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

problem and encourages him to come to some insight regarding the direction of treatment.
    Palpation is an art and a skill. It requires work, practice, and the constant awareness that you are touching a person , not just a muscle. As most myofascial problems involve sequences of numerous associated muscles, effective examination will generally involve extensive palpation around the area of most acute presentation. In acupuncture, a common assessment principle has the practitioner examine left and right, up and down, and front and back relative to the presenting region. This simply means that if a patient is complaining of pain in the left lumbar region, examination should include the right lumbar region, the upper back and shoulders, the buttocks and legs, and the abdomen. Such wide examination not only renders significant information but also respects the patient as a whole person.
    Learning to touch another person includes awareness that the body will often tense to “guard” itself against invasive touch, particularly in painful areas. Such responses mitigate effective palpation, so the practitioner must learn how to touch, gradually applying pressure and earning the trust of his patients to allow for accurate palpation.
    Regardless of the particular method of treatment employed, skillful palpation is the defining factor differentiating highly successful practitioners from those who obtain erratic results. Regardless of theory, method, or amount of treatment, skillful palpation is without question the singular most important component of treatment.
    Listen closely. First, the patient has direct experience of the problem. His descriptions of what he feels and when and how he feels it are extremely important pieces of data. Second, many patients with chronic pain have suffered the experience of being told that the pain is “in their head” or “isn’t real.” They will often feel they have to convince you of the reality of their experience. Listening and confirming their reality is important in developing the trust necessary for treatment. Educating patients about the nature of myofascial pain syndromes, showing them wall charts of pain patterns, describing postures and movements that can trigger pain patterns as well as what kinds of organic dysfunctions might be associated with such syndromes is important. We have seen patients lose their tension and anxiety as soon as they saw their pattern on a wall chart; many have exclaimed, “I’m not crazy!” This kind of confirmation and education goes a long way in establishing a relationship that leads to effective treatment.
    Additionally, it is important to remember and respect the subjective nature of the experience of pain. What might seem to be a mildly constricted area to your touch can in fact be a source of considerable pain to the patient. As you listen to your patient, hear him and embrace his reality.
    Treat with precision and attention. The following approach to patient care is designed to help to focus in on the problem at hand and its resolution.
Clearly define the areas of pain and restrictions of movement that the patient is experiencing. Have him delineate, and perhaps draw, the areas of the body that feel painful. Have him demonstrate the movements that cause pain. Be certain that you understand, to the best of your ability, what he is experiencing.
Determine the various muscles that might be the source of your patient’s pain and restriction. Utilizing the pain pattern and symptom indices (see pages 229–242) will be useful in this determination.
Palpate for constrictions and taut bands in the individual muscles that you have hypothesized to be the source of the difficulty.
Palpate associated regions for additional constrictions and taut bands. It is important to palpate the entire body, anterior and posterior, to determine associated constrictions. Additionally, awareness of the pathways of meridians and cutaneous