There are no gold standards in manual therapy. Our environment is very extensive, and the way of working depends on training, books, teachers - with whom a given therapist has become acquainted. Often the theories and theses of one of the therapeutic approaches are completely contradictory to the other approach. A lot of similarities, related thoughts and observations - but often fundamental differences.
This article will consider one of these differences - the role of pain accompanying therapy. It will be described on the basis of therapy of patients with myofascial trigger points (MPs). Regarding trigger points, there are also differences in nomenclature - that's why in this case I would like us to consider the issue of trigger points from the clinical point of view as a complex: shortened sarcomeres, local circulation disorder, hypoxia within the mps, fascia disorders (endomysial stenosis) and all the implications that follow attracts. On the other hand, let us treat the mpps itself as the inability to relax the sarcomeres. Importantly, the mpps themselves do not have to be a factor initiating the formation of this complex, but only one of the links. The theory of trigger points is the Integrated Trigger Point Hypothesis, which developed from the Energy Crisis Hypothesis. In short, the sarcomere is in contraction and cannot relax due to several factors, including: Excessive release of acetylcholine (Ach), which leads to dysfunction of the neuromuscular plates. Excess ACh affects the voltage-gated sodium channels of the sarcoplasmic reticulum and increases the concentration of intracellular calcium, which causes sustained muscle contractions.[1]
ATP deficiency, which is necessary for relaxation - more scientifically - separation of cross-bridges between actin and myosin. The above condition causes hypoxia of the surrounding tissues, blood flow disorders, release of the so-called pain mediators that chemically irritate nociceptors, connective tissue disorders will cause stimulation of mechanoreceptors - as a consequence, characteristic symptoms associated with trigger points.
Myofascial trigger points
However, in order to understand therapy and the main topic of the article, you need to understand myofascial trigger points. These are places where there is no energy - energy for proper work - ATP for diastole. These may be places that will be biomechanically inappropriately adapted to their role to accept loads - exploited. These may be places that did not perform the activity and its start caused exploitation with which they could not cope. Literally, these will be places of energy deficits, where the body is unable to cope with the load properly, and our psyche is very much connected with it.
Our character and emotions influence our attitude, behavior and the way we behave. We are talking here about psychosomatics, which to a large extent translates into the formation of places prone to overload. Every emotion and personality trait is reflected in our body. It cannot be said that a given emotion will cause a specific reaction in the musculoskeletal system in every person. It is an individual matter and despite the different patterns, one emotion cannot be assigned to a specific place. (Although suspensions of emotion have been highlighted, but this topic will not be touched upon). This is a good point to come to a conclusion: the tissues accumulate tensions - emotions. An individual scheme for everyone - a given emotion will tense a specific place (the muscle was not written on purpose).
Example
You go to work, where you are responsible for other employees - you react to the above pressure with raised shoulders and tension, e.g. in the quadriceps muscle. In addition, increasing sympathetic activity will lead to vasoconstriction - Myofascial trigger point is only a symptom.
The resulting trigger point will result in the inability to relax and the deterioration of the function of a given area, constant afferent stimulation of the nervous system. This will increase the work of the sympathetic nervous system, negatively affecting the mood and the inability to relax psychologically, which in turn will drive the spiral away from the main problem, which is pressure. However, now a smaller amount of stress stimulus will be needed to cause somatic effects. The relationship between pain due to mpps and pressure problems at work under the principles of Type I conditioning will be attributed to each other. As the problem was initially psychosomatic - it has also become somatopsychological - the tension of the trapezius will result in the impossibility of letting go of the feeling of pressure.
That is why, when conducting therapy, we can say that we release the tension accumulated in the tissues and emotions. It will also not be a lie to say that we release the emotions stored in the tissues, because they are closely related. Although the tissues do not directly collect emotions, such a mental shortcut changes a lot in the perception of our work. We do much more than relax a fibrotic muscle that can't relax. We really influence the mood or psychological state of our patients. This changes the view on therapy, where it should not be a series of successive fisticuffs, but conscious work with the patient.
Refrences
[1] Jan Dommerholt, Carel Bron, Jo Franssen – Myofascial Trigger Points: An Evidence- Informed Review