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Hi Ian, i have not encountered any problems so far. As far as i am aware, i am covered by my podiatry insurance, which was checked when i completed the course 2.5 yrs ago. The course i took is a recognised course by the society of Chiropodists and Podiatrist, and as long as i don't go above waist level, I am insured. The trust i work for, have accepted this and we have a protocol for podiatrists having done the course, to practice in the Trust. It is becoming more and more popular.
I have been using low level laser on myofascial trigger points for some years with great success. The most astonishing success was on my son who suffered from disabling "groin strain" following soccer injuries in his mid teens.
Locating and lasering the trigger points in his adductor longus gave almost immediate cure.
You wrote in regards to Jones strain Counter strain " Further training in strain counter strain can be arranged via me!" Where abouts are you based? Do you run a course? I have recently used this technique on 5 pts with 1st PMA pain (2 of whom had sesamoiditis confirmed via xrays) and have so far had a 100% success rate. As such, Im pretty keen to learn more about it.
Two studies appearing in Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs. However, the feedback loop suggested in this hypothesis has a few weak links, and studies by Shah and colleagues in particular supply a solid link for one of them. The feedback loop connects the hypothesized energy crisis with the milieu changes responsible for noxious stimulation of local nociceptors that causes the local and referred pain of MTPs. Shah’s reports quantify the presence of not just 1 noxious stimulant but 11 of them with outstanding concentrations of immune system histochemicals. The results also strongly place a solid histochemical base under the important clinical distinction between active and latent MTPs. The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment, and it images stress produced by adjacent tissues with different degrees of tension. This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues.
Objective
To explore the feasibility of using a new magnetic resonance imaging (MRI) technique—magnetic resonance elastography (MRE)—to identify and quantitate the nature of myofascial taut bands.
Design
This investigation consisted of 3 steps. The first involved proof of concept on gel phantoms, the second involved numeric modeling, and the third involved a pilot trial on 2 subjects. Imaging was performed with a 1.5T MRI machine. Shear waves were produced with a custom-developed acoustically driven pneumatic transducer with gradient-echo image collection gated to the transducer’s motion. Shear wave propagation were imaged by MRE.
Setting
An MRI research laboratory.
Participants
Two women, one with a 3-year history of myofascial pain and the other serving as the control.
Interventions
Not applicable.
Main Outcome Measures
MRE images, finite element analysis calculations, and tissue and phantom stiffness determinations.
Results
Results of the phantom measurements, finite element calculations, and study patients were all consistent with the concept that taut bands are detectable and quantifiable with MRE imaging. The findings in the subjects suggest that the stiffness of the taut bands (9.0±0.9KPa) in patients with myofascial pain may be 50% greater than that of the surrounding muscle tissue.
Conclusions
Our findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination.
Objectives
To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.
Design
We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.
Setting
A biomedical research facility.
Participants
Nine healthy volunteer subjects.
Interventions
Not applicable.
Main Outcome Measures
Preselected analyte concentrations.
Results
Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).
Conclusions
We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.
Hiya has anyone done any research or compiled any case studies in using trigger points (ATAs) or with acupuncture that I can use (and cite)? I am a second year Podiatric research student and would welcome any feedback as evidence for podiatry using acupuncture or trigger points as an adjunt to podiatry treatment is non-existant. There is plenty of acupuncture research per se but not actual podiatric ones..
A friend of mine did a study for her degree comparing the results of acupuncture for treating PF with acupuncture and orthoses combined in the treatment of PF. If this is what you are looking for then I can ask her if I can give you her email.
You could try Anthony Campbell to see if any Pods who have studied with him have given him research data. Whilst I use the modality I have not done a study on it.
Dear Ian
Just a note to your enquiry about Trigger Points.
I am an osteopath with a special interest in Foot Conditions.
I have had much success with treating a variety of Foot syndromes using my Foot Mobilisation Techniques with Myofascial Trigger Point treatment.
For instance trigger points in a muscle may be the cause of weakness in the muscle.
I have found that Podiatrists are very interested in my courses.
Yours
BJ
The Following User Says Thank You to JosephFootMobilisation For This Useful Post:
Hi Ian
Paul Turner is giving a talk on ‘Musculo Skeletal Trigger Points’ at Bucks Branch Meeting of SCP at Duke of Edinburgh Hall, Stoke Mandaville Hosp Aylesbury (directions on web site www.buckspodiatry.org) on 20th June 2010 7.30 pm, SCP members welcome for joining fee of £5.00 for year, others welcome at an extra charge.
A friend of mine did a study for her degree comparing the results of acupuncture for treating PF with acupuncture and orthoses combined in the treatment of PF. If this is what you are looking for then I can ask her if I can give you her email.
You could try Anthony Campbell to see if any Pods who have studied with him have given him research data. Whilst I use the modality I have not done a study on it.
Cheers
Ian
Ian I would be interested also as just starting to work with an accupuncturist on this very problem.
Trigger point therapy is often taught in Massage Therapy courses, you may be able to do further training through one of these courses. I recently read the text by Trvell & Simons - there is one book specifically for the lower limbs, absolutely brilliant. (Mind you, I found it varied in price from $250 - $500 AUD, but available from Amazon books in USA for $100 AUD)
I found this technique very useful in my massage therapy treatments, think it is an underrated but effective tool we should be using!!
HI There
I use trigger point therapy with good results, it is important to use a good technique as just finger pressure can, over time cause you problems in your joints. If you want to know more plesase try The Trigger Point Therapy Workbook by Clair Davies, he has studied Travell and Simon's work and simplified it. He covers the whole body and gives techniques for practitioner and for the patient to self treat.
I keep trying to promote this book, I am not on commission not am also qualified in Remedial Massage Therapy and wish it had been around when I was in practice. Dry needling is the obvious way to go, not traumatic to the operator.
(Even though Chiropodists and Podiatrists may be covered by their insurance check out with your local authority if the premises have to be registered for acupuncture)
Dear Itchyfeet
I agree that Clair Davies book is an excellent introduction to Myofascial Trigger points, I recommend it all the time we have ordered it for our libaray at the British College of Osteopathic Medicine in London.
Also on the Foot Mobilisation course, I taught,they gave the Pods who had attended all 4 courses,copies of this book on my recommendation.
I do agree that you have to be careful with your hands as they have to manipulate knives? You can use various implements such as Grostic etc.
Nice to see a kindred spirit.
Brian
Dear Itchyfeet
Re your hands I just remembered there is a company; Pressure Positive that has an excellent range of articles to use for MTrPs.
They have a web site. Let me know if you think it is useful please.
Brian
Thanks for the website - here in the UK you can get allsorts of different tools for deeper tissue massage; I no longer treat other folk but do self treat my own trigger points (we all have them) and I find the simplest and most portable for those hard to reach areas is the small, firm ball in a sock. Throw it over the shoulder and lean on the wall - heaven.
Dear Itchyfeet
Thank you for your reply. I am glad you use self help treatment I am sure you heard how Janet Travell stated on her long and epic journey to her superb work on Myofascial Trigger Points by curing her own shoulder.
I wonder why with your obvious skills you do not use these techniques any more on your patients?
All the best
Brian
I no longer practice Rem. Mass. and do not have the time to do more myself. I try to teach people the techniques themselves but I find most want the immediate fix it;( that's why dry needling is the way to go) or they are caught up with GP or Physio. I stop banging my head on brick walls much sooner these days.
RE: Strain Counter Strain / Jones Technique
This is what I use when I receive a podiatrist referral for chronic cases with a more updated version called Structural Relief Therapy. l also treat the trigger points in the muscles with a 1 inch sphere magnet. I role it into the trigger point,preferably from the proximal side, until it creates discomfort then role it away repeating until feed back loop is cleared.
Counter strain is the best response when tender points are at ligament and tendon attachments. Find the position where the tender point is most diminished and hold for 90 seconds.
The podiatrist sends clients with the admonition "He is going to tell you the pain at the base of your big toe is coming from the base of your neck but make sure he treats the toe also." I do in fact I have found a positioning using a body ball where I can position both at the same time for optimum results.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist
insurance
Linear Mode
