If I remember correctly it is lactic acid, uric acid, and other metabolic wastes.What "toxins" are locked up in the myofascial knot?
It was from the butt close to the crack, legs bent in the supine position.did they inject into your perineum, i.e., about halfway between the back of your scrotal sack and your butthole?
Thanks for the very interersting and informative post. A couple of questions:MB wrote:I had 50 or so sessions of PT that did not manage to get rid of a single trigger point.
PT would release my muscles temporarily and then a day later the PFD would be back.
T.Sawyer advised me to consider trigger point injections. I had it in the adductors, the levator ani and the transverse perineal muscle.
The effect has been immediate. The muscles released instantly and the PFD never came back.
It is also extremely safe and almost painless.
The trigger point injection technique is the "original" treatment developped by Janet Travell, JFK's MD.
some good information at: http://www.aafp.org/afp/20020215/653.html
I see, so the theory would be that the trigger points don't allow fuel in an waste products out. This promotes chronic muscle fatigue which is an inflammatory and pain inducing condition, therefore, any disruption of trigger points is helpful.MB wrote:If I remember correctly it is lactic acid, uric acid, and other metabolic wastes.What "toxins" are locked up in the myofascial knot?
It was from the butt close to the crack, legs bent in the supine position.did they inject into your perineum, i.e., about halfway between the back of your scrotal sack and your butthole?
)
| HAS THIS SITE HELPED YOU? Say Thanks by donating. Keep the Forum alive on the Internet! PayPal link at end of page ↓ Contact me at support at ucpps.men |  |
Good question. I am not sure.Were there any specific reasons why your trigger points kept coming back?
For the external muscles, Dr.Mark Sontag, a physiatrist in Redwood City.Where/with who did you have the injections performed?
I asked PTs about it. Some claim that injections work but that TrPs come back more easily than using the long route.If injections work why do any of us bother with the long route?
Dry needling with acupuncture needles will only release secondary trigger points in the connective tissue close to the skin (the TrPs that form close to the tendons for example) and restrict the muscles.Just to get this right, the name of this is "Dry Needling" correct?
Dear Mark,
I am responding to your note asking for my viewpoint on the injection of trigger points. The short answer is that trigger point injections are occasionally useful for some stubborn trigger points but are no answer in themselves to the problem of pelvic pain. The problem is, however that in the novice's mind the idea of trigger point injection can create the illusion of a quick fix to the problem of pelvic pain. High tech medicine, including trigger point injection has to cooperate with the healing mechanisms of the body. Of itself, it has no power unless it helps the body heal itself. It is in this context that I want to respond the question of trigger point injections for pelvic pain.
As far as the Stanford/Wise-Anderson Protocol is concerned, I want to be clear that trigger point injections are a very minor part of our treatment and only useful in combination with our entire protocol. We suggest that perhaps 10% of our patients occasionally consider trigger point injections for one or two specific stubborn trigger points -- not all of them . Trigger point injections are not a substitute for a talented and intuitive physical therapist who knows the trigger points related to pelvic pain, can find them and release them manually or for the patient to diligently do self physical therapy treatment that we teach in addition to the ongoing relaxation of the pelvic floor. In other words, trigger point injections can only be useful if the major perpetuating factor of anxiety and tightening the pelvis under stress is being regularly and competently lowered.
I try to look at the big picture of effective treatment for pelvic pain. What is the point of treatment I ask? The point is to return the pelvis to its natural, flexible, uncontracted and pain-free state -- a pelvis not caught in the cycle of tension, pain and anxiety that is the heart of chronic pelvic pain syndromes. The point of treatment is to bring peace back into the pelvis.
It is not possible for a painful pelvis to become quiet without the person also becoming quiet. The pelvic floor, in pelvic pain, in my view is in large part a mirror of the psyche of the sufferer. To quiet the pelvis down you have to quiet yourself down. To bring peace into your pelvis, you have to bring peace into yourself. Physical therapy releases the contracted pelvic tissue to allow one to be able to relax the pelvis. Trigger point injections occasionally can help this process within the context of working with an experienced and talented physical therapist who knows how to do trigger point release inside and outside of the pelvis.
The primary focus on high tech medicine, surgery, injections and other interventionist and aggressive strategies for pelvic pain loses sight of this big picture in my opinion. When relied upon alone, it has been my observation that these approaches simply fail to reduce or resolve symptoms. That is the bottom line. From the physical therapy aspect of our treatment, most trigger points can be coaxed into becoming latent and non-symptom producing through competent manual therapy. While manual intervention is painful at first, it is the most conservative method for dealing with the tightened, shortened, painful tissue of the trigger point. And, as a rule, correctly done manual therapy does the trick most of the time.
For the beginning student of trigger points, it is important to understand that trigger points are rarely eradicated no matter what method is used. The key in trigger point release related to pelvic pain is to resolve trigger points so that they become latent and not actively symptom-creating. This requires the active PT intervention, much of which can be done oneself with proper instruction and guidance. Ultimately it is an inside job of relaxing the pelvis, lowering the general level of nervous system arousal and stress and stopping the stubborn old habits of squeezing the pelvis.
Trigger point injections involve locating the trigger point and then injecting it with anesthetics like Lidocaine or Marcaine. Doing this has to be done carefully. The physician needs to be able to correctly locate the problematic trigger point. This is no mean trick for most physicians who usually have no training in trigger point identification or treatment. I wouldn't have anyone inject my trigger point without my physical therapist corroborating the location to be injected.
Patients have come to us telling us that they had 20 trigger point injections. Upon more careful scrutiny, we discover that the doctors had not properly identified the trigger point and therefore those injections, for the most part, were a waste of time. Tim Sawyer, our senior physical therapist will often mark the trigger point on the skin and with a trigger point map before the patient goes for the injection to make sure that the doctor injects the proper place.
I myself am not a big fan of injecting internal trigger points as the environment inside the pelvis is usually unclean and sticking a needle inside the pelvis is intuitively questionable to me. Some doctors inject internal trigger points by getting to them through the outside. While doctors who do this swear by its safety, sticking a long needle inside through the lower abdomen and pelvis scares me and I wouldn't have it done on myself.
In the Stanford/Wise-Anderson Protocol we teach people to do as much of their own treatment as possible. We teach them to do self-trigger point release inside and outside the pelvic floor, skin rolling, appropriate stretching in conjunction with Paradoxical Relaxation. These methods all have one goal in mind -- to bring peace and ongoing relaxation to a tightened and painful pelvis.
In my view we want to be gentle and loving to the pelvis and related parts of the body involved in pelvic pain especially when we do trigger point release. We want to remember that our pelvis is a precious part of our body that responds immediately when we treat it with respect and caring or when we treat it like an offending hunk of meat that we just want to shut up.
Trigger point injections have their place. This subject of using needles to do trigger point release, however, as a first intervention, for me is part of the larger subject of doing surgery, nerve blocks, implants, injections, invasive procedures and invasive diagnostic tests for pelvic pain. My own observation is that the large majority of people I have seen with pelvic pain, at best, have felt like the interventionist and aggressive procedures did nothing for them. More than a few times patients have told me that they deeply regretted subjecting themselves to aggressive procedures and have felt harmed by aggressive medical intervention for their pelvic pain.
The principle I support is the principle of doing first what has the least possibility of harm. Failing that, more risky strategies can be considered. In summary, aggressive strategies would be the last thing I would consider and only after I gave everything else the longest chance to work.
When trigger point injections are used, they should work relatively quickly. We don't advocate ongoing trigger point injections to the same trigger point.
My view is that it is better to err in the direction of doing a lot of manual therapy before the decision is made to stick the body with a sharp object and force a drug into it. Some clinicians feel much more free about using trigger point injections, sometimes as a first line of intervention. I do not.
Occasionally the trigger point injection works miracles like the man who reports such good results from it in your letter to me. The idea however, that trigger point injection is the answer to resolving pelvis related trigger points is usually short lived as most people with pelvic pain will find out who go the route of trigger point injections as their major treatment. Trigger point injections have their place but are no panacea.
From my view, treatment of pelvic pain should set patients on the road of being independent from having to go to others for help and special treatment. While trigger point injections can sometimes be more helpful than manual therapy, and should be used, I feel it is important to be clear that you ultimately do not need fancy methods that you have to continue to see someone to receive. Once trained in the effective methods of self care, I am convinced that most people with pelvic pain can resolve and take care of themselves.
You just can't kill a trigger point. Rarely is there a one time permanent external fix for a trigger point that is symptom creating. Keeping trigger points latent and not active in the pelvis or elsewhere is a lifelong issue like brushing your teeth or keeping fit. Ultimately, the resolution of pelvic pain is an inside job. It is my view that the clinician's place is to teach the patient the skills and impart the critical information and attitudes to take care of his or her own trigger points, to be able to deeply and regularly relax the pelvis, to help the patient release himself from catastrophic and anxiety producing thinking, and help free the patient from having to come back for treatment.
David Wise, Ph.D.
| HAS THIS SITE HELPED YOU? Say Thanks by donating. Keep the Forum alive on the Internet! PayPal link at end of page ↓ Contact me at support at ucpps.men | |
webslave wrote:I asked David Wise to comment, and received this response:
The pelvic floor, in pelvic pain, in my view is in large part a mirror of the psyche of the sufferer. To quiet the pelvis down you have to quiet yourself down. To bring peace into your pelvis, you have to bring peace into yourself.
David Wise, Ph.D.
