In the world of Organized Pain, the trigger point is a weapon looking for a hitman. Sometimes, it is The Rogue Hitman. This hitman acts outside of The Pain Organization. This happens when the trigger point gets into a loop where it becomes self-aggravating and goes on a binge of pain.
Raymond L. Nimmo, a chiropractor in a small town chiropractor in Texas, is largely considered the founder of trigger point therapy and introduced the concept of the physiopathological reflex arc. This concept has been widely supported by chiropractors and Paul St. John, the massage pioneer of neuromuscular therapy.
If you want to brush up, here’s a short animation that explains the reflex arc. In most cases, we think of the reflex arc as having a sensory experience like touching a hot surface, and different a motor response, like contracting a muscle that jerks our hand away. In this case, the sensory irritation of the trigger point actually feeds motor responses that worsen the trigger point. Yeah, it’s a viscous loop and just not fun. The irritation produces sensory input back to the reflex center at the spine. The reflex center creates a motor response back to the trigger point. Irritation increases at the trigger point. That creates more sensory input, which creates more motor response, which creates more irritation, which creates more sensory input, which… well, you get it. It’s The Circle of Strife.
Let’s look at our example with the unstable, painful ankle caused by peroneus longus. Let’s say that, instead of getting some therapy, using a support and wearing stable shoes, this person keeps walking on this foot with bad shoes, over uneven surfaces and does not plunge the ankle in ice. The body develops a facilitated pathway. A facilitated pathway doesn’t have proper restraint, the way that Sonny doesn’t have proper restraint, He acts outside of The Organization and goes rogue on Carlos.
If this continues, irritation builds in the reflex center in the spinal cord. At a point, it incites The Rogue Mob that preys on the weak throughout the body making other old injuries flare up. I’ll talk about that in another post.
The solution is to interrupt the cycle. Neuromuscular uses specific sensory input to interrupt the pathological cycle. Properly applied pressure, ice, heat, stretching and other sensory stimuli are used to break up this short circuit and interrupt the pathological cycle of the reflex arc. Ice and Stretch, which I’ve talked about in this blog, was patterned after Spray and Stretch. Janet Travell, MD considered this type of treatment to be “the workhorse” of trigger point treatment.
Working on the underlying problems that perpetuate trigger points through proprioceptive input create longer lasting results. Your neuromuscular therapist can help with that too.