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Referring to Rule 3, if you cannot believe where you hurt or where the pain comes from, this rule is about what you can really and truly believe. Indeed, the only thing you can believe as a patient is that where you are specifically tender, mm by mm, is where the fascia strings and cords that attach to you and hold you together are either tied in a knot or they are injured.
Referring to Rule 4, the specific places where your body and fascia are most tender usually relate to the most significant of the injuries causing the pain symptoms that are more likely to attract your attention. It's fascinating that this seems to be true no matter what turns out to be your pain issues of affliction – from headache to foot pain and all areas in between. Examine very carefully and trust what is tender.
Referring to Rule 5, when you can get your body to heal from the injuries discovered during the physical examination of Rule 3, you will find the pain from Rule 1 will mostly or possibly even completely go away. This means that coping skills, medications, epidural steroids, nerve blocks, neuro-ablative procedures and more might not be so necessary if we could only make the pain go away nearly all of the time. And indeed, there is a path which you can work to make this happen.
One of the issues of treatment for chronic pain is that the practitioner or doctor prescribing your medication and surgery has likely never really touched you. Your chiropractor has to some extent, massage therapist has perhaps more, but who else? Success from this work and understanding of injury and pain depends on knowing a touch that is not taught in medical school. And then, an understanding of what that touch means to healing injury and resolving pain.
What about treatment? Besides basic stretching, has anyone taught you how to work on and change the "kinks" in your myofascia? And are you doing this a few times each day?
Every muscle and fascia injury has three physical engineering issues. First there are injuries where the fascia weaves to the periosteum weakening the attachments that anchor muscle. These injuries can also be anywhere along the fascia cords between anchor (enthesis) and trigger point. Second, there are the actual places where the fascia cords and muscle cells are wound into the trigger point. This actual coil is not only tender when palpated, it is directly responsible for much of the tightening that causes the ropey bands and is also responsible for generating much of the noticed discomfort or pain as it applies pressure to the interstitial nerve endings. Lastly, there is the ropey band. The significance of the ropey band is that it has to impede blood flow. This will mean the muscle will then necessarily start to burn fuel anaerobically long before it normally should. At this point, continuing to use the muscle will increase formation of lactic acid as ATP is made. The consequence is that with more use of tight muscles, the more a person will have to massage or use their foam roller to squeeze metabolic exhaust from the ropes just to keep up. See Figure 5.
Trigger points and fascia kinks need to be smoothed out so the nerve endings in-between the fascia cords stop being squeezed and causing symptoms. Sometimes the injured enthesis and fibers in the muscle cord require repair so that muscle pull can be more solid without recurrence of the kinks (trigger points).
For more than 25 years I have taught about massaging trigger points and fascia with a rubber ball. This ball can reduce concentration of metabolic toxicity within a muscle, and also help untangle the wound up knots of fascia called trigger points. Fascia-based pain patterns from these knots are illustrated along with rubber ball massage and stretching techniques in my book, Winners' Guide to Pain Relief, Danua Press.
Trigger point injections and dry needling induce the fascia knots to directly unwind. Discomfort from this treatment is from the free nerve endings sensing the ripple along the fascia that results from the release. Afterwards the person will likely feel soreness of a muscle that finally has a chance to relax after too much exercise.
What about joint pain? Doesn't it come from arthritis? Many are advised that their bone on bone joint will require replacement surgery. Orthopedic texts state that we are born with cartilage to wear out and when this happens our joints require replacement. In a body that grows a new gut lining every three days, new skin every 7-10 days, and even new brain cells, it does not make sense that our body cannot repair cartilage from daily wear and tear. A closer truth is that we regrow cartilage in every joint in our body every minute of every day, and there are alternatives to joint replacement surgery.
One of the first questions to ask is about how well the joint still moves. If you can fully straighten your knee and also bend it 100°, there is no possible way this joint is bone on bone. Moreover, the joint has enough cartilage remaining to not only move, but also there is a good chance of regenerating and avoiding replacement surgery.
There are surgeons who call joints bone on bone to persuade patients to proceed with replacement surgery. Some x-rays I have seen in second opinion consultation have more joint space than mine. Even when cartilage is very thin and the x-ray may look like bones are very close together, it only takes two to three cell layers of cartilage for a joint to move. Seeing cells requires a microscope, and this thin layer cannot be seen by x-ray.
What then of the pain? Again, much of our pain comes from injury demarcated by where the fascia is tender. With regard to knees, nearly all people have tender injuries in their pes anserine tendons and the insertions of distal vastus medialis muscles. Not only do these patients need to regenerate cartilage in their joints, these fascia injuries also need repair. And it is often injury to these structures that is the basis for chronic knee pain after joint replacement surgery.
What about food and its effect on fascia and pain? Of all therapeutic challenges, this simple issue is one of the more complicated to work with and motivate people for change. Many of the answers however, are much more straight forward.
When injury occurs at the enthesis and throughout the muscle as fascia cords get stretched and torn, inflammatory mediators are released. It has been shown that 90 seconds of osteopathic touch can change this chemistry and reduce the inflammatory soup in the local tissue.7
In a similar fashion, exposure to inflammatory food also increases the release of inflammatory mediators by the fibroblast diffusely and throughout the body.8 In the central nervous system this has been shown to increase cerebral injury.9 In the body this fascia inflammatory response increases pain.
Where pain comes from interstitial nerves reacting to injuries in fascia, in my experience inflammation from food and environmental toxicity makes these injuries light up like a holiday tree for days to weeks. According to our research, being able to sense pain from weather and barometric change implies a fascia-wide level of inflammation caused by some ingested food during the previous six weeks. The corollary is that in the absence of any food inflammatory to your body through six weeks, most likely you will not feel "rain pain," or it will be much lighter than expected and you are looking to discover another sensitivity.
Of equal significance, if the fibers of a ropey band can be separated by a treatment, they will stick back together by the inflammation from food. Indeed, success of myofascial treatment is intimately tied to nutrition and environmental toxicity.
There are many practitioners and treatments for chronic issues. Many are helpful to people who suffer and much has been written. Common denominators of successful treatments can often be found in fascia and nutrition.
There are many diets and nutritional philosophies that have been helpful for those with chronic issues. In figuring this out, it is helpful to know our body speaks with a common and particular language. If one wakes in the morning with pain not present the night before, and there was no intervening injury, a highly likely cause of this increased pain is inflammation from food ingested the evening before. A stiff neck does not come from the window, and it is unlikely for anyone without Ehlers-Danlos syndromes to sleep that wrong. It is more likely the sudden pain issue came from last night's pizza and a high dose of inflammatory bread flour and dairy. Similarly, pain in the evening may have come from breakfast or lunch.
At heart to the issues of chronic pain is that current treatment does not work very well. In addition, reliance on opiates and other medications has not proven to be such a good option. Surgery remains controversial, with success and failure less than predictable. And pain treatment is often based on epidural steroids and ablative procedures that may be harmful.
Alternative medicine pain clinics offer acupuncture, mind-body-spirit, herbal medicine, and training in coping skills. This article discusses a different paradigm…that of finding and healing the injuries and watching the pain go away. Really, please, why don't we learn to just make it go away!
In my experience after 30 years of research, pain is not what we are taught. It is not about inflammation, disc, spine, or even joint. Indeed, all of this can be in the mix, but the predominant injuries are to the fascia that holds our bodies together. The very tissue we were taught to discard during anatomy and also surgery is more important than ever imagined.
The miracles of healing bring us the ability to repair from old injuries and also to regrow worn cartilage in our joints. Many of us have patients who are living proof. No one should be led to think their cause is hopeless. So many people who suffer with chronic pain can be helped to function better and with much less discomfort.
To feel better and better, locate and help heal the pain generators caused through time, stop all ingestion of inflammatory food, and then consider your next steps. Practitioners of regenerative medicine, detoxification, ozone therapy, nutrition and myofascial pain may be a good choice for information and help.
If you are a practitioner, learning new ways to consider common problems of pain will help you be more able to help people with frustrating issues where there are otherwise too few good options.
Patient XX is a 62 year old woman who presented on June 17 with a history of scoliosis and pain in her neck, back, hip, and leg on the right side. She had felt a pulling sensation in her psoas muscle during yoga about 1 year prior, and then again while doing a Rumba dance about 5 weeks prior to this office visit. She had one acupuncture treatment and then more recent activities with her grandchildren greatly aggravated her symptoms.
Health care professionals have been taught to think this pain could likely be related to her history of scoliosis and x-ray findings of degenerative lumbar facet changes.
Her presenting pain pattern is illustrated in Figure 1.
Figure 1. XX colors blue for pain are all along the right side of her body, neck to lower back and into her right groin and thigh. The x's in the diagram represent the most active of the fascia knots or trigger points in her myofascia. Short horizontal lines represent some of the tendon or enthesis injury detectable on physical examination by noting texture of myofascia.
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