The presentation includes audience interaction, visual aids and a guided meditation through the lymphatic system, to give participants a more felt sense of the pace and flow of the system. A special focus on the anatomy of the breast and it’s lymphatic drainage patterns, and information about how individuals can support their breast health, can be included in the program. The class is provided with handouts and additional resource guides.

What are perpetuating factors? The Trigger Point Manual cites mechanical stresses, nutritional inadequacies, metabolic and endocrine inadequacies, psychological factors and chronic infection. Other factors could include allergy, impaired sleep, radiculopathy and chronic visceral disease.

One common structural factor is lower leg length inequality which can cause a tilted pelvis when standing. Resulting TPs often cause back pain. Postural stresses are another perpetuating factor, and can be caused by misfitting furniture, poor posture, abuse of muscles, immobility and repetitive movement overload.

Dr. Travell cites nine common faults of most household chairs: “No support for your low back, armrests too low or too high, too scooped a backrest in its upper portion, backrest nearly vertical, backrest short, failing to support your upper back: jackknifing effect at hips and knees, high front edge of the seat, shutting down the circulation to your legs, seat bottom soft in the center, creating a bucket effect which places the load on the outer side of your thighs, rather than on the bony points in the buttocks; an excellent chair may be the wrong size for you.”

Another common problem is poor posture, including unphysiologic positioning at a desk or work surface and head tilt resulting from poorly adjusted reading glasses. “Reading and copy material should be placed at eye level to avoid sustained forward tilting of the head to relieve the posterior neck and upper back muscles of prolonged checkreining overload. Other common sources of postural strain include malpositioning of materials that a person uses, such as placing documents flat at one side without a stand, writing on the lap, or using the neck and shoulder muscles to hold the receiver of a telephone against the ear.”

“Abuse of muscles perpetuate TPs by poor body mechanics that render body movements needlessly stressful, by sustained isometric contractions or immobility of the muscles, with too many repetitions of the same movement, and by excessively quick and jerky movements. A common example of poor body mechanics is leaning over while twisting sideways to lift an item from a shelf or the floor. The same effect is produced when a person leans over the sink to brush the teeth, or stoops forward to get in and out of a chair.

“A frequent repetitive movement can overload muscles and cause TPs…as in sorting tasks in an assembly line, post office, or movements by a performing artist. Bruxism and emotional tension can interact to overload the masticatory muscles, perpetuating TPs which cause head and face pain.

“Myofascial TPs are perpetuated by prolonged constricting pressure on a muscle, such as the pressure from a a strap of a ponderous purse hung over the shoulder or by narrow brassiere straps that support heavy breasts and groove the upper trapezius.”

Determining the perpetuating factors which apply in your case is key to improving myofascial ease and comfort.

“Active Trigger Points (TrPs)produce a clinical complaint (usually pain) when a TrP is digitally compressed. Latent TrPs can produce the other effects characteristic of a TrP including muscle tension and muscle shortening (but do not produce spontaneous pain.) Both active and latent TrPs can cause significant motor dysfunction.

“The activation of a Trp is usually associated with some degree of mechanical abuse of the muscle in the form of muscle overload, which may be acute, sustained and/or repetitive. In addition, leaving the muscle in shortened position can convert a latent Trp to an active TrP, and this process is greatly aggravated if the muscle is contracted while in the shortened position.

“The patient is aware of the pain caused by an active TrP but may or may not be aware of the dysfunction it causes. Latent TrPs characteristically cause some increased muscle tension and limitation of stretch range of motion, which often escapes the patient’s attention or is simply accepted. The patient becomes aware of pain originating from a latent TrP only when pressure is applied to it. Spontaneous referred pain appears with increased irritability of the TrP, and then it is identified as active.

“The patient usually presents with complaints due to the most recently activated TrP. When this TrP has been successfully eliminated, the pain pattern may shift to that of an earlier, key TrP which also must be inactivated. If the key TrP is inactivated first, the patient may recover without further treatment.

“The intensity and extent of the referred pain pattern depends on the degree of irritability of the TrP, not on the size of the muscle. Myofascial TrPs in small, obscure muscles can be as troublesome to the patient as TrPs in large, familiar muscles.”

“Although she was brought up on the unitary concept of disease that all of the patient’s symptoms should be explained by one diagnosis, she soon learned that life is not like that. The man who has both heart disease and pulmonary tuberculosis may suddenly die of cancer of the lung. Patient complaints that originate in the musculoskeletal system usually have multiple causes responsible for the total picture.

“Early in her medical career, Dr. Travell served simultaneously on pulmonary, cardiology and general medical services. On all the services, the major complaint she encountered among patients was pain. The patient might be dying of a serious illness, but when asked, “How are you?” would answer, “Well, ok, except I have this terrible pain in my shoulder. I can’t sleep. I can’t lie on that side.” When asked the cause of the pain, the resident on the pulmonary service would say it was a reflex from the lung. On the cardiology service, in another hospital, patients had the same complaint of shoulder pain, but the resident explained the pain as a reflex from the heart, of course. In the general medical clinic, a secretary who spent all day typing and pulling heavy file drawers would describe precisely the same pain complaint; but its origin was said to be “psychosomatic.” In none of these patients did the doctors find objective evidence of disease to account for the patient’s pain, but the skeletal muscles had not been examined.

“When Dr. Travell examined these patients, all three groups had isolated tender spots in muscles which, when compressed, reproduced the patient’s pain in the shoulder, arm or chest. The common ailment was an unrecognized myofascial trigger point syndrome.

“Fortunately, these observations were made in an environment rich in experimental expertise. She regularly taught pharmacology to medical students whom, to answer their questions, she inspired to perform the appropriate experiments for themselves in the laboratory. The inquisitive students and faculty at the Cornell University Medical College helped Dr. Travell formulate her investigations of the nature of trigger points and how they function. She herself was inspired by the interchange of ideas and the criticism of leaders in basic and clinical research at the New York Hospital, Cornell Medical College Center.

“The successful care rendered Senator John F. Kennedy five years prior to his election as President led Dr. Travell to the position of White House Physician under Presidents John F. Kennedy and Lyndon B. Johnson. Except for that one short detour, she never strayed from her primary focus on the diagnosis and management of the myofascial pain syndromes due to trigger points.”

Dr. David Simons met Dr. Travell when she lectured at the School of Aerospace Medicine at Brooks Air Force Base in San Antonio, Texas, just a few years before he completed his military career as a United States Flight Surgeon pioneering aerospace medical research. In the 1970s, they joined forces to begin writing Volumes One and Two of this groundbreaking book- a monumental contribution to the understanding and treatment of myofascial pain and dysfunction.

Why are they important? Skeletal muscle is the “largest single organ of the human body and accounts for 50% of body weight.” There are over 400 muscles in the body, and any one of these muscles can develop myofascial trigger points (TrPs) that refer pain and motor dysfunction, often to another location.

The “severity of symptoms caused by myofascial TrPs ranges from the agonizing incapacitating pain caused by very active TrPs to the painless restriction of movement and distortion of posture due to latent TrPs that are so commonly overlooked. Patients who have had other kinds of severe pain such as that due to a heart attack, broken bones, or renal colic, say that the myofascial pain from TrPs can be just as severe. Despite their painfulness, myofascial TrPs are not life threatening, but their painfulness can, and often does, devastate the quality of life.”

Cost: Further, “unrecognized myofascial headache, shoulder pain and low back pain that have become chronic are major causes of industrial lost time…disabling chronic pain costs the American people billions of dollars annually. A considerable portion of chronic pain due to myofascial TrPs could have been prevented by a prompt diagnosis and appropriate treatment. Active myofascial TrPs are largely responsible for that enigmatic scourge of mankind, musculoskeletal pain. The cost of it is incalculable, but enormous, and most of it is unnecessary.”

“The report found that the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse events.”

Read more at: http://www.ConsumerReports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/overview/maternity-care.htm

Lymph Drainage Therapy (LDT) refers to a specific type of gentle touch bodywork designed to stimulate the body to take in more lymph through the capillaries and vessels of the lymphatic system.  Increased intake and circulation of lymph results in more lymph brought to the lymph nodes, where the white (immune) cells are activated by exposure to bacteria, viruses and other antigens.  The lymph nodes also filter and break down waste materials captured in the lymph, such as cell debris, metabolic waste products, allergens, cancer cells and manmade chemical toxins.  These waste products are then returned to the liver and kidneys via the blood circulation and disposed of by the body’s excretory systems.

The proper functioning of the lymphatic system is critical to our body’s ability to drain stagnant fluids, detoxify, regenerate tissues, filter out toxins and foreign substances and maintain a healthy immune system (Asdonk, 1970, Adair & Guyton, 1982.) Lymphatic vessels rely on tiny muscular units (lymphangions) to propel the lymph flow.  LDT is a hands on technique designed to attain and sustain proper functioning of this fluid system.

In this class we learned and practiced:

techniques to assist with clearing of chronic sinus  and ear infections

techniques to promote the healthy functioning of the internal organs through stimulation of their lymphatic flow

techniques for releasing scar tissue adhesions and fibrosis

techniques for assisting the body in one of it’s amazing functions: the rerouting of lymph after surgery or other trauma in which the original flow has been disrupted

Fibromyalgia patients may benefit from massage therapy because it enhances immunological and neuro-endocrine function: for example, decreasing cortisol and norepinephrine levels and increasing serotonin levels and natural killer cell activity.  The low serotonin  levels in fibromyalgia patients have been related to their nonrestorative sleep, mood alteration, and increased pain sensitivity.  In at least one study, massage therapy increased serotonin levels (Ironson et al 1996) and in another, sleep patterns improved (Field et al 1992).  Although these data are suggestive, they are based on studies with other disease groups.

Visit the Touch Research Institute website for more information on the Institute and massage therapy studies done with various populations, including abstracts.  www.miami.edu/touch-research/

Excerpted from the book TOUCH THERAPY, Tiffany Field, PhD., Churchill Livingstone, 2000, pp.68-73.

Many people still depend on massage for relaxation (22 percent); however, the trend (30 percent) is to use massage therapy  for “medical purposes such as injury recovery, pain reduction, headache control, and for their overall health and wellness.”

source: Massage Therapy Journal  winter, 2007