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  1. muddy is offline

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    Posted On:
    7/15/2009 1:26pm


     Style: boxing

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    Myofascial Pain Syndrome

    I've had a on/off back problem for 20+ years (think I discussed it on this board even some time ago). The "strap" just to the left of my right shoulder blade tightens up and I get a really stiff neck. No doctor has really ever been able to help though I get a certain amount of relief from massage, accupuncture, and stretching.

    Lately it has gotten worse and Im getting significantly weaker in my right arm.

    I was asking around for nuerologist when a friend recommended a particular sport medicine doctor that had helped her with an injury when no one else could.

    I went for an office visit yesterday. She had an xray done to rule out spine problems, then pressed on three points on the right side of my shoulder blase (away from the knotted problem area) that caused pain to shoot from the knotted area to over my deltoid. She told me I had Sindrome miofascial doloroso del musculo infraespinoso ... which I translated via internet to be Myofacsial Pain Syndrome of the Infraspinatus Muscle. She showed me a picture in a medical text that had the three points marked and my exact area of pain highlighted on a drawing of a person's back. This gave me some confidence in her diagnosis (I was skeptical at first when she started talking about trigger points) ... but this is the first Ive really heard of any of this.

    She says she can cure it with a series of therapy which is basicially injecting anesthesia (something-caine I think) into the three trigger points she identified (at least thats what I understood) along with some exercises and stretching.

    I did some reading on MPS on the internet and found a lot of conflicting information. I was wondering if anyone here had any personal experience/advice related to MPS or Trigger Point Therapy.

    Thanks in advance for any input.

    Edit: This link looks a lot like the book the doc showed me. I might even be identical, except of course its in English and my docs book was in Spanish. Anyway it shows the trigger points and referred pain I was talking about (scroll down in linked page below to see diagrams). http://books.google.com/books?id=sU0...esult&resnum=1
    Last edited by muddy; 7/15/2009 1:48pm at .
  2. socratic is offline

    How do elenchus?

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    Posted On:
    7/15/2009 9:03pm


     Style: gah, transition again

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    Trigger-point injections with something like cortisone [an anti-inflamatory/anaesthetic] will probably help, just like it says on the tin. I know people who've gone in for similar treatments with mixed results. The point being after she's jabbed you [it'll fucking hurt, fyi] don't forget to do whatever the hell program she prescribes you. Fail one part and you'll be back to square one.
    Lord Krishna said: I am terrible time the destroyer of all beings in all worlds, engaged to destroy all beings in this world; Of those heroic soldiers presently situated in the opposing army, even without you none will be spared.
    Bhagavad Gita 11:32
  3. muddy is offline

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    Posted On:
    7/16/2009 7:47am


     Style: boxing

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    Thanks for the reply.

    I went in yesterday evening for the shots. She is going to repeat every Wednesday (probably 4 more times). Every Friday I go in for an electric stimulation therapy session where, if I understood it right, she will stick a needle into the trigger points and send a small electric current. There is one stretch and one isometric I have to do three times a day.

    The stretch is 10 reps for a slow exhale each and looks like the 2nd picture on the 2nd row here:
    http://www.fenixstopspain.com/stretching_guide.html

    The isometric is 5-8 reps for a slow exhale each and looks like the "Test 1" picture here (except I use a door frame instead of another person):
    http://www.massagetherapy.com/articl...tus-Tendinitis

    No gym or boxing for 4-5 weeks. Only running. I plan on complying at least for now ...

    I'm also sleeping on a heated pad (on my own - she didnt mention heat).

    The only advice of hers I am not following is a medication she wanted me to take (Lyrica). I read about it fairly extensive and decided I didnt want to take it. Comments on this appreciated, btw. She seemed a bit dissapointed with that but is pressing on with the rest of the therapy.

    The text she was referring to on my first visit was Travell & Simons' "Myofascial Pain and Dysfunction"

    First Day Results:
    The "strap" (original problem I went in for) is definitely significantly better. It is only tender when I look straight up, and it feels just a bit tight still. But still a big improvement. Now my delts and infraspinatus are sore, but nothing major.
    Last edited by muddy; 7/16/2009 8:28am at .
  4. Akara11 is offline

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    Posted On:
    7/16/2009 2:34pm

    Bullshido Newbie
     Style: MMA-ish stuff

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    Hell yeah! Hell no!
    Quote Originally Posted by muddy View Post
    Thanks for the reply.

    I went in yesterday evening for the shots. She is going to repeat every Wednesday (probably 4 more times). Every Friday I go in for an electric stimulation therapy session where, if I understood it right, she will stick a needle into the trigger points and send a small electric current. There is one stretch and one isometric I have to do three times a day.

    The stretch is 10 reps for a slow exhale each and looks like the 2nd picture on the 2nd row here:
    http://www.fenixstopspain.com/stretching_guide.html

    The isometric is 5-8 reps for a slow exhale each and looks like the "Test 1" picture here (except I use a door frame instead of another person):
    http://www.massagetherapy.com/articl...tus-Tendinitis

    No gym or boxing for 4-5 weeks. Only running. I plan on complying at least for now ...

    I'm also sleeping on a heated pad (on my own - she didnt mention heat).

    The only advice of hers I am not following is a medication she wanted me to take (Lyrica). I read about it fairly extensive and decided I didnt want to take it. Comments on this appreciated, btw. She seemed a bit dissapointed with that but is pressing on with the rest of the therapy.

    The text she was referring to on my first visit was Travell & Simons' "Myofascial Pain and Dysfunction"

    First Day Results:
    The "strap" (original problem I went in for) is definitely significantly better. It is only tender when I look straight up, and it feels just a bit tight still. But still a big improvement. Now my delts and infraspinatus are sore, but nothing major.


    Weeeell, Lyrica is a sodium channel blocker as I recall. Kind of resembles GABA, although like Gabapentin it can't penetrate the blood/brain barrier. It was originally designed for long term neuropathic pain, like diabetic neuropathy or shingles...and as an anti-epileptic. Both Gabapentin and Lyrica have been used for long term chronic pain with a decent amount of success. It's kind of a pop up as to wether or not it'll help you specifically, but it's pretty innocuous and worth a shot, in my not so humble opinion. The side-effects are minimal and long term use isn't a big problem. If the drowsiness is going to be a big factor, you might want to ask your doc to start you on a lower dose and move your way up from there.
  5. muddy is offline

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    Posted On:
    7/16/2009 3:50pm


     Style: boxing

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    Quote Originally Posted by Akara11 View Post
    Weeeell, Lyrica is a sodium channel blocker as I recall. Kind of resembles GABA, although like Gabapentin it can't penetrate the blood/brain barrier. It was originally designed for long term neuropathic pain, like diabetic neuropathy or shingles...and as an anti-epileptic. Both Gabapentin and Lyrica have been used for long term chronic pain with a decent amount of success. It's kind of a pop up as to wether or not it'll help you specifically, but it's pretty innocuous and worth a shot, in my not so humble opinion. The side-effects are minimal and long term use isn't a big problem. If the drowsiness is going to be a big factor, you might want to ask your doc to start you on a lower dose and move your way up from there.
    Thanks for that.

    Most of the reason I didnt take it was because the pain really is not unbearable ... not by a long shot. Its the weakness and lack of range of motion in that arm that bother me the most. I really didnt get the impression that Lyrica addressed anything other than pain. Also, the possible nasty side effects seemed to be a little more probable with Lyrica than with most medicines. Some things listed as "common" side effects in the info that came with the medicine were increase appetite, weight gain, confusion, iritability, diminished libido (enuff read right there).

    So strictly looking at it as risk vs reward it just didnt seem to make sense to me.
  6. Akara11 is offline

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    Posted On:
    7/16/2009 3:55pm

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    Quote Originally Posted by muddy View Post
    Thanks for that.

    Most of the reason I didnt take it was because the pain really is not unbearable ... not by a long shot. Its the weakness and lack of range of motion in that arm that bother me the most. I really didnt get the impression that Lyrica addressed anything other than pain. Also, the possible nasty side effects seemed to be a little more probable with Lyrica than with most medicines. Some things listed as "common" side effects in the info that came with the medicine were increase appetite, weight gain, confusion, iritability, diminished libido (enuff read right there).

    So strictly looking at it as risk vs reward it just didnt seem to make sense to me.

    People overhype the side effects of Lyrica. The most common side effect is drowsiness. You're right, though. Lyrica is really most likely only going to treat the pain in your case. To deal with serious trigger points, usually you'll need a combo of ischemic release, massage, stretching, exercises, etc... as provided by a (hopefully) good PT. The Lyrica might be a good bet if the pain WAS the worst part...but otherwise you could probably do without it, certainly.
  7. muddy is offline

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    Posted On:
    7/16/2009 4:10pm


     Style: boxing

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    Quote Originally Posted by Akara11 View Post
    ... ischemic release,...
    What is this? I did a search and came up with a bunch of seemingly unrelated stuff. I saw that ischemia is an inhibition of blood flow to a body part. Ive noticed for a while now circulation is much less in my bad arm (less pump on that arm when lifting). Is all this related to MPS? Can you point to any references for ischemic release?

    Thanks for the help.
  8. Akara11 is offline

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    Posted On:
    7/16/2009 4:20pm

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    Quote Originally Posted by muddy View Post
    What is this? I did a search and came up with a bunch of seemingly unrelated stuff. I saw that ischemia is an inhibition of blood flow to a body part. Ive noticed for a while now circulation is much less in my bad arm (less pump on that arm when lifting). Is all this related to MPS? Can you point to any references for ischemic release?

    Thanks for the help.
    Yeah. Ischemic release is placing pressure on the knot itself for a time, which can cause a slow release of said knot. I dunno if there's consensus on WHY it works, theoretically I think the lack of blood flow to the area might make it harder for the localized 'piece' of muscle to stay contracted and tight. I think I can muster up a few articles here somewhere...


    The Wiki talks a bit about it, however much credence one wants to put in THAT... http://en.wikipedia.org/wiki/Trigger_point

    Here's one on pubmed, although again...full understanding of why muscle knots in these ways is kinda sketchy sometimes. http://www.pubmedcentral.nih.gov/art...?artid=2505027

    I've had luck with it to a certain degree myself...but YMMV of course. Always follow what the PT is suggesting, of course.

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