Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando Read Free Book Online Page A

musculoskeletal anatomy, and a state of relaxation that helps maximize information gathering skills. It is through extensive clinical practice that one can evolve a clear sense of the continuum of myofascial states and an understanding of the habits of action that are the source of an enormous percentage of pain syndromes.
    It is important to remember that when a patient experiencing pain is touched by a practitioner in the “right” places, a level of trust develops immediately, alleviating a great deal of the patient’s fears and tension. This alone provides enormous therapeutic benefit. It begins with understanding hands, with informed touch.

CHAPTER 4
    D IAGNOSIS AND T REATMENT
    I t is assumed that the reader of this book has some experience in working with myofascial pain. However, a few basic ideas, perhaps known in some disciplines but not in others, may serve as common ground in delineating a broad protocol for the diagnosis and treatment of myofascial disorders.
    Spend some time looking at the patient. Observe how he or she walks, stands, sits, breathes, holds his hands, crosses his legs, reads intake forms, rubs his neck, carries a purse, backpack, or briefcase. These and myriad other behaviors provide clues regarding the nature of his condition. While some patients will have difficulty identifying the sites or patterns of their pain, the observant clinician can learn a great deal by paying close attention to this person who has come for help. It is rare that muscular constrictions and trigger points exist in an isolated, single muscle. Careful attention can reveal a great deal about the unique and often complex pattern presented by each patient. Watching how the patient rises from a chair, gets on or off a treatment table, removes a coat, or wears out his shoes can provide valuable information leading to the effective treatment of his complaint. As in many medical therapies the clinician must be part detective, developing an ability to pick up on these clues, since they can be as important as any diagnostic testing procedure.
    We had the privilege of watching Dr. Janet Travell treat a number of patients. She began formulating her treatment the moment she saw the patient enter the room. She took note of the person’s shape, size, asymmetries, gait, posture, and the many ways he was holding himself, particularly when in pain. When the patient pointed out his problem, Dr. Travell was already aware of the muscular patterns involved—the history expanded the data she had already collected through observation. Before Dr. Travell touched the patient she knew a great deal about him; in fact, after fifty years of clinical experience she was so integrated in her awareness that she often saw the problem in seconds.
    Dr. Travell trained herself as a better clinician with each patient she treated, which left us with another tenet for good practice: Do not assume that you know anything. Be it through palpation or questioning, in every treatment with every patient always seek more information about the problem (and the person) at hand.
    Evolve palpation skills. Through touch the patient discovers much about the nature of the practitioner. That first touch tells the patient whether you are gentle or rough, respectful or invasive, careful or careless, and most importantly, if you know what you are doing. It is a good idea to first palpate the area where the patient is complaining of pain, since it demonstrates, in a matter of seconds, that you understand that he or she has pain and that the pain is there, where you are palpating. So often patients will exclaim, “That’s it,” and with those two words they have begun to accept and trust you as a practitioner. As the practitioner explores related areas the patient will often remember pains or injuries that were not mentioned in his medical history. It is as if the palpation examination opens new doors in the patient’s understanding of his own