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Trigger Point Therapy Relieves Back Pain

[Jeff Wittmaier wrote after we  expressed a bit of  skepticism about  Stuart McRobert’s claim that Active Release Techniques (ART), a patented form of  massage, healed  injuries that had plagued him for years (# 163, Personalities category).  McRobert wrote in his book Build, "I regained ranges of motion throughout my body that I’d not had for many years. I could now perform stretches and motions I’d been unable to since I was a teenager. I could now perform resistance exercises safely that I’d been unable to for several years.”

Jeff admits to knowing next to nothing about ART, but says he experienced dramatic results from what he believes are similar protocols. We are always interested in people who succeed through perseverance and self help and invited Jeff to tell our readers his story.]

It was Christmas Eve 1991. After wishing farewell to visiting family I started up the stairs to go to bed. Halfway up the stairs I felt a searing pain in my lower back, so severe that I crumbled to my knees, unable to breathe, unable to talk. Such was my welcome to the world of lower back pain. 

Sixteen years later I am largely pain free, with an occasional, much less painful, relapse. I thank Stuart McRobert and his book Beyond Brawn for helping me find my way to a local therapist who helped me recover. Here’s my story.

After the Christmas Eve incident, I visited my MD. He prescribed muscle relaxers and pain killers along with stretching and strengthening exercises. These masked the problem, but didn’t make it go away. For several years I lived with the chronic pain, not able to lift my children, make my bed without kneeling, or brush my teeth without supporting my upper body with my extended arm. Weight lifting was out of the question.

Eventually I visited a physical therapist, spending hundreds of dollars and dozens of hours, only to get temporary relief that would quickly return. I cycled through more physical therapists, chiropractors, surgeons, acupuncturists, and all manner of healers, hell-bent on finding a cure. A surgeon said I had degenerative disk disease fissures that are incurable, but improve with age; a diagnosis I didn’t find very helpful.

I eventually found tremendous relief in a procedure called Prolotherapy. Under this protocol you are injected multiple times in a single sitting with something to cause your muscles to inflame. In my case the Doctor injected a mixture of cod liver oil and lidocaine, a local anesthetic. Undergoing this procedure twice and receiving dozens of injections up and down my spine and across my hips each time, I walked away pain free - at least temporarily. After the first series my pain was permanently reduced 50 to 60 percent (frankly, it’s been so long, I can’t hardly remember with precision). After the second series my pain was reduced another 20 or 30 percent – again, permanently. I felt immensely better, but pain remained; sometimes severe.

The theory behind Prolotherapy is that your ligaments have become hyper-extended, causing your tendons (and muscles) to take their place. This constant tension is unnatural for tendons/muscles causing them to cramp due to oxygen deprivation, eventually causing pain. Prolotherapy claims efficacy throughout the body. I can only attest to its effect on my back. It was wonderful, just not complete. But I was able to lift weights again and my lifestyle was much more normal. [For a more about Prolothera, go to www.prolotherapy.com]

A few years later I was reading Stuart McRobert’s Beyond Brawn. In the back of that book he relates his own story of back pain and gaining relief from a protocol called Myotherapy as performed by Bonnie Prudden certified therapists. Finding Prudden’s site on the web and a local therapist, I was told that I’d have to come in for three to five treatments with at least a day in between, while performing exercises at home. Only then would the therapist know if I could be helped.

Prudden’s theory is that your muscles go into a spasm for one reason or another and don’t relax. If this is allowed to continue, the muscles develop a memory that this is their natural state after use (and you remain in pain). Prudden teaches that these spasms occur at standard locations throughout the human body and that therapists can be trained to locate the spasms, also called trigger points. They are trained to apply pressure to these trigger points, typically using their fingers, thumbs and elbows. Usually the pressure is applied increasingly until the patient experiences slight pain, then pressure is reduced slightly (to a no-pain state) and held for five to ten seconds, and then the pressure is slowly released. When undergoing a treatment protocol, all potential trigger points are located and treated. Some are found to be painful, others are not.

My experience was one of shock and awe. I was shocked at the number of places where the therapist found painful trigger points, around my back, and in other parts of my body as well. I was awed by her ability to release these spasms and remove or at least reduce the pain. I left each of the sessions largely pain free with simple stretching and strengthening exercises to perform at home between visits. After the five initial visits my therapist concluded that since I got temporary relief from the therapy, permanent relief was possible. On my last visit she sent me home with a piece of electrical conduit shaped into a crook (her husband made them in the basement and sold them for $15), instructions on how to use it to perform my own therapy, and the same exercise instructions. Total cost for all five visits and equipment was about $300.

I performed the therapy religiously twice a day every day for four or five months. Each time the pain would go away. Each time it would slowly return. One day it went away and never came back. It happened so quietly and so simply, I didn’t really realize it for a while. Hallelujah! I was cured. [For more about Myotherapy, go to www.myotherapyseminars.com]

I am now convinced that my back pain was a stress related bodily reaction; the small relapses I’ve had have come when I’ve been under heavy stress, typically work related. I believe both the Prolotherapy and Myotherapy were effective because they caused my cramped muscles to relax for a sustained period of time, helping them ‘forget’ their bad habits. But who really knows. I only know for sure that it worked.

Since finding this cure, I’ve experienced similar relief when treated by my chiropractor for a couple of weight lifting induced injuries. He used trigger point therapy and ‘stripping’ as he put it, which is similar to trigger point therapy, but using the arm to apply pressure while drawing it down the  affected muscle.

Clarence, as you say, we are all conducting an experiment of ‘one.’ This worked for me. Hopefully someone else can find relief from their chronic pain using this simple procedure. As I told you, I’ve been trying to convince friends with various muscular problems to try this. They’ve instead elected to swallow pills, go under the knife, or simply live with their continued pain. Maybe someone on your site will give one of these methods a shot.

 [For self-care, Richard Winett, PhD, in the August, 2007, issue of Master Trainer, recommends Davies’ book The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief (New Harbinger Publications, Oakland, CA, 2001)]

 Jeff Wittmaier
St. Louis, Missouri, USA

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Law Professor Thrives on Short, Efficient Workouts

40-minute workouts, 15 weights and 25 aerobics

Dear Clarence,

I’ve been working out for 30 years (I’m 46), but I’m happy to say that I am still learning valuable lessons through your books and website. I have been reading your books since I was a college student, when your first book, “Ripped,” came out. I have followed your fitness journey through your column in Muscle & Fitness, your many books and DVD’s, and now your monthly website postings.

What has impressed me most through all these years is that you’ve never tried to “sell” your approach or philosophy – you’ve simply presented it for consideration. Your pitch is never, “My way or the highway;” rather, it’s “You might want to try this and see if it works for you.”  In the end, as you have stressed, everyone has to find what works best for them – the “ownership principle” is what you called it in one of your recent books.

I have long been a fan of the high-intensity approach to training and have used it successfully in my weight-training through the years. Even with that approach, though, I have very much appreciated your advice through the years about the need to back off and to “coax” your body through sticking points. The longer I’ve trained, the more I’ve seen the wisdom of this point. Put another way, if I’m going to be training for decades, I just can’t imagine trying to go to “failure” every single workout!

My weight workouts have evolved into something both efficient and effective. I now spend just 45 minutes each week on the weights. With that small investment, I have maintained my bodyweight where it was when I was in college (150 lbs.), my body fat at a desirable level (11.9%), and my strength close to where it was when I was 20 years younger.

My basic weight-training approach is as follows: 1) Three 15-minute workouts each week, training half of my body with each workout (body is trained three times every 2 weeks); 2) Six total sets per workout (not counting ab exercises), one set per exercise; 3) Slow controlled sets that give me a total “time under load” of about one minute; 4) Poundages are close to max but allow room to grow (based on your periodization insights); 5) Compound exercises that work major muscle groups (e.g., lat pulldown, incline bench press, leg press); and 6) One minute rest between sets.

My most recent breakthrough has been with aerobics. My aerobics journey has followed a similar pendulum path as my weights: from high volume to high intensity to “just right for me.” I started doing aerobic training in college, but never took it too seriously. I followed the standard prescription of 30 minutes three times per week, staying within my target zone of 65% to 85% of maximum heart rate. I don’t think I was really that fit aerobically; I never had myself tested.

After your website turned me on to the Tabata protocol, I decided to have myself tested at the Cooper Clinic. I was 42 and spending just 10 minutes per week on aerobics: four-minute Tabata protocol twice a week on my stationary bike with just a one-minute warm-up. I did 25 minutes on the CC treadmill test, which put me in the “excellent” (but not “superior”) category for my age. [Darn good for 10 minutes a week]

Scheduled to go back to the Cooper Clinic in two years, I vowed to improve my time. I upped my aerobic training to three times per week, adding a 15-minute warm-up to get my heart rate to a higher level before beginning the Tabata sprint/rest cycle. I was prepared to do much better on the treadmill test, but I got sick a few weeks beforehand and was not able to train properly. Nevertheless, I did improve my time to 25:30. Not where I hoped to be, but not bad under the circumstances.

Following that, I decided to just practice the test. That worked for me as a law student with final exams, so why not here? I believe you have called that the “specificity principle.” I bought a home treadmill that inclines to 30% so my workouts could precisely mimic the Cooper test. [The Cooper Clinic protocol increases the incline 1% each minute.] This requires more aerobic training time, but I actually find the Cooper-test workout to be friendlier than the Tabata workout. You’ve referred to this as the “comfort factor.” Most importantly, it worked! With just three 25-minute workouts each week (the first 15 minutes are essentially a warm-up), I was able to achieve, at age 46, a time of 28:00 minutes when I visited the Cooper Clinic this fall. This put me in the top 1% for my age and in the “superior” category for a 30-year-old. [Anyone who has done the test can attest that 28 minutes is outstanding.]

My other success story to note for your readers has been my experience training my son, Matt, who is now 14. At this point, Matt does not care much about aerobics, and his various sports (football, basketball, tennis) keep his heart in decent shape anyway. Like many boys his age, he just wants to get big. While some of his friends have been flailing away in the weight room with little plan or direction, I have helped Matt train systematically in our basement gym for just 60 minutes a week with great results. I use for him basically the same training principles I use for myself, and they seem to be doing the job.

Although I am just 5'11", 150 lbs., Matt is already 6'1", 165 lbs, and still growing. With an assist from some plyometric exercises, he can now grab the rim in basketball. When you’re 46 and training as long as I have, it is a thrill to work with someone who still has so much natural growth potential. It also makes me think about all of the hours I wasted as a teenager with marathon workouts from the pages of the muscle magazines. When Matt first started lifting about a year ago, I would often have to remind him about his workouts. Now he reminds me. He has truly taken ownership of his training, and has that hunger only seen in one making steady progress.

 Dan and Matt square off in father-son “arms race.” We’re calling it a tie.

Well, this account has gone longer than I had intended, but I want to close by highlighting, for both Matt and me, that you have guided our training from afar.  Although the precise details of the plans we use are our own, the tools and principles from which they developed are all yours. Thank you for being there all these years; thank you for being so generous in sharing all that you have learned; and thank you for doing the hard research so that the rest of us can focus on our day jobs and wait to hear from you about what is new each month!

[For more about Dan's family, his workout regimen and diet, along with a great training photo, see a recent lifestyle-health-and-fitness piece in the St. Louis Post-Dispatch: Go ]

Dan Keating, J.D.
Vice Dean and Tyrrell Williams Professor of Law
Washington University School of Law
St. Louis, MO

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ABS LIKE BRUCE LEE—at 13

Dad tells about simple approach

“Can you train me?  I want to look like Bruce Lee.”

These words were spoken by my, at the time, 13-year-old son Joshua.  Although, I’ve always been convinced that sensible training increases the chances of maintaining health and promoting longevity, I never wanted to force it on my son.  So you can imagine how thrilled I was when, out of the blue, he told me he wanted to start working out.   As a typical 13-year old boy, I knew I might have about 4 weeks to get him “hooked” on exercise before some new interest would come along.

 I thought that the best way to start out, especially since his goal was to have the physique of Bruce Lee, would be to focus on exercising the “show muscles” (chest, arms and abdominals).  I also decided to work exclusively with bodyweight exercise, no weights.  Bodyweight exercises can be used to great effect and they have the advantage that they are not hard to learn.  Joshua agreed because, after all, he had read that Bruce Lee rarely used weights for fear that it would slow his reflexes and reaction time.  So we were ready to begin.

   

Although Joshua is an only child, we have a bunk bed in his room.  The bunk bed proved to be a great piece of gym equipment for bodyweight exercises.  As you can see in the two photos, Joshua was able to perform chin-ups and, what we called wide-grip pull-ups using the bunk bed.  The other three exercises I started him out with were push-ups (varying the width of his hand positions), chair dips and abdominal crunches.

The difficulty with starting out with bodyweight exercises is typically the trainee cannot perform too many repetitions because their own weight is too much to handle.  In Joshua’s case he could do about two chin-ups, ten push-ups, twenty dips, and twenty crunches (when we started out he could not perform even one wide grip pull-up, so we dropped that exercise until his strength increased).   

Right from the outset, I conveyed to Joshua that maintaining exercise form was the most important thing to worry about.  I told him I didn’t care how many reps he was able to do.  The focus would be on doing smooth full reps and not on trying to get to a certain number of reps.  Three really good reps were better than 10 lousy ones.

I also started right from Day 1 to convince Joshua that when you exercise you create an injury and that injuries need time to heal.  Though he wanted to train everyday I told him he would be wasting his time.  Focus on infrequent but hard workouts.  He started out training on three non-consecutive days a week.  Each exercise was performed for 2-3 sets, with a total workout time of about 15 minutes.  As he became stronger, and, therefore could work harder, I sometimes cut him to two workouts per week. 

Once his strength increased to the point where he could perform 5 smooth slow chin-ups, I started him on static holds.  In other words, after he did five smooth chins, he would hold the last rep in the contracted position for 10 seconds and they slowly lower.  For push-ups I had him work with strict form, not locking out at the top and taking about 3 seconds per rep.  We did the same for the chair dips and the abdominal crunches (slow reps, with static holds and lowers at the end of the set).

He’s been training in this way for about 8 months. As you can see, his progress has been very good.  With results comes greater motivation so, after soccer season, I’m going to start training Joshua in the weight room at his high school.  Once we get to the weight room, we’ll start working the lower body.  The philosophy will be same: strict form, infrequent training, and working toward muscular failure.

 

Thank you Bruce Lee for getting my son interested in physical culture!

Kevin Fontaine, PhD, Assistant Professor of Medicine, Johns Hopkins University Medical School

[Editors note: See Success Stories 11 for what happens when Joshua moves on to weight training--From Bruce Lee to the Hulk.]

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