spread surprisingly far away (via the mechanism of referred pain, another major sub-topic for later).TrPs are to MPS as pimples are to a serious acne problem. There are many other possible causes of unexplained pain, but trigger points are an interesting piece of the puzzle for many people, and knowing about them offers some potential for relief. Check all that apply — if you have more than half of these, and no other apparent explanation for your pain, you probably have a trigger point or two. While uncommon, it’s a distinctive symptom of trigger points. But trigger points can and do co-exist with any other kind of painful problem. Don’t worry, it won’t happen again.” And it didn’t. But I had learned a useful lesson: muscle tissue is sensitive stuff! 16 Aches and pains are an extremely common medical complaint, 17 and trigger points seem to be a factor in many of them. 18 19 They are involved in headaches (including migraines), 20 21 neck pain and low back pain, and (much) more. What makes trigger points clinically important — and fascinating — is their triple threat. They can: Trigger points can cause pain directly. Trigger points are a “natural” part of muscle tissue. 22 Just as almost everyone gets some pimples, sooner or later almost everyone gets muscle knots — and then you have some pain with no other explanation or issue. It is easy for an unsuspecting health professional to mistake trigger point pain for practically anything but a trigger point. For instance, muscle pain is probably more common than repetitive strain injuries (RSIs), because many so-called RSIs may actually be muscle pain. 23 A perfect example: shin splints. 24 The trigger point therapy workbook, by Clair Davies, p. 2 They aren’t a flaky diagnosis, 26 but they’re not exactly on a solid scientific foundation either.http://www.drupalitalia.org/node/76444 Some critics have harshly criticized conventional wisdom about them — criticisms I’ll cover in detail later. So all the more reason to have a rational tour guide to take you through a murky subject. What’s useful in the theory of trigger points. Who disagrees and why. What’s half-baked and obsolete. What are the major pitfalls. I critically analyze the topic from all sides. 27 Trigger point science may be a bit of a hot mess, but it also isn’t over: the controversy about trigger points is a legitimate, interesting controversy. And meanwhile, as far as I know, I am actually the only author out there who is both promoting and criticizing trigger point therapy. Cartoon by Loren Fishman, HumoresqueCartoons.com No medical speciality claims it.” 29 Muscle tissue is the largest organ in the body, complex and vulnerable to dysfunction, and full of biological puzzles. 30 Although it is the “primary target of the wear and tear of daily activities,” nevertheless “it is the bones, joints, bursae and nerves on which physicians usually concentrate their attention.” 31 They are busy with a lot of other things, many of them quite dire. And the topic is just trickier than it seems to be, so it’s not really surprising that doctors aren’t exactly muscle pain treatment Jedi. They may be the best option for serious cases. Doctors in pain clinics often know about trigger points, but they usually limit their methods to injection therapies — a bazooka to kill a mouse? — and anything less than a severe chronic pain problem won’t qualify you for admittance to a pain clinic in the first place. This option is only available to patients for whom trigger points are a truly horrid primary problem, or a major complication. Medical specialists may know quite a bit about muscle pain, but still can’t help the average patient for practical reasons. The trigger point therapy workbook, by Clair Davies, p.http://drbillbaker.com/images/boss-59-bassman-pedal-manual.pdf 2 These approaches have their place, but they are often emphasized at the expense of understanding muscle pain as a sensory disorder which can easily afflict people with apparently perfect bodies, posture and fitness. A lot of patient time gets wasted trying to “straighten” patients, when all along just a little pressure on a key muscle knot might have provided relief. Their training standards vary wildly. Even in my three years of training as an RMT (the longest such program in the world 34 ), I learned only the basics — barely more than this introduction. Like physical therapists and chiropractors, massage therapists are often almost absurdly preoccupied with symmetry and structure. The right hands can give you a lot of relief, but it’s hard to find — or be — the right hands. Muscle tissue simply has not gotten the clinical attention it deserves, and so misdiagnosis and wrong treatment is like death and taxes — inevitable. And that is why this tutorial exists: to help you “save yourself,” and to educate professionals. These patients commonly arrive with a long list of diagnostic procedures, none of which satisfactorily explained the cause of, or relieved, the patient’s pain. Myofascial Pain and Dysfunction, by Janet Travell, David Simons, and Lois Simons, p. 36 They are too historically important not to be familiar with. If you don’t see dog-eared copies of these books, ask about them — it’s a fair, polite clue about a therapist’s competence. Muscle Pain (the blue one) is just as important. I highly recommend it to any professional who works with muscle (or should). It’s more recent, and it covers a much wider range of soft tissue pain issues, putting trigger points in context. Fibromyalgia is a syndrome, not a disease, which means that it is unexplained by definition. 38 It is just the label we give to undiagnosed chronic widespread pain. So “no one has FM until it is diagnosed.” 39. It would be nice if such a clear distinction were established someday.https://1sis.com/wp-content/plugins/formcraft/file-upload/server/content/files/16272181d54640---brc-lpg-system-manual.pdf FM and MPS are both imperfect, imprecise labels for closely related sets of unexplained symptoms, which makes them harder to tell apart than mischievous twins who deliberately impersonate each other. They may be two sides of the same painful coin, or overlapping parts on a spectrum of sensory malfunction, or different stages of the same process. Some cases are effectively impossible to tell apart. There may be no real difference between FM and severe MPS. Pain is a trickster; it is often not always what it seems to be. Trigger points are a common alternative explanation. Sure, it might be something scary or rare. But in many cases it’s probably just a trigger point — about as serious as banging your funny bone. But it can feel worrisome. In addition to minor aches and pains, muscle pain often causes unusual symptoms in strange locations. For instance, many people diagnosed with carpal tunnel syndrome are actually experiencing pain caused by an armpit muscle (subscapularis). 43 Seriously. I’m not making that up. Many other trigger points are mistaken for “some kind of nerve problem.” (And, to be fair, some kinds of nerve problems can be mistaken for trigger points. More on this to come.) This image shows a classic example.I treated a man for chest and arm pain — he had been in the hospital for several hours being checked out for signs of heart failure, but when he got to my office his symptoms were relieved by a few minutes of rubbing a pectoralis major muscle trigger point. “Heart attack cured!” The same trigger point sometimes raises fears of a tumor. Here’s a particularly excellent example sent to me by a physician who had this experience: I’d had bad chest pain for a month. I was on the table, permit signed, draped. The doctor wasn’t sure: she said she wanted another mammogram.The physical therapist pulled out the big red books on trigger points, and we read together. Treatment was a complete success.AYNADAKIKEMALIZM.COM/resimler/files/6-port-db25-manual-switch-box.pdf A month-old severe pain that I had been treating with ice packs in my bra and pain-killers — gone! Some of which can become quite serious. Over the years I have met many people who were in so much pain from muscle dysfunction that they could hardly think straight. Is muscle pain “trivial”. Not if you have it! One of the nice things about working with trigger points is that sometimes they do make me seem like a miracle worker, because they are such a clinical “slam dunk” for garden variety persistent pain. She’d received some common misdiagnoses, particularly sacroiliac joint dysfunction. 49 But she had a prominent gluteus maximus trigger point 50 that, when stimulated, felt exactly like her symptoms — a deep ache in the region of the low back and upper gluteals. Her pain was permanently relieved in three appointments. She was quite pleased, I can tell you. A big thank you for all your help. Lois McConnell, retired airline executive, suffered chronic low back and hip pain for a few years Jan developed a hip pain sometime in early 2004 during a period of intense exercising. The pain quickly grew to the point of interfering with walking, and was medically diagnosed as a bursitis, piriformis strain, or arthritis. “ Ain’t nobody got time for that.” I did not think any of these were likely, and treated a trigger point in her piriformis muscle once on June 12, 2004. Her symptom was 100 relieved for about eight months, before it slowly began to reassert itself (as trigger points often do, despite our best efforts — more about that to come). Jan Campbell, retired French language teacher, Palm Springs, recovered easily from several months of hip pain. So much unnecessary suffering! Is there such a thing as a “trigger point whisperer”. Or even less. 52 The idea is exasperating to all the honest, humble professionals who know better. And, if you know the basics about pain and muscle knots, it’s obviously foolish.https://lakecountyoralsurgery.com/wp-content/plugins/formcraft/file-upload/server/content/files/1627218301e77a---brc-manual-issue-6.pdf The skill of a therapist is actually only one relatively minor factor among many that affect the success of massage therapy for trigger points — or any therapy, for any pain problem. Even the best therapists can be defeated by a no-win situation and factors beyond their control. 53 And nearly any therapist can luck out and get great results with the occasional patient when all the planets are aligned: sometimes trigger points respond well to virtually any intervention. It depends on the situation. This is a major theme in this document, and it is why I am dedicated to teaching concepts and principles, not treatment recipes and formulae — and that’s why it’s an important thing to cover in the introduction. There are several common kinds of muscle pain, or pains that can seem like it: arthritis, medication side effects, exercises soreness, muscle tears, and the profound body aching caused by an infection like COVID-19. 55 The only hope of telling these things apart is a good working knowledge. There are some clues you can look for that will help you to feel more confident that, yes, this kind of muscle pain is the problem instead of something else, maybe something scarier. Almost everyone more or less knows what it feels like to have a muscle knot, so almost everyone has a head start in self-diagnosing trigger points. If you’ve ever been inexplicably stiff — and really, who hasn’t? If you’ve ever wrenched your neck around trying to stretch and squirm your way free of discomfort. If you’ve begged a boyfriend to dig into that nagging sore spot in your back. If you had experiences like those, then you already know something about what trigger points feel like: pain and stiffness that feels like it’s in your muscles, sensitive patches of soft tissue in locations where there’s no obvious reason for it. See a complete table of contents below. Most content on PainScience.com is free. ? This page is only one of a few big ones that have a price tag.https://buddingheights.org/wp-content/plugins/formcraft/file-upload/server/content/files/1627218403149e---brc-manual-version-6.pdf There are also hundreds of free articles, including several about trigger points. Book sales — over 68,700 since 2007. This is a tough number for anyone to audit, because my customer database is completely private and highly secure. But if a regulatory agency ever said “show us your math,” I certainly could. This count is automatically updated once every day or two, and rounded down to the nearest 100. It includes all individual and bundled books for sale on PainScience.com since 2007, and excludes a trickle of earlier sales, donations, and gifts. — keep the lights on and allow me to publish everything else (without ads). Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. Note that my small business does not handle your credit card info: it goes straight to the payment processor (Stripe). You can also pay with PayPal: for more information, click the PayPal button just below. My prices are set slightly lower than current exchange rates, but most cards charge extra for conversion. So I offer my customers prices converted at slightly better than the current rate. But some customers prefer to use PayPal, instead of giving their card number to a small business. Using a credit card here is as safe as using it in any store (probably safer, actually). PayPal orders are processed by me personally. To buy with PayPal, please “manually” login to PayPal and send payment of 19.95 USD to Just the topic is fine, e.g. “trigger points.” Order confirmation emails are often mis-identified as junk email. An online tutorial, book-length (180 chapters). Free updates forever, read on any device, and lend it out. E-book only! MORE There is no paper book — I only sell book-length online tutorials. This format is great for instant delivery, and many other benefits “traditional” e-books can’t offer, especially hassle-free lending and updates.AYKUTEMLAK.COM/upload/ckfinder/files/1100-zxi-shop-manual.pdf You get free lifetime access to the always-current “live” web version (and offline reading is easy too). Is there any way around that? You can also print the book on a home printer. No complicated policies or rules, just the honour system. You buy it, you can share it. You can also give it as a gift. No password or login: when payment is confirmed, you are instantly granted full, permanent access to this page. MORE Card info never touches my servers.You aren’t “subscribing” to anything: I never send email to customers except to confirm purchases. No legalese, just plain English. But the set is ideal for professionals, and some keen patients do want all of them, for the education, and for lending to friends and family. And, of course, you do get a substantial discount for the bulk purchase. But no rush—complete the set later, minus the price of any books already bought. More information and purchase options. Quick checklist: classic trigger point symptoms Why muscle pain matters The shabby state of trigger point science Why are trigger points so neglected by medicine. Does your trigger point therapist have the big red books. Myofascial pain syndrome versus fibromyalgia Trigger points may explain many severe and strange aches and pains Two typical tales of trigger point treatment The myth of the trigger point whisperer Diagnosis — How can you tell if trigger points are the cause of your problem? The all-powerful acne analogy The evolution of muscle pain: does muscle “burn out”. Getting a trigger point to “release” Basic tips and tricks for better, longer-lasting trigger point release Top 5 mistakes beginners make What about massage tools. A brief detour: why not The Trigger Point Therapy Workbook. Don’t be fooled by “reverse referral” Beyond the tennis ball: commercial massage tools Thumping trigger points with vibrating massage tools Commercial massage tools to avoid Massage tools: 7 free (or very cheap) and tools from objects not originally intended for massage The sock trick The bath trick Introduction to non-massage self-treatments for trigger points Stretching (executive summary) Mobilizations: massaging with movement and the Goldilocks zone Case study: mobilizations prove to be crucial factor in recovery from neck pain that started in the 1970s Trying to squirm your way out of trigger point pain. Don’t do it! Consider a little more method in your madness Strengthening: should you take your trigger points to the gym. Stretch tolerance What about stretching the antagonist muscle. Stretching “conclusions” Getting Help — How do you find good therapy for your trigger points. How about the Paul St. John Method of Neuromuscular Therapy. Spinal manipulative therapy How about myofascial release and fascial stretching. Maybe stabbing will help. How about Botox injection therapy. How about nerve blocks. How about acupuncture. Measuring progress in trigger point therapy Final Thoughts — How is a lemon like a trigger point.Here are some other free samples from the book, and other closely related articles on PainScience.com: Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. To buy with PayPal, please “manually” login to PayPal and send payment of 19.95 USD to Just the topic is fine, e.g. “trigger points.” Order confirmation emails are often mis-identified as junk email. Please don’t buy this book and then ask for a refund because it doesn’t have charts: it’s like asking for a refund for your zoo admission because you didn’t see any cats, dogs, or squirrels! Many specific pain problems are mentioned briefly, but the book doesn’t go into detail about any of them. You don’t really need the link to every common pain problem spelled out. Trigger points cause and complicate all injuries in fairly predictable ways — that’s why they are clinically intriguing! It’s illustrated nicely, and offers detailed muscle-by-muscle reference material — things this tutorial deliberately lacks. Why not just recommend the Workbook. Because this tutorial has grown to offer a lot that the Workbook doesn’t. But the Workbook has fallen behind the times on that score. The current edition still promises too much and neglects important new knowledge. Trigger point therapy has been challenged by many scientific insights and new ways of understanding pain, but the Workbook doesn’t acknowledge any of that. This topic is too important for such neglect. Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. To buy with PayPal, please “manually” login to PayPal and send payment of 19.95 USD to Just the topic is fine, e.g. “trigger points.” Order confirmation emails are often mis-identified as junk email. The devil is in the details, and that’s why there’s a very large book about them behind the paywall. But this summary should help give you a better sense of whether or not you want to learn more from this source. This section is included as a free sample, like the introductory sections. I avoided publishing this section of the tutorial for many years, because I am generally not impressed by the resources available (to both patients and professionals), especially online resources. I remember a slightly testy conversation with someone from an American organization (that shall rename nameless): You shouldn’t say that. We certify good trigger point therapists! That’s one certified therapist for about every 60,000 people and 200,000 square miles. If “needle in a haystack” is the new “easy to find,” then sure, I’ll say that your certified therapists are easy to find. If you live in a big city, there’s a fair to middlin’ chance that you can find one of those therapists.For instance, although professional associations are rarely of much interest to patients, they may provide directories of professionals to help patients find practitioners. If you are aware of important resources and organizations elsewhere in the world, please let me know. NAMTPT provides resources for both patients and professionals, such as a trigger point therapist directory ( just over 100 therapists) and a symptom checker. IMS publishes the MYOPAIN, a Journal of Myofascial Pain and Fibromyalgia. A CPE educates clinical peers, patients, families, and caregivers on ways to relieve pain by the safest means possible. ASPE training is not focused on muscle pain. Similar to the ASPE in that members do not focus on muscle pain in particular: they are included here because they are chronic pain experts in general (although, interestingly, in 2016 they did “spontaneously” form a new “interest group” about myofascial therapy ). They provide a directory of members and listings of pain clinics. Their website provides many useful resources for both patients and professionals. Like DSGA, Myopain Seminars is focused more on teaching skills and knowledge and not a branded certification program, but they do have a directory of graduates of their courses (see their find a clinician feature) and more than a dozen faculty members all “provide high-level diagnostic and management services” for pain patients that may be of interest to many readers of this book. I have a friendly occasional correspondence with founder Dr. Jan Dommerholt, the author of several influential books and papers on this topic; although we don’t necessarily agree on everything — I’m not a fan of dry needling, primarily — I think of him as a mentor and have learned a great deal from him. But my testimonials are mostly about the quality of the information I’m selling, and I hope that makes all the difference. These are all genuine testimonials, mostly received by email. In many cases I withold or change names and identifying details. He acknowledges that the trigger point science is “half-baked,” but he’s leaving the door open to debate, unlike some others. And he does this with the humor and aplomb of someone who’s actually read and studied the relevant science and is therefore humbled by it. He also admits that his trigger point manual is his bread and butter, so he’s also transparent about competing interests, which is more than I can say for many clinical researchers in the field of trigger points. Just read his stuff. John Ware, Physical Therapist This is, bar none, one of the finest endorsements I’ve ever received. You have consolidated and correlated many things that I have previously read as a chaotic patchwork quilt in diverse places and provided valuable additional information and insight that I have not previously found. Alessandra Campbell I really appreciate all of the time and effort you have put into your work. I have had arthritis and a hip replacement, with all of the attending issues. My goal has been to seek the proper information to rationally and practically address this. Your work has given me better direction and clarity in understanding some of the body dynamics from an honest perspectice. Many thanks for your work with this. Phillippa Lutz First of all thank you for what you do. I stumbled onto your site about six months ago and it has radically changed my perspective on myofascial pain and how I approach and treat patients. In the 16 years I have been a licensed acupuncturist and the 20 before that as a certified massage therapist this is far and away the most useful and eye opening information I have ever come across. Alishia Livingston Thank you for your website, it is really a great resource. I have purchased 2 tutorials (trigger points and PF). I also love the concept that you permanently update them and that we have permanent access. I have never seen this concept anywhere else but I find it is really worth the money and better than a book, in the long run. Bryn Gonzalez Firstly I would like to thank you for your Trigger Point therapy book, which is very easy to read and follow (and the witty sense of humor doesn’t hurt!). Yusra Winters First, thank you for the very informative e-book; I am thoroughly enjoying it — which is strange since it’s a medical text. That attests to your ability to write in a very engaging and easy-to-follow tone. Safia Salinas Thank you for delivering information about trigger points and resulting pain in a manner that is understandable to the general public. While I am a Physical Therapist most everything I read or listen to automatically gets translated into a more scientific jargon. This helps me to relay the message to my clients. Kaydon Joyner, physical therapist The clarity of your writing is very impressive, and you bring a great attitude to it. Brittney Taylor Thank you so much for taking the time to put this book together, and in a way that makes it feel like you wrote it just for me. You have a great writing style. Hanna Beck One more noteworthy endorsement, with regards to this whole website and all of my books, submitted by a London physician specializing in chronic pain, medical education, and patient-advocacy (that’s a link to his excellent blog): I teach a course, Medicine in Society, at St. Leonards Hospital in Hoxton. I originally stumbled across your website whilst looking for information about pain for my medical students, and have recommended your tutorials to them. Your work deserves special mention for its transparency, evidence base, clear presentation, educational content, regular documented updates, and lack of any commercial promotional material. — Dr. Jonathon Tomlinson, MBBS, DRCOG, MRCGP, MA, The Lawson Practice, London I do not host public comments on PainScience.