Liệu pháp kích hoạt điểm trigger point cho đau chân, mắt cá chân, đầu gối và chân

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Các điểm kích hoạt Trigger Point là những điểm gây ra sự đau đớn, nó tồn tại ngay trong các mô mềm. Điểm Trigger Point xuất hiện khi căng thẳng, stress, sai tư thế liên tục, rối loạn chuyển hóa, chấn thương cấp và mãn tính. Nó có thể xuất hiện ngay tại vị trí đau hoặc xuất hiện ở một vùng khác do đặc tính sợi cơ dài. Trên cơ thể có thể có nhiều điểm kích hoạt khác nhau. Nếu các điểm kích hoạt này không được giải quyết sẽ gây ra sự co cứng hệ cơ, gây đau đớn và trạng thái căng cứng liên tục. “ValerieDeLauneclearlyexplains,insimple,non-clinicalterms,what every person should know about conservative self-treatment and the preventionoflowerextremitypain Althoughtheauthorpointsoutthat trigger point therapy is often classified as alternative medicine, these proven techniques are supported by current research and based on manyyearsofeffectiveclinicalexperience Thebeautyoftriggerpoint therapy is that the average person can quickly learn the self-care techniquesand incorporatethemintoadailyroutine,measuringtheir own success by their steady and sometimes drastic reduction of pain and their ability to return to normal activities If myofascial trigger pointsarethesourceofyourlowerextremitypain,thenyouwillfind thisbasicbooktobeacriticaltoolinyourjourneytoself-healing.” —ReneeGladieuxPrincipe,NCTMB,massagetherapistand vicepresidentofsalesforthePressurePositiveCompany “There are few self-help books I can routinely recommend because most of them either dumb it down, or demand too much prior knowledge Thisbookisasterlingexception Ihavebeenusingtrigger point therapy routinely for well over thirty years, and there was new material that rocked my boat At the same time, the uninitiated can benefit from this book DeLaune has synthesized a wonderful book that works as a standalone breakdown of trigger point therapy of the lower extremities or as part of her series Any time people increase theirknowledgeofhowtocarefortheirbodiesandstarttakingmore responsibility, they achieve a greater level of control This translates intoahigherqualityoflife Read,enjoy,and,mostofall,apply!” —Steven Lavitan, DC, chiropractor, licensed acupuncturist, andnutritionist Publisher’sNote Thispublicationisdesignedtoprovideaccurateandauthoritativeinformationinregardtothesubjectmattercovered Itissoldwith theunderstandingthatthepublisherisnotengagedinrenderingpsychological,financial,legal,orotherprofessionalservices If expertassistanceorcounselingisneeded,theservicesofacompetentprofessionalshouldbesought DistributedinCanadabyRaincoastBooksCopyright©2010byValerieDeLauneNewHarbingerPublications,Inc 5674ShattuckAvenue Oakland,CA94609 www.newharbinger.com CoverdesignbyAmyShoupTextdesignbyMicheleWaters-KermesAcquiredbyJessO’BrienEditedbyJeanM BlomquistAll RightsReserved EpubISBN:978-1-60882-239-3 TheLibraryofCongresshascatalogedtheprinteditionas:DeLaune,Valerie Triggerpointtherapyforfoot,ankle,knee,andlegpain:aself-treatmentworkbook/ValerieDeLaune p cm Includesbibliographicalreferencesandindex ISBN978-1-60882-239-3 Foot Diseases Chiropractictreatment Handbooks,manuals,etc Ankle Diseases Chiropractictreatment Handbooks, manuals,etc Knee Diseases Chiropractictreatment Handbooks,manuals,etc Leg Diseases Chiropractictreatment-Handbooks,manuals,etc Pain Alternativetreatment Handbooks,manuals,etc Self-care,Health Handbooks,manuals,etc I Title RZ265.F66D452010 617.5’85 dc22 2010020701 Contents Acknowledgments INTRODUCTION PARTITRIGGERPOINTS&FOOT,ANKLE,KNEE,ANDLOWER LEGPAIN CHAPTER1 WHATARETRIGGERPOINTS? CHAPTER2 YOUDON’TNEEDTOLIVEWITHPAIN CHAPTER3 FOOT,ANKLE,KNEE,ANDLOWERLEGPAIN PARTIIWHATCAUSESTRIGGERPOINTSANDKEEPSTHEM GOING:PERPETUATINGFACTORS CHAPTER4 BODYMECHANICS CHAPTER5 DIET CHAPTER6 OTHERPERPETUATINGFACTORS PARTIIITRIGGERPOINTSELF-HELPTECHNIQUES CHAPTER7 GENERALGUIDELINESFORSELF-TREATMENT CHAPTER8 WHICHMUSCLESARECAUSINGMYPAIN? CHAPTER9 GLUTEUSMINIMUS CHAPTER10 QUADRICEPSFEMORISMUSCLEGROUP CHAPTER11 ADDUCTORMUSCLESOFTHEHIP CHAPTER12 SARTORIUS CHAPTER13 HAMSTRINGSMUSCLEGROUP CHAPTER14 POPLITEUS CHAPTER15 GASTROCNEMIUS CHAPTER16 SOLEUS/PLANTARIS CHAPTER17 TIBIALISPOSTERIOR CHAPTER18 PERONEALMUSCLEGROUP CHAPTER19 TIBIALISANTERIOR CHAPTER20 LONGFLEXORMUSCLESOFTHETOES CHAPTER21 LONGEXTENSORMUSCLESOFTHETOES CHAPTER22 SUPERFICIALINTRINSICFOOTMUSCLES CHAPTER23 DEEPINTRINSICFOOTMUSCLES RESOURCES REFERENCES Acknowledgments Approximately38percentofthehumanpopulationisinpainatanygiventime Although30percentofpatientsseeninageneralphysician’spracticearethere due to pain caused by trigger points (Simons 2003), there is still very little emphasisinmedicalschoolonmusclepainandtriggerpoints Thankfully,afew pioneers have worked endlessly to research trigger points, document referral patterns and other symptoms, and bring all of that information to medical practitionersandthegeneralpublic This book would not have been possible without the lifework of Dr Janet TravellandDr DavidSimons,andmyneuromusculartherapyinstructor,Jeanne Aland,whointroducedmetothebookswrittenbyDoctorsTravellandSimons All three have now passed on, but I know that I and all of my patients are eternally grateful for their hard work and dedication Their work lives on throughthehundredsofthousandsofpatientswhohavegottenreliefbecauseof theirresearchandwillingnesstotrainothers Dr JanetTravell Dr Travellwasbornin1901andfollowedinherfather’sfootstepstobecomea doctor Sheinitiallyspecializedincardiologybutsoonbecameinterestedinpain relief, as had her father She joined her father’s practice, taught at Cornell UniversityMedicalCollege,andpioneeredandresearchednewpaintreatments, including trigger point injections In her private practice, she began treating Senator John F Kennedy, who at the time was using crutches due to crippling backpainandwasalmostunabletowalkdownjustafewstairs Thiswasata timewhentelevisionwasjustbeginningtobringimagesofpoliticiansintothe nation’slivingrooms,andithadbecomeimportantforpresidentialcandidatesto appear physically fit Being on crutches probably would have cost President Kennedytheelection Dr Travell became the first female White House physician, and after PresidentKennedydied,shestayedontotreatPresidentJohnson Sheresigneda year and a half later to return to her passions: teaching, lecturing, and writing aboutchronicmyofascialpain Shecontinuedtoworkintoherninetiesanddied attheageofninety-fiveonAugust1,1997 Dr DavidG Simons Dr Simons,whostartedouthiscareerasan aerospace physician, met Dr Travell when she lectured at the School of Aerospace Medicine at Brooks Air Force Base in Texasinthe1960s Hesoonteamedupwith Dr Travell and began researching the internationalliteratureforanyreferencesto the treatment of pain He discovered there were a few others out there who were also discovering trigger points but using different terminology He studied and documentedthephysiologyoftriggerpoints in both laboratory and clinical settings and tried to find scientific explanations for triggerpoints TogetherDoctorsTravellandSimonsproducedacomprehensive two-volume text on the causes and treatment of trigger points, written for physicians Dr Simons continued to research the physiology of trigger points, update the trigger point volumes he coauthored with Dr Travell, and review triggerpointresearcharticlesuntilhisdeathattheageof87onApril5,2010 He was also on the scientific advisory committee of the David G Simons Academy,whichhasthegoalofinternationallypromotingtheunderstandingand knowledgeofmyofascialpainsyndromeandtriggerpointtherapy OtherThanks Manyadditionalresearchershavecontributedtothestudyoftriggerpoints,and manydoctorsandotherpractitionershavetakenthetimetolearnabouttrigger pointsandgivethatinformationtotheirpatients Iwouldliketoacknowledgeall of them for their role in alleviating pain by making this important information available My editors Jess Beebe, Jess O’Brien, and Jean Blomquist did an excellent jobprovidingorganizationalsuggestionsandinspiringmetomakeeachrevision evenbetter IwouldalsoliketothankArtSutch,SkipGray,andJaimeClappfor the still photography; David Ham for being the model in the referral pattern photos;andSarahOlsenforgraphicdesignwork VirginiaStreet(JanetTravell’s daughter)andDr Simonsprovidedsomeofthephotos Iowemanythankstothethousandsofpatientsandsomepractitionerswho sharedwithmewhatworkedforthemsothatIcouldsharethatinformationwith you And once again, I would like to thank Sasha the dog, who was forced to waitformewhileIworkedtoomanyhourstofinishthisbook,albeitalittleless patiently this time She has learned to perfect the “stare through the window” that would force even the strongest person to her bidding She keeps me honest infollowingmyownself-helptechniquesof takingbreaksandwalking forexercise Introduction Ifyou’vepickedupthisbook,chancesarethatyousufferfromlowerleg,knee, ankle, or foot pain that occurs frequently or that is intense or debilitating You needtoknowthatthere’sseldoma“magicbullet”forcuringpain Inpart,thisis because the causes of pain are often wide-ranging and complex Until the underlyingorperpetuatingfactorsareaddressed,painusuallyrecurs Lowerleg, knee, ankle, or foot pain can be an intractable problem because some of the causesareseldomrecognized WhatYourHealthCareProviderMayNotKnow Themostimportantthingtoknowabouttriggerpointsisthatthey“refer”painto otherareasinfairlyconsistentpatterns Forexample,painfeltontheoutsideof yourupperlegmaybecomingfromamuscleinthatarea(thevastuslateralis), butitmayalsobecomingfromatriggerpointlocatedinamusclehigherup(the gluteus minimus) Knowledge of referral patterns gives us a starting point of wheretolookforthetriggerpointsthatareactuallycausingthepain Withoutaknowledgebaseoftriggerpointsandreferredpain,ahealthcare provider cannot effectively treat pain syndromes Although trigger points and their referral patterns have been documented for decades and those of us with clinicalexperienceintriggerpointshaveneverhadanydoubtthattheyarereal, onlymorerecentlyhavescientificdouble-blindcontrolledplaceboexperiments beenableto“confirm”theirexistence(Shahetal 2008;Chenetal 2007) This confirmation allows the subject of trigger points to get more press in scientificandmedicaljournals,butwordisstillslowingettingouttohealth careproviders I’vetreatedhundredsoffairlysimplecaseswherepeoplehadbeentoldtheir only recourse was to learn to live with their pain The reason? Their doctor or otherproviderdidn’tknowabouttriggerpointsorwasunwillingtorefertoan “alternative”practitioner Thankfully,that’schanging Newdoctorsareexposed to a wider range of alternative treatments in medical school, and some doctors whohavepracticedmedicineforyearsaregettingexcitedaboutexploringother treatmentoptions I’m frequently contacted by people who are pretty sure trigger point treatment is at least part of the solution to their pain problems, but they are completely frustrated because they can’t find a practitioner who knows about Totreattriggerpointsintheextensorshallucisbrevisanddigitorumbrevis, useyourfingersorthumbsonthetopofthefoot,forwardoftheoutsideankle bone Stretches TOEFLEXORSSTRETCH Putyourfootovertheoppositeknee,andusetheoppositehandtostabilize the ankle Use the hand on the same side as you are treating to pull up on the toes, until you feel the stretch along the entire foot Doing this in warm water increasesthebenefitsofthestretch AlsoSee Long Extensor Muscles of the Toes: see extensor digitorum longus (chapter21) PeronealMuscles:seeperoneuslongusandperoneusbrevis(chapter18) DeepIntrinsicFootMuscles:seeadductorhallucis,flexorhallucisbrevis, interossei(chapter23) Long Flexor Muscles of the Toes: see flexor digitorum longus (chapter 20) Gastrocnemius(chapter15) Soleus/Plantaris:seesoleus(chapter16) DeepIntrinsicFootMuscles:seequadratusplantae(chapter23) Conclusion Search for trigger points in the long extensor muscles of the toes (extensor digitorumlongus)andperonealmuscles(peroneuslongusandperoneusbrevis), sincereferralpatternsaresimilartotriggerpointsintheextensorhallucisbrevis andextensordigitorumbrevis Alsosearchfortriggerpointsinthedeepintrinsic footmuscles(adductorhallucis,interossei)andlongflexormusclesofthetoes (flexor digitorum longus), since referral patterns are similar to that of trigger pointsintheflexordigitorumbrevis Chapter23 DeepIntrinsicFootMuscles Likethesuperficialintrinsicfootmuscles(chapter22),thedeepermusclesmove the toes and provide the same functions The deep muscles probably help the toesadjusttovariationsinterrainandtodiginmoreeffectivelywhenwalking onsoftsurfaces,suchassand Muscular imbalancesinthefoot,alongwithmisalignedjoints,mayleadto problemsintheknee,hip,pelvis,andspine;therefore,treatingtriggerpointsin the feet and resolving the associated perpetuating factors may be crucial to resolvingproblemsinotherareasofthebody CommonSymptoms Triggerpointsinthequadratusplantaemusclereferpainandtenderness tothebottomoftheheel Triggerpointsintheadductorhallucismusclereferpaintotheballofthe footandarelikelytocauseastrange,“fluffy”feelingofnumbnessanda senseofswellingoftheskinovertheballofthefoot Trigger points in the flexor hallucis brevis muscle refer pain and tenderness to the ball of the foot adjacent to the big toe, and on the outsideandtopofthebigtoe,withspilloverpainthatmayincludemost ofthesecondtoe Triggerpointsintheinterosseimusclesreferpaindownthetopofthetoe closest to the affected muscle, and onto the ball of the foot in an area closesttotheaffectedmuscle Trigger points in the interosseous muscle between the first and second metatarsals(behindthebigandsecondtoes)cancausetinglinginthebig toethatmayalsotravelintothetopofthefootandshin Trigger points in the interossei muscles can cause hammer toes, which maydisappearafterinactivationoftriggerpoints,particularlyinyounger people Trigger points in the deep intrinsic foot muscles are usually found in combination with trigger points in other muscles that refer pain to the foot Walkingislimitedduetopain Youmayhavenumbnessoftheentireendofthefootaccompaniedbya feelingofswelling,mostlyfromtriggerpointsintheflexordigitiminimi brevis,flexorhallucisbrevis,oradductorhallucismuscles Youmayhaveanintolerancetowearingorthoticinsertsduetopressure onthetriggerpoints PossibleCausesandPerpetuators INJURIESORMUSCLEABUSE Wearingshoesthataretootightaroundthetoesandballofyourfoot,or inflexibleshoes(suchasclogs) Injuriesreceivedbybangingorstubbingyourtoes,orbyfalling Repeatedly using your feet to pull yourself closer to your desk on a rollingchair Walkingorrunningonunevengroundoraside-slant Chillingyourfeetincoldwaterorwearingwetsocksincoldweather MEDICALORSTRUCTURAL Afractureoftheankleorotherbonesofthefoot,especiallyifacastwas used Alongersecondtoecausingfootrocking Footpronationorsupination(standingunevenlyontheoutsideorinside ofyourfeet) Hypomobility or hypermobility of the joints of the foot, where there is eithernotenoughmovementortoomuchmovementinthejoints Gout(diagnosedwithabloodtest) HelpfulHints Thepainandtendernessfromquadratusplantaetriggerpointscanbeconfused withplantarfasciitis Plantarfasciitisiscausedbytensionoverloadonthefascial attachment(plantaraponeurosis)onthebigboneintheheel,duetotightnessin the gastrocnemius (chapter 15), soleus (chapter 16), abductor hallucis, flexor digitorum brevis, and/or abductor digiti minimi (chapter 22) muscles The quadratusplantae(seeabove)mayalsobeinvolved See“PlantarFasciitis,Heel Pain,andHeelSpurs”inchapter3formoreinformationonplantarfasciitis If your ankle is hypomobile (doesn’t have much movement), see a chiropractor or osteopathic physician to increase mobility If it is hypermobile (movestoomuch),orthoticswithgoodarchsupportandadeepheelcup,along withankle-highshoesforsupport,willhelpstabilizeyourfoot Read “Bunions and Hallux Valgus” in chapter Avoid high heels, shoes withnarrowtoes,andinflexibleorslipperysoles Feetgetwiderandlongerwith age, so old shoes should be discarded Pick a shoe with a wide base and cushioning,suchasanathleticshoe Until trigger points are inactivated, walk or run only on smooth surfaces, start with short distances, and increase mileage gradually Try rowing, swimming,orbicyclinginstead Self-HelpTechniques Youmayneedtotreattheextensordigitorumbrevis(chapter22)and/orextensor digitorum longus (chapter 21) first in order to prevent reactive cramping when youreleasethedeepintrinsicfootmuscles ApplyingPressure Startwiththesamepressuretechniquesasinchapter22 INTEROSSEIPRESSURE Buy an eraser that fits on the end of a pencil Using the tip of the eraser, pressinbetweenthebonesofthefoot,onboththetopandthebottom Youmay holdpressure,butalsomovetheeraserbackandforthinthegrooveinbetween thelongbonesofthefoot Stretches Thestretchesandexercisesarethesameasinchapter22 AlsoSee Soleus/Plantaris:seesoleus(chapter16) Gastrocnemius(chapter15) LongFlexorMusclesoftheToes(chapter20) SuperficialIntrinsicFootMuscles:seeflexordigitorumbrevis,abductor hallucis(chapter22) TibialisAnterior(chapter19) LongExtensorMusclesoftheToes:seeextensorhallucislongus(chapter 21) Conclusion Also search for trigger points in the gastrocnemius, soleus, flexor digitorum longus, and abductor hallucis muscles, since they can have referral patterns somewhat similar to that of the quadratus plantae Search the gastrocnemius, flexor digitiorum longus, and flexor digitorum brevis muscles, since referral patterns from those trigger points can be confused with those of the adductor hallucis Searchthetibialisanterior,extensorhallucislongus,andflexorhallucis longus muscles, since those trigger points could be confused with referral patternsfortheflexorhallucisbrevismuscle Resources NewHarbingerPublications NewHarbingerpublishesbooksonavariety of self-helptopicsthatyoumayfindhelpful 800-748-6273 newharbinger.com ThePressurePositiveCompany Thiscompanysellsself-pressuredevicesand massagetools Theirwebsitehasaninformationcenterwitharticlesandlinksto otherhelpfulsites 800-603-5107 pressurepositive.com Superfeet This company sells noncorrective footbeds, and their website can helpyoulocateadealerwhocanmakeSuperfeetcustomfootbedsforyou 800634-6618 superfeet.com TriggerPointRelief.com Author’s website with additional resources, articles, andlinkstohelpfulsites References Audette,J F.,F Wang,andH Smith 2004 Bilateralactivationofmotorunit potentialswithunilateralneedlestimulationofactivemyofascialtrigger points AmericanJournalofPhysicalMedicineandRehabilitation 83(5):368–74 Balch,J F.,andP A Balch 2000 PrescriptionforNutritionalHealing:A PracticalA–ZReferencetoDrug-FreeRemediesUsingVitamins,Minerals, Herbs,andFoodSupplements NewYork:Avery Borg-Stein,J.,andD G Simons 2002 Myofascialpain ArchivesofPhysical MedicineandRehabilitation83(Suppl1):S40–47 ChenQ.,S Bensamoun,J R Basford,J M Thompson,andK N An.2007.Identificationofmyofascialtautbandswithmagneticresonance elastography.ArchivesofPhysicalMedicineandRehabilitation88:1658– 1661 Edwards,J.,andN Knowles 2003 Superficialdryneedlingandactive stretchinginthetreatmentofmyofascialpain:Arandomisedcontrolled trial AcupunctureinMedicine21(3):80–86 Hinkers,M 2009 Diabetes:Takingstepstopreventamputation Lower ExtremityReview1(2):33–40 Issbener,U.,P Reeh,andK Steen 1996 Painduetotissueacidosis:A mechanismforinflammatoryandischemicmyalgia?NeuroscienceLetters 208(1996):191–194 Kuan,T 2009 Currentstudiesonmyofascialpainsyndrome CurrentPainand HeadacheReports13:365–369 Latremoliere,A.,andC J Woolf 2009 Centralsensitization:Ageneratorof painhypersensitivitybycentralneuralplasticity TheJournalofPain 10(9):895–926 Li,J ,andC Muehleman 2007 Anatomicrelationshipofheelspurto surroundingsofttissues:Greatervariabilitythanpreviously reported.ClinicalAnatomy20:950–955 Marcus,D A.,L Scharff,S Mercer,andD C Turk 1999 Musculoskeletal abnormalitiesinchronicheadache:Acontrolledcomparisonofheadache diagnosticgroups Headache:TheJournalofHeadandFacePain 39(1):21–27 Murphy,L.,T Z Schwartz,C G Helmick,J B Renner,G Tudor,G Koch,A Dragomir,W D Kalsbeek,G Luta,andJ M Jordan 2008 Lifetimerisk ofsymptomatickneeosteoarthritis ArthritisandRheumatism59(9):1207– 1213 Niddam,D M 2009 Brainmanifestationandmodulationofpainfrom myofascialtriggerpoints CurrentPainandHeadacheReports13:370–375 Partanen,J.,T A Ojala,andJ P A Arokoski 2009 Myofascialsyndromeand pain:Aneurophysiologicapproach Pathophysiology, doi:10.10266/j.pathophus.2009.05.001 Shah,J P.,J V Danoff,M J Desai,S Parikh,L Y Nakamura,T M Phillips, andL H Gerber 2008 Biochemicalsassociatedwithpainand inflammationareelevatedinsitesneartoandremotefromactive myofascialtriggerpoints ArchivesofPhysicalMedicineand Rehabilitation89:16–23 Simons,D G 2003 Enigmatictriggerpointsoftencauseenigmatic musculoskeletalpain PresentationattheSTARSymposium,Columbus, Ohio,May22 Availableathttp://ergonomics.osu.edu/ pdfs/2003%20STAR%20Symposium/Simons%20Trigger.pdf ——— 2004 ReviewofenigmaticMTrPsasacommoncauseofenigmatic musculoskeletalpainanddysfunction JournalofElectromyographyand Kinesiology14(1):95–107 Simons,D G.,J G Travell,andL S Simons 1999 MyofascialPainand Dysfunction:TheTriggerPointManual Vol 1,TheUpperExtremities,2nd ed Baltimore,MD:LippincottWilliams&Wilkins Travell,J G.,andD G Simons 1983 MyofascialPainandDysfunction:The TriggerPointManual Baltimore,MD:LippincottWilliams&Wilkins ——— 1992 MyofascialPainandDysfunction:TheTriggerPointManual Vol 2,TheLowerExtremities.Baltimore,MD:LippincottWilliams& Wilkins Wickstrom,E.,andM Cordova 2009 Anklebalancetrainingtargetsrecurrent injury LowerExtremityReview1(3):51–54 ... with health insurance companies; they are far more likely to cover acupuncture, massage therapy, and manual therapy (suchas trigger point therapy, myofascial release, Rolfing, and related types... Chiropractictreatment Handbooks, manuals,etc Knee Diseases Chiropractictreatment Handbooks,manuals,etc Leg Diseases Chiropractictreatment-Handbooks,manuals,etc Pain Alternativetreatment Handbooks,manuals,etc... musclecontaining trigger points and leadstoadditionalpain Why Trigger Point Therapy Works Massage and self-treatment of trigger points will allow muscle cells to uptakemoreoxygen and nutrients and eliminatemetabolicwastesagain,which
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