Treating muscles, fascia and myofascial trigger points

7 Treating muscles, fascia and myofascial trigger points


Myofascial pain is defined as pain arising from muscles or related fascia and comes from hyperirritable areas of muscle, ligaments and fascia known as myofascial trigger points (Bennett 2007). There are approximately 400 muscles forming the largest organ in the body amounting to approximately 40% of the body weight and there is no single medical specialty that is solely responsible for the study of their diagnosis and function. Myofascial trigger points have been associated with low back pain, neck pain, tension headaches, temporomandibular joint pain, forearm and hand pain and pelvic and urogenital pain syndromes in 44 million Americans and so a clinical practitioner in any specialty is likely to see patients with myofascial pain caused by trigger points (Borg-Stein 2006, Simons 1983, Fernandez-de-las-Penas 2006, 2007, Ardic 2006, Hwang 2005, Dogweiler-Wiygul 2004).


The first challenge for the practitioner is to recognize that myofascial trigger points may be causing the patient’s pain; the second challenge is to locate, effectively treat and eliminate myofascial trigger points as pain generators; the third challenge is to eliminate the factors in the patient’s biomechanics, physiology and lifestyle that perpetuate the myofascial dysfunction. Myofascial pain caused by trigger points must also be distinguished from the full body pain, central sensitization, sleep disturbances and neuroendocrine dysfunction characteristic of fibromyalgia.




Characteristics of myofascial trigger points


Active myofascial trigger points cause pain at rest, restrict muscle range of motion and have characteristic myotomal pain referral patterns that do not follow dermatomal nerve root patterns or scleratomal patterns emanating from joint structures. The original referral patterns were identified in the 1930s by injecting hypertonic saline into muscles (Kelgren 1938) and pain patterns for over 100 muscles have been documented in detail in the two-volume text, Myofascial pain and dysfunction: the trigger point manual (Travell 1983, 1992). Myofascial trigger points are found by gentle palpation across the direction of the muscle fiber to identify an indurated taut band of muscle and then specific palpation within the taut band to locate a painful nodule that feels like a hardened grain of rice or lentil. Firm pressure on the small nodule may cause the muscle to twitch and may recreate the patient’s pain complaint in the myotomal referral area. Latent myofascial trigger points have taut bands that are tender to touch and restrict range of motion but do not cause spontaneous referred pain.



Calcium release


Myofascial trigger points are thought to arise from focal injury to muscle fibers caused by trauma or overuse. Biopsies of myofascial trigger points reveal a cluster of numerous microscopic foci of sarcomere “contraction knots” that are scattered throughout the tender nodule (Simons 2001, Gerwin 2004). These contraction knots are thought to be caused by calcium release from the sarcoplasmic reticulum and are maintained by an “energy crisis” in the now hypermetabolic muscle once the constant contraction is initiated. Muscle contraction requires the energy of four ATP; muscle relaxation requires two ATP (Adenosine triphosphate, ATP, is the chemical energy that fuels all physical processes; Guyton 1996). Once facilitated, the motor endplates release increased amounts of acetylcholine to maintain the contraction, perpetuating the contraction knots and forming a self perpetuating cycle of activation, energy depletion and local metabolic stress (Mense 2003). Calcium release from the sarcoplasmic reticulum becomes relevant for FSM treatment of trigger points because the frequency thought to “remove calcium ions” is one that softens the taut band and usually eliminates the trigger points.



Nerve sensitization


Persistence of the trigger point leads to neuroplastic changes at the level of the dorsal horn in the spinal cord, leading to central pain sensitization and expansion of the pain beyond its original boundaries into the referred pain area (Arendt-Nielsen 2003). The central neuroplastic changes account for the characteristic trigger point referral patterns. Neuropathic pain sensitization at the level of the nerve root and the spinal cord accounts for the pain intensity seen during stimulation of the trigger point that often appears disproportionate to the stimulus (Curatolo 2006). The twitch response that occurs when the muscle is stimulated is a spinal reflex that can be abolished by transection of the spinal nerve that innervates the trigger point (Hong 1994, 1996).


The local biochemical milieu in an active trigger point is different from that of normal muscle fibers or latent trigger points. A microdialysis needle was used to take constant stream samples of the biochemical environment within an active trigger point before, during and after a twitch response and compared it to normal muscle and latent trigger points. Active trigger points show significantly elevated levels of the inflammatory peptides TNF-α, Interleukin-1(IL-1), calcitonin-gene-related-peptide (CGRP), substance P, bradykinin, serotonin, and norepinephrine (Shah 2005). Early biopsies of trigger points showed mast cells degranulating releasing histamine into the area around the trigger point (Simons 1983). The neural component of trigger point pain and perpetuation is relevant to FSM treatment because the most effective treatment protocols have evolved to include treating “inflammation in the nerve and the spinal cord” first with the FSM treatment protocols known to reduce inflammatory cytokines (McMakin 2005).



Treating myofascial trigger points


There is no form of drug therapy that alleviates myofascial trigger point pain or muscle dysfunction. Trigger point injections with saline and 1% lidocaine or procaine or dry needling are considered to be the most effective therapy but require a skilled well trained therapist to precisely localize the active trigger point by identifying a local twitch response in the taut band. Studies have shown problems with localizing the taut band and the active trigger point (inter-rater reliability) between therapists depending on their skill and training (Gerwin 1997, Hsieh 2000, Sciotti 2001). Needling or injection of single active trigger points limits effectiveness in muscular areas populated by multiple active, latent and satellite trigger points. Full length stretching of the muscle while using an ethyl chloride vapocoolant spray, called “spray and stretch”, disrupts the focal contractions and stops the prolonged ATP consumption that perpetuates the contraction knots. Not all muscles are suitable for this intervention and environmental considerations have reduced its use in recent years. Postural and ergonomic corrections to modify factors that perpetuate trigger points are critical to successful management.



Diagnosing myofascial pain


Any patient who presents with a chronic pain complaint should have a focused neuromuscular evaluation that includes evaluation of reflexes and sensation and a palpatory evaluation to check for taut bands and myofascial trigger points. There are wall charts and diagrams in text books that illustrate the referred pain patterns for specific muscles (Travell 1983, 1992, Niel-Asher 2008). The diagrams give guidance as to what muscles are likely to be a source of the referred pain in a given area. The practitioner should match the patient’s area of complaint with the pain patterns in the diagram and then check the muscles that refer pain to that area. Palpation of a taut band and the small painful nodule that is the trigger point, pressure on the nodule that reproduces the patient’s pain and restricted range of motion due to muscle tightness are all diagnostic of an active myofascial trigger point.


image

Figure 7.1 • Myofascial trigger points refer pain to sites distant from the source of the pain in distinct patterns that do not follow dermatomal or scleratomal referral patterns. Pain in the arm, shoulder or hand may originate with a trigger point found in the anterior scalenes. The trigger points in the scalenes may in turn be a result of a disc injury or overuse caused by poor posture.



History of causation consistent with myofascial trigger points


The patient should have some history of overuse or trauma that would account for the formation of a myofascial pain problem. Chronic postural strain, repetitive muscle use, degenerative joint and disc disease, acute disc injuries, food allergies and other inflammatory conditions and emotional stress are among the conditions that contribute to trigger points. Look for some temporal association with activities or events and the onset of pain. If the pain started around June of 1999, ask what was happening in May of 1999.



Physical examination


Physical examination should include deep tendon reflexes, a dermatomal sensory examination and palpation of the muscles suspected to be the source of the pain. The presence of dermatomal hyperesthesia or numbness, or hyper or hypoactive reflexes suggests neuropathic involvement that may influence treatment.


Myofascial palpation should be guided by the patient’s pain diagram and description. If the patient locates the pain at the “shoulder” the 12 muscles that can refer pain to the shoulder should be evaluated for the presence of taut bands and active and latent trigger points. Sustained pressure on the trigger point may reproduce the patient’s pain but a trigger point that is already maximally referring may not increase its referral in response to pressure. Detailed descriptions and advice on how to conduct a myofascial palpatory examination are beyond the scope of this text but the reader is encouraged to pursue training in this skill.


The discs and facet joints should be considered and examined because myofascial trigger points can be created by and perpetuated by degenerative joint and disc disease and can in turn exacerbate degenerative joint disease when the taut muscle compresses the spinal segment.


Myofascial trigger points can create abnormal biomechanics in the peripheral joints – the shoulder, the elbow, the hip, the knee and even in the wrist and ankle when taut bands interfere with optimal joint motion. Conversely, inflammation in the peripheral joints, tendons and bursa can create muscle guarding and tightness that leads to taut bands and active trigger points. The dysfunction forms a feed forward and feedback cycle that perpetuates both the joint inflammation and the myofascial trigger points.


A visceral examination or abdominal palpation may be necessary if the patient has myofascial trigger points created by gastrointestinal or gynecological organ referral.



Treating myofascial trigger points with FSM


FSM was first used to successfully treat myofascial trigger points in 1996 and the first two articles published were collected case reports showing successful pain resolution in trigger points in the head, neck and face pain and in low back pain (McMakin 1998, 2004). FSM provides microamperage current known to increase ATP production by 500% in rat skin (Cheng 1982). The current alone would address the energy crisis that perpetuates the contracture knots allowing the knots to release by increasing ATP.


The frequencies used to “reduce inflammation in the nerve” have been shown to decrease inflammatory cytokines including IL-1, CGRP, substance P and serotonin – demonstrated by Shah to be increased in the active trigger point milieu (McMakin 2005, Shah 2005). FSM has been shown to down regulate spinal cord activation and reduce central sensitization in the treatment of fibromyalgia associated with spine trauma and could reasonably be assumed to perform the same function to reverse the central neuroplastic changes seen in myofascial pain. The observed effects of muscle softening, relaxation of the taut band and resolution of the trigger point occur as a response to specific frequencies meant to reduce inflammation in the nerve and reduce calcium ion deposits in the fascia. It is reassuring that these frequencies coincide with the pathologies now known to be associated with myofascial trigger points.


When FSM is used to treat myofascial trigger points the positive pair of electrodes are applied at the spine where the relevant nerve root exits and the other pair is applied at the end of the dermatomal nerve supplying the muscles being treated. The current flows through a regional area of biomechanically and neurologically related muscle tissue. The treatment does not require precise localization of the taut band or active trigger point which eliminates the reliability problems that have plagued dry needling and injection trigger point treatment methods and allows successful treatment by less skillful clinical assistants. The treatment can be applied to any muscle or muscle group and has no known negative environmental impact which gives it a distinct advantage over vapocoolant spray and stretch technique. When the dysfunctional muscle is treated at the same time as its related agonist and antagonist muscles in a functional region it provides biomechanical balance that enhances recovery and return to function.


The treatment is pain free, low risk and non-invasive and produces rapid reduction in pain giving it a distinct advantage over other methods in the treatment of myofascial trigger points.



Treating chronic myofascial pain and trigger points


Treatment of myofascial pain and trigger points has been developed over 12 years of clinical experience and literally tens of thousands of patient treatments. The protocols have become so predictably effective that the response to treatment can be used diagnostically.


The myofascial protocol has three parts. It starts with the frequencies to treat the nerve then moves to the frequencies to treat the muscle and then to the frequencies to treat the facet joint, the disc or the peripheral joints that might be instigating or perpetuating factors. This treatment is so consistently effective that if it does not eliminate the taut band and reduce the pain then some visceral source for the trigger points should be considered.



image Hydration




• The patient must be hydrated to benefit from microcurrent treatment.


• Hydrated means 1 to 2 quarts of water consumed in the 2 to 4 hours preceding treatment


• Athletes and patients with more muscle mass seem to need more water than the average patient.


• The elderly tend to be chronically dehydrated and may need to hydrate for several days prior to treatment in addition to the water consumed on the day of treatment


• DO NOT accept the statement, “I drink lots of water”


• ASK “How much water, and in what form, did you drink today before you came in?”


• Coffee, caffeinated tea, carbonated cola beverages do not count as water.


• Water may be flavored with juice or decaffeinated tea.




Channel A: condition frequencies


The frequencies listed are thought to remove or neutralize the condition for which they are listed except for 81, 49 / which are thought to increase secretions and vitality respectively. They are listed alphabetically and not in order of use or importance.



























• Calcium, induration

 91 /


• Chronic inflammation

 284 /


• Inflammation

 40 /


• Scarring

 13 /


• Sclerosis

 3 /


• Support Secretions:

 81 /


• Restore vitality

 49 /


Channel B: tissue frequencies



Neuropathic component




• Nerve: ___ / 396


image Dermatomal nerve roots become inflamed and sensitized from constant input by the contracting myofascial tissue or from a nearby disc injury. The disc nucleus contains very concentrated levels of the inflammatory substance phospholipase A2 (PLA2). When the annulus is damaged by trauma or postural strain it allows diffusion of small amounts of PLA2 to the nerve. This concentration is sufficient to cause nerve inflammation and muscle hypertonicity but insufficient to cause a classic dermatomal neuropathy.

• Spinal Cord: ___ / 10


image The spinal cord becomes sensitized and facilitated by the constant neural input from the muscle and nerve.


Myofascial component




• Fascia: ___ /142


image The fascia is the thin connective tissue covering surrounding the muscles and all soft tissues. The fascia becomes inflamed, calcified and fibrosed during the degenerative process.

• Artery and Elastic Tissue in the Muscle Belly: __ /62


image 62 is the frequency used for the artery and the elastic tissue in the arterial walls. The muscle belly responds to this frequency either because it is full of small arteries or because the elastic tissue in the muscle belly is somehow related to the artery wall.

• Nerve: ___ / 396


image Fine neural fibers travel between layers of fascia in a fascia–nerve–fascia sandwich to innervate the muscles. Constant contractures and local metabolic dysfunction create inflammation at the site of the trigger point. Inflammation leads to calcium influx and fibrosis. Fibrosis between the nerve and fascia restricts movement, creates neuropathic pain and muscle activation when the nerve is stretched as the fascia moves. Calcium ions flow into the nerve when it is inflamed and change the firing threshold.

• Connective tissue: ___ / 77


image This frequency appears to influence the connective tissue that creates the matrix for the muscles and fascia.

• Tendons:___ / 191


image The tendons attach the muscles and fascia to the joint capsule and periosteum.


Joint component – facet joints, discs, and peripheral joints




• Periosteum: ___ / 783


image The periosteum lines the outside of the bone, interweaves with tendinous and ligamentous attachments and is very pain sensitive. Inflammation and calcification in the periosteum are the most common chronic pain generators in facet and peripheral joint pain.

• Joint Capsule: ___ / 480


image The joint capsule attaches to the periosteum, surrounds the joint and becomes fibrosed, calcified, scarred and inflamed when damaged by trauma or chronic mechanical stress.

• Cartilage: ___ / 157


image Cartilage lines the facet and peripheral joint surface and becomes damaged, degenerated, calcified and inflamed when traumatized by acute or chronic compression of the joint surface (see Chapter 6: Treating Facet Joint Pain).

• Disc Annulus: ___ / 710


image The disc annulus wraps around and contains the nucleus and is very well innervated and pain sensitive. It is the most common pain generator in chronic discogenic pain and in mild acute disc injuries that would create myofascial trigger points (see Chapter 4: Treating Discogenic Pain).

• Disc as a whole: ___ / 630


• This frequency is thought to address the disc as a whole.

• Disc Nucleus: ___ / 330


image The gel like disc nucleus fills the center of the disc and absorbs water to become a cushion for the vertebral bodies in the spine. It is very high in PLA2 and very inflammatory.

• Bursa or tendon sheath: ___ / 195


image The major tendons in the peripheral joints are cushioned by bursas that lie between the tendons and between the tendons and the periosteum. Bursas become inflamed and calcified by overuse and repetitive stresses.

• A/B pairs for Scar Tissue:


image 58 / 00

image 58 / 01

image 58 / 02

image 58 / 32

These frequencies were discovered in a list of frequencies published by Albert Abram’s in Electromedical Digest in 1931. 58 / 00 was the frequency combination to remove “abnormal cellular stroma”, probably meant to address the tendency of the cell to form scar tissue. 58 / 01 was used for scar in bony tissue. 58 / 02 was used for scar in soft tissue and 58 / 32 was used for scar tissue adhesions. When there is no bone involved 58 / 01 is not used. These are A/B pairs in which channel A is not a condition and channel B is not a tissue but both frequencies form a frequency pattern that appears to eliminate or lengthen scar tissue.


In treating chronic complaints the 58/’s are used in order as listed above for approximately 1 to 2 minutes each at the beginning of the treatment to soften the tissues. If there is no bone involved in the complaint it is customary to leave out 58 / 01. For those practitioners who can feel the softening produced by the frequency, it is often helpful to run the frequency until the softening stops and the tissue becomes relatively more firm. There may be some patients in whom one or more of these frequencies will produce softening for up to 3 to 4 minutes.


The 58/’s will increase range of motion but do not change pain.



image




Caution: 58 / 00, 01, 02, 32



• Do not use these frequencies on injuries newer than 5 to 6 weeks old.


• Newly injured tissue must form scar tissue in order to repair itself.


• Removing the scar tissue seems to undo the healing by weeks in a new injury.


• The 58/’s can be used very briefly (15 seconds) to modify scar tissue as it is forming after the first four weeks.


• Never use this combination before the injury is 4 weeks old


This precaution is the result of trial and uncomfortable error. A patient was being treated for facet joint and soft tissue injuries caused by an auto accident that had occurred 3 weeks previously. She was pain free after four treatments in 21 days and was treated on a Tuesday. She returned on Thursday complaining that whatever had been done on Tuesday had “undone” 2 weeks worth of healing and she felt as much pain as she had 2 weeks previously. Review of the Tuesday treatment notes revealed that the 58/’s had been used in addition to the protocols that had been reducing the pain for the preceding three weeks. She was so much improved that it seemed as if the injury was much older and the date of injury was not checked before treatment. When the symptoms increased the presumption was made that the 58/’s had removed repair tissue necessary to keep the joint and soft tissues pain free and stable. Treatment with frequencies to reduce inflammation and increase collagen eliminated her pain and she recovered as expected. The 58/’s were used again 4 weeks later to increase range of motion and there was no increase in pain.


Trial and error during the first year of treating with FSM in similar situations helped to determine that the 58/’s should not be used within 5 to 6 weeks of a new injury. They can be used briefly four weeks after the date of injury – for 5 to 10 seconds each – to thin out scar tissue as it is forming, especially in athletes who seem to heal faster than non-athlete patients. This reaction is predictable and reproducible. Take this precaution seriously.



image Treating myofascial pain and trigger points


Treat the nerve – Treat the muscle – Treat the joint



Treat the nerve



Nerve protocol




40 / 396



• Reduce Inflammation in the nerve.


• Polarize current positive +.


• Treatment time: 5 minutes or as long as positive response occurs.


• The protocol to reduce inflammation in the nerve usually begins softening the muscles between the two contacts within one minute. At the end of 5 minutes the softening should have maximized and achieved whatever reduction in neural inflammation or sensitization that can be accomplished.



40 / 10



• Reduce inflammation in the spinal cord.


• Polarize current positive +.


• Treatment time: 2 minutes or as long as positive response occurs.


• The protocol to reduce inflammation in the cord is especially helpful in treating muscles in the cervical spine and shoulder that are especially tight bilaterally and seems to address spinal cord sensitization and upregulation. If this frequency combination is going to produce additional softening of the muscles it will do so within the first 2 to 3 minutes. If no change in muscle tone or texture becomes apparent in that time, change frequency to the next in the protocol. If the muscle softens in response to this frequency, the frequency combination can be used until no further softening is perceived which may take up to 5 to 10 minutes depending on the patient.


• Predicted Response: The frequencies for inflammation in the nerve and cord cause muscle relaxation in more than 80% of patients treated. As this response begins, use the manual techniques described below and wait for the tissue to stop softening before changing to the muscle protocol.



image Stenosis precaution


If there is dense scar tissue or bony stenosis of the nerve root or spinal cord or if a disc fragment is compressing the nerve root or cord at the involved level the patient’s pain may increase when polarized positive current is applied. It is the only time the pain will increase during polarized positive treatment for nerve inflammation. It may increase in the dermatome or at the spine or both.


Stop treating immediately if pain goes up during treatment. Move the patient to a seated position if possible. Move the contacts slightly up the spine superior to the nerve root being treated, reduce current levels and change the current from polarized positive to alternating. If this is going to reduce the reaction it will do so in 5 to 10 minutes. If the pain continues to increase, stop treating with current. The pain should go back down in a few hours although it may take up to 24 hours to reduce to base line.


This reaction is diagnostic. If physical examination findings of reduced sensation and deep tendon reflexes at the involved level or hyperactive deep tendon reflexes below the involved level are present this reaction suggests the need to x-ray or perform an MRI to confirm the presence of compression.



Treatment application



Lead placement: manual therapy




• The positive leads from channel A and channel B are placed in one glove.


• The negative leads from channel A and channel B are placed in the other glove.


• The two gloves will always be on opposite sides of the body part being treated during manual treatment of trigger points and myofascial tissue. The required interferential field forms in the space between the two gloves which should include the tissue being treated. The polarized positive current used with 40 / 396, 10 relaxes the tissue even if the contacts are not set up proximal distal.


• Positive leads: The positive leads are wrapped in or attached to a warm wet contact, such as a hand towel or long graphite electrode that is wrapped around the neck or placed along the spine where the nerve roots exit that innervate the involved muscle group.


• Negative leads: The negative leads are wrapped in or attached to a warm wet fabric contact or long graphite electrode that wraps around the end of the nerve root at the distal end of the muscle group to be treated.


Adhesive Electrode Pads may be used for convenience although the gloves seem to be more effective for reasons not understood. The adhesive electrode pads are especially useful for home treatment because they allow the patient to be active while being treated. The pads become “prickly” or sting when current levels are above 150μamps so may not be useful for larger patients or athletes.


When applying treatment with adhesive electrode pads, the current and the frequencies must pass through the area to be treated in an interferential pattern, forming an “X” in three dimensions. The positive electrodes are placed at the spine at the level of the disc to be treated. The negative electrodes may be placed directly anterior or anterior and slightly inferior to the spinal contacts if the disc alone is being treated or if the nerve is to be treated the negative electrodes may be placed at the ends of the nerve root affected by the injured disc.


A diagram for the placement would look like this:












Positive Electrode Channel A Positive Electrode Channel B
Area to be Treated
Negative Electrode Channel B Negative Electrode Channel A

Manual therapy between the contacts: The practitioner’s hands can palpate, mobilize, and manipulate the myofascial tissue as it is treated by the current and frequencies being delivered by the stationary contacts. There should be some interference to prevent current flow through the practitioner. Latex or nitrile gloves can be worn on the hands or even on one hand to block the current or some form of massage oil can be applied lightly on the hands to serve as an insulator. Follow the directions for manual technique covered below.



Current level




• Average patients require 100–300μamps. Use lower current levels, 20–60μamps, for very small or debilitated chronically ill patients. Use higher current levels, 300–500μamps, for larger or very muscular patients. In general, higher current levels reduce pain and create softening more quickly. Do not use more than 500μamps as animal studies suggest that current levels above 500μamps reduce ATP production (Cheng 1982).


• Note: Current levels over 150μamps make it difficult to use the graphite gloves directly on the skin because they dry out quickly and the current becomes uncomfortable easily. It becomes cumbersome and tedious to continually moisten the graphite gloves. If higher current levels are required due to the patient’s size using wet towel contacts is recommended.



Waveslope




• Use a moderate to sharp waveslope with a ramped square wave pulse.


• The waveslope refers to the rate of increase of current in the ramped square wave as it rises from zero up to the treatment current level every 2.5 seconds on the Precision Microcurrent and the automated family of FSM units. Other microcurrent instruments may have slightly different duty cycles and the waveslope may be different but any unit which provides current flow with a square wave pulse should produce the desired effect. A sharp waveslope has a very steep leading edge on the square wave indicating a very sharp increase in current. A gentle waveslope has a very gradual leading edge on the waveform indicating a gradual increase in current.


• Use a moderate to sharp waveslope for chronic pain. Use a gentle waveslope for new injuries. A sharp waveslope is irritating in new injuries.


• Different microcurrent devices may provide different wave shapes and waveslopes but the reader may find them to be equivalent.



Manual technique: let the frequencies and current do the work


For those trained in manual therapies treating the muscles while using FSM requires some adjustment of technique. The key is to let the frequency do the work and to use the hands with gentle but firm pressure and minimal muscle contraction allowing maximal sensitivity to the softening affect created by the frequencies. The hands should lie gently on the skin allowing the pads of the finger tips to glide across the muscle. Ideally the hands will be almost limp with just enough tone in the distal finger muscles to allow the finger pads to gently assess the state of the tissue. This gentle touch allows the muscles being examined to relax and avoids the resistance created by overly aggressive palpation. The therapist may use body weight translated through the shoulder muscles and serratus anterior to advance the arm and increase the pressure of the hand and finger pads rather than use tension in the forearm and finger flexors to increase pressure.


The hands are sensing the change and softening in the muscles being created by the current and frequencies and helping it along but not forcing it. The frequencies will create the desired change of state in the muscle; it is not necessary to use force. The patient’s muscles will relax and allow deeper palpation if the practitioner’s hands are relaxed and will defensively tense if the contact is too firm or if the palpating fingers are too tense.


Move the fingers slightly every two to three seconds across the region, using gentle but firm pressure and a gentle pulling motion as if trying to warm, soften and elongate a piece of nougat or soft taffy. Pressure can be directed both along and across the muscle fiber direction. A gentle kneading motion is sometime effective. Small circular scrubbing motions are less effective and should be avoided especially in the anterior cervical spine near the sensitive baroreceptors and neurovascular structures.



Manual myofascial therapy using graphite gloves




• See Figures 7.2 to 7.9.


image

Figure 7.2 • A latex or nitrile glove is worn under the graphite glove to block current conduction to the practitioner. The graphite conducting gloves are placed on the practitioner’s hands over the insulating glove. Two positive leads are connected to one glove, usually the right. Two negative leads are connected to the other graphite glove. The interferential field where the current and frequencies mix is created between the two gloves.


image

Figure 7.3 • The graphite glove must be moist or wet to conduct current comfortably. The gloves may be sprayed with water at regular intervals during the treatment. Or the practitioner may dip the fingers of the graphite glove into a small plastic dish at regular intervals, usually when a frequency is changed or when the patient complains of a prickling or stinging sensation when the gloves become dry. It is best to avoid the stinging by wetting the gloves at regular intervals before they become dry.


image

Figure 7.4 •

Related posts:

The theoretical foundation for frequency-specific microcurrent Treating concussion, central pain and emotions Treating ligaments and sprain injuries Treating fibromyalgia associated with spine trauma Treating the discs Treating facet joint generated pain

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Jun 14, 2016 | Posted by in PAIN MEDICINE | Comments Off on Treating muscles, fascia and myofascial trigger points

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