Review and Recomendation: The Trigger Point Therapy Workbook

This is a review of Trigger Point massage, and a particular self-help book about applying the technique:  The Trigger Point Therapy Workbook by Clair Davies. I've been trying self-applied Trigger Point massage for a while now, using this book as my guide. I've found it to be a useful technique, and I recommend trying it. I've used it for back pain and hip pain, but the book contains sections for almost all areas of the body. 

The theory behind trigger point therapy is that muscles get knotted up in very specific locations in the body, and that the stress caused by these knots causes referred pain to nearby parts of the body where those muscles attach.  The Trigger Point Therapy Workbook  shows you where all these trigger points are, and the pattern of referred pain associated with each point. In addition, for each set of trigger points there is a lengthy discussion of the typical causes of problems at those points, how to locate the points by touch, and how to treat the trigger points. 

The treatment is almost always the same: high pressure massage of the muscle around the location of the trigger point. Exactly how the massage is done probably doesn't matter that much, so long as you get the spot right. The book's advice, however, can be helpful for figuring out how to get sufficient leverage and pressure for each point.  In many cases, the suggested massage tool is just a regular tennis ball, though sometimes more fancy tools like the thereacane are suggested. 

The book is a useful resource for finding the trigger points because the pain is usually referred. You may massage near the area of pain, but usually the actual point where the massage is needed is outside the area which aches. Interestingly, however, once you know the general area to search for the points, it's much easier to find them by touch than by religiously following the diagrams in the book. Nonetheless, the diagrams are important for figuring out the right areas to start searching. 

The book is very clearly written. It is intended to be read by pain sufferers, and while it doesn't dumb down the topic, care is taken to not be overly technical. It does suffer from overly grandiose claims for all the different conditions it might treat - in one section it even speculates that dyslexia may some day be treated by trigger point therapy.  Don't be too turned off, however, as in contrast to dyslexia, trigger point therapy really does seem to help chronic pain. On the other hand, I'm going to go out on a limb and suggest that there is less than 1% chance that trigger point therapy will ever provide a measurable help to dyslexics.  Oh well, like most self-help books you have to learn how to filter the good from the bad. 

In the end the book wouldn't be worth reading if it didn't help. Luckily, it does. In my own life, I've found that trigger point massage can significantly reduce my acute back pain around 30% of the time I apply it, and makes for at least some improvement almost every time I try it.  That's a pretty impressive level of improvement, in my book. It's well worth the $15 that it costs to buy it from Amazon (or other good online booksellers).  And, given that the only other tools you really need are a tennis ball, and perhaps a bottle opener, it's a very economical way to treat your pain.

Good posture for sitting

One of my reader's suggested I check out his website: www.lower-back-pain-toolkit.com. It turns out to have lots of interesting information, and has inspired me to put up a post about 'good' posture.

First, what is good sitting posture? The general/traditional view is that you want to sit upright, with a gentle s-curve in your lower spine from a lumbar role. See this link for a much more detailed discussion. Whenever this 'good' posture is illustrated, the person is almost always sitting with a 90 deg. angle between their legs and their torso. Undoubtedly, this is better than the forward slouch, where your back slowly curves forward and your chin ends up nearer your kneecaps than your hips.

This traditional view, however, may not be quite right, at least with respect to the 90 deg. angle between your hips and your back. MRI scans have revealed that when you sit in this posture, you actually put a lot of strain on the disks in your lower back. It may be significantly better to lean backward at a greater angle, such as 135 deg. See this BBC article for an example of this posture, and a short discussion of the science behind it.

In my personal experience, less than 90 deg. can quickly lead to pain. Exactly 90 deg. feels much better, at least in the short term. Greater than 90 deg. seems, however, to be the least painful of all. It can be hard to get a > 90 deg. position in a regular upright chair, however, without also leaving your back unsupported and hanging, leading to a reduction of lumbar lordosis. One way to avoid this is to role up a towel and sit on it. This will increase the angle between your hips and your back, while still maintaining the good lordosis. Another option is to slouch backwards, and then support your lower back by placing both of your arms behind your back.