The Seven For TRIGGER POINTS
For Arthritis, Fibromyalgia, Lyme Disease, and other painful disorders
First, I do not know of many safe therapies that work as well and for as many people as injections of ten to 15 drops of 50% glucose solution into trigger points (TP) .
Second, TPs are painful, tender points in muscles, ligaments, tendons, and other soft tissues of the body. Such points often fail to heal inspite of repeated massage therapy and manipulation.
Third, TPs develop as local problems in tissues around joints after injury and in chronic conditions, such as arthritis, tendonitis, fasciitis, and others. Such trigger points may occur as single or multiple problems. TPs develop as components of systemic conditions such as fibromyalgia, chronic fatigue syndrome (CFS) which may involve any part of the body.
Fourth, at a fundamental level TPs in systemic disorders are caused by too much oxidation and too little oxygen. Excessive oxidation means tissue injury. Insufficient supply of oxygen interferes with healing. Both factors lead to stagnation of toxic lymph (oxidized tissue fluid).
Fifth, a strong (50%) solution of glucose when injected directly into a TP stimulates a powerful healing response. By contrast, steroid injections suppress the inflammatory (and healing) response. There is no known toxicity of small quantities of 50% glucose solution.
Sixth, when TPs are part of the larger picture of CFS, fibro, Lyme disease, and other chronic conditions, the treatment requires that all the systemic issues, such as battered bowel, blood, and liver ecosystems, be addressed in a systematic and comprehensive way.
Seventh, for excellent results it is essential that the TP be precisely localized. As a young surgeon in England in 1960s, I learned the core importance of deep knowledge of human anatomy. Now I recognize the same for TP injections. Once healed, recurrence of TPs must be prevented by properly designed stretching exercise and slow, sustained, and non-competitive limbic exercise.
How Do Trigger Points Develop?
There are two mechanisms:
- Local injury to tissues causes tearing in the fibers of muscle, tendon, ligaments, and tissue lining the bone called periosteum. Such tears do not heal due to continuing stress and other reasons.
- Systemic toxicity (accumulation of toxins in all tissues) that creates painful tender points in areas of chronic mechanical stress, such as the back of upper neck, shoulders, lower back, knees, legs, and other tissues. Systemic toxicity also causes the formation in the blood of micro-curdles which clog tiny vessels and further impede blood flow and healing.
The injured tissue fails to heal for a variety of reasons. First, the injured tissues are not allowed to rest adequately soon after the injury is sustained. Second, persistent spasm of muscles in close vicinity of TP can compromise the flow of blood to the injured tissue and impair inflammatory and healing responses. Third, persistent muscle spasm continues to traumatize the injured tissues. Fourth, accelerated oxidative stress of associated clinical entities, such as CFS and fibromyalgia, increase the local acidosis of tissue injury and impair healing. Fifth, subliminal injury to injured tissue is another frequent cause of delayed healing.
Too Much Oxidation, Too Little Oxygen
It is important to clearly understand the basic roles of too much oxidation and too little oxygen so that we can fully understand why steroid injections, muscle-relaxing drugs, and painkillers cannot heal TPs. Indeed, such therapies are often counterproductive because such treatments turn easily treatable trigger points into hard-to-treat lesions.
TPs are caused by accumulation in the painful area of stagnant oxidized and toxic tissue fluid. Much oxidation and little oxygen not only cause TPs, but also prevent tissue healing. Oxygen hungry cells produce yet more free radicals which, in turn, increase oxidative stress and further reduce available oxygen. Thus, the cycle feeds upon itself. A natural consequence of too much oxidation and too little oxygen is rapid local build-up of acidity which further interferes with the healing process. Specifically, in tissues involved with TPs, proteins of lymph, cells and matrix (cement substance which holds cells together) solidify, just as milk curdles when a few drops of lime juice is squeezed into it. We should remember all enzymes are proteins, and readily oxidized and denatured. For additional information, I refer advanced and professional readers to an article my colleague, Omar Ali, M.D., and I published in The Journal of Integrative Medicine (1997;1:6-112).
Trigger Points After Injury
Trigger points commonly develop after injury to soft tissues and bones, especially in the neck, shoulder, low back, knees, and ankles. In essence, such traumatic trigger points represent unhealed tears in ligaments, tendons, and periosteum, the strong and dense membrane of tissues which is wrapped around bones. Post-traumatic TPs are generally easy to detect with a careful examination. Chronic inactivity and bad posture often contribute to formation of such points. Thus, regular daily stretching is key to prevention of recurrence.
TPs In Degenerative Arthritis
Degenerative (osteo) arthritis is a painful inflammation of a joint which destroys the cartilage lining of its bony surfaces. That results in bone rubbing against bone, causing yet more pain and muscle spasm.
What injures the internal tissues of a joint will eventually injure tissues external to that joint. Similarly, what stresses the tissues surrounding a joint will eventually stress the tissues inside that joint. That is how painful tender trigger points develop in soft tissues surrounding inflamed joints. That sets up a destructive cycle of more joint inflammation resulting in more trigger points around it, and more trigger points preventing healing of arthritis. It is for that reason that I am always careful not to manage arthritis without diligently searching for and treating TPs in tissues surrounding the joint.
TPs In Fibromyalgia
The number and locations of TPs define fibromyalgia in rheumatology, the specialty concerned with bone, joint, and muscle disorders. Specifically, according to the diagnostic criteria for fibromyalgia established by the American College of Rheumatology, trigger points must be present in at least eleven out of eighteen established sites. I strongly disagree with that definition of TPs because it totally ignores the systemic nature of fibromyalgia with its associated: (1) persistent fatigue; (2) disabling symptoms of mood, memory, and mentation; (3) disruptions of the bowel, blood, and liver ecosystems; (4) digestive-absorptive dysfunctions; (5) sugar-insulin-adrenaline roller coasters; (6) menstrual irregularities and, in many cases, total absence of menstruation; (7) hormonal abnormalities involving the thyroid and adrenals; (8) frequent problems of dry mouth, dry eyes, and dry skin; (9) a host of other symptoms.
TPs In Chronic Fatigue Syndrome
I consider chronic fatigue syndrome (CFS) a twin sister of fibromyalgia. Individuals whose illness begins as fibromyalgia eventually develop full-blown CFS, and those who begin with disabling fatigue eventually show the full picture of fibromyalgia. Thus, my comments made about trigger points in fibromyalgia fully apply to CFS.
TPs In Lyme Arthritis, Rheumatoid Arthritis, And other Types of Immune Arthritis
TPs in immune types of arthritis are caused by the same inflammatory process that effects the joint tissues. However, the two core mechanisms of injury in such trigger points are the same: too much oxidation and too little oxygen. Properly injected TPs in such cases generally heal as well as those in CFS and fibromyalgia. Regrettably I see far too many patients with such TPs are given steroids and other immunosuppressant drugs while the simple technique of TP injection is ignored.
Trigger Points In Neck, Low Back And Sciatica
TPs in the above categories usually occur after injury and become chronic when ignored. Accurate localization in most cases is easily done. Initial response to treatment sometimes is slow.
Doing Away With Tongue-Twisters
We physicians have a passion for tongue-twisting terms. If you are as amused as I am with such diagnostic labels, then here is a feast of names given to TPs in the European and American literature: myofascial trigger points, trigger areas, idiopathic myalgia, traumatic myalgia, rheumatic myalgia, myalgic spots, myositis chronic, rheumatic myositis, nodular fibromyositis, myofascitis, myofibrositis, myodysneuria, interstitial myofibrositis, muscular rheumatism, fibrositis, myalgic rheumatism, occupational myalgia, fibromyalgic trigger points, myalgic patches and my very favorite myleogelosis. Long live our infatuation with tongue-twisters!
About the Author
MAJID ALI, M.D.
President and Professor of Medicine of Capital University of Integrative Medicine
Editor, The Journal of Integrative Medicine
Formerly, Associate Professor of Pathology (adj.),
College of Physicians and Surgeons of Columbia University, New York
Formerly, President of Staff and Chief Pathologist, Holy Name Hospital, Teaneck, NJ
Fellow, Royal College of Surgeons of England
Diplomate, American Board of Anatomic and Clinical Pathology
Diplomate, American Boards of Environmental Medicine
http://www.majidali.com/
