Perpustakaan The Practice of Informed Touch ag ‘ i) Hh AN hy (\ \ DONNA FINANDO, L.Ac., L.M.T, AND STEVEN FINANDO, 1 BaybeeBODYWORK $19.95 Myofascial pain syndromes are among the fastest growing problems that physicians, osteopaths, acupuncturists, and physical, occupational, and massage therapists encoun- ter in their patients. In Trigger Point Therapy for Myofascial Pain Donna and Steven Finando have organized vast amounts of information on treating muscle pain into an accessible and comprehensive clinical reference manual for healthcare practitioners. ‘They examine a wide range of pain patterns and present evaluation and palpation tech- niques for reducing trigger points—and thereby alleviating pain—in the most clinically significant musculature of the body. ‘This revised and fully expanded edition of Informed Touch begins with chapters on the concept of qi and its relationship to myology, the reasons for trigger point devel- opment, and palpatory skill-building techniques. Subsequent sections provide detailed information on individual muscles to teach clinicians to locate quickly and accurately specific points of pain and patterns of compensation. In addition to anatomical diagrams of trigger points and pain patterns, each muscle discussion includes illustrations showing self-help stretching techniques for home care. A visual index summarizes pain patterns and the muscles that may be involved. Trigger Point Therapy for Myofascial Pain is an invaluable resource for any professional involved with myofascial disorders. DONNA FINANDO, L.Ac.,L.M.T, has taught myology and myofascial meridian therapy throughout the country for more than twenty years. STEVEN FINANDO, Ph.D., L.Ac., is currently on the advisory board for the New York Chiropractic College School of Acupuncture and Oriental Medicine. Both studied extensively with Janet Travell, M.D., a pioneer in the field of pain management. Donna and Steven live on Long Island, New York, where they have been in continual practice for the past twenty-nine years. HEALING ARTS PRESS ROCHESTER, VERMONT mn eae | ‘6aLOUHEALTH & W Cover design by Jonathan Desautels — at Printed and Bound in Canada ae lero SRal aTrigger Point Therapy for Myofascial PainTrigger Point Therapy for Myofascial Pain ‘The Practice of Informed Touch DONNA FINANDO, L.AC., L.M.T. AND STEVEN FINANDO, PH.D., L.AC.CONTENTS ACKNOWLEDGMENTS A GATHERING OF FORCES: Toward an Era of Interdisiplinary Cooperation in the Treatment of Pain ‘THE NATURE OF MUSCLES AND TRIGGER POINTS Qi, MoveMENT, AND HEALTH INFORMED TOUCH DIAGNosis AND TREATMENT How 70 Use THIs MANUAL Muscles of the Head, Neck, and Face S STERNOCLEIDOMASTOID SCALENES SPLENTUS CAprTis SPLENTUS CERVICIS POsTERIOR CERVICALS ‘TEMPORALIS MASSETER PTERYGOIDS Muscles of the Shoulder Girdle ‘Trapezius LEVATOR SCAPULAE Ruomporns SERRATUS ANTERIOR PECTORALIS MINOR fuscles of the Upper Limb _ PECTORALIS Major DetroID LaTissimus DORSt TERES Major SUPRASPINATUSAPPENDIX 1 APPENDIX 2 APPENDIX 3 INFRASPINATUS TERES MINOR ‘SUBSCAPULARIS BICEPS BRACHIL ‘TRICEPS BRACHIL BRACHIALIS BRACHIORADIALIS HAND AND FINGER EXTENSORS HAND AND FINGER FLEXORS Muscles of the Torso ERECTOR SPINAE QUADRATUS LUMBORUM TLiosoas: RECTUS ABDOMINIS ABDOMINALS Muscles of the Lower Limb GLUTEUS Maximus GLUTEUS MeDIUs GLUTEUS MINIMUS ‘TENSOR FASCIAE LATAE PIRIFORMIS HaMsTRines QUADRICEPS Abpuctors PEcTINEUS Gracius SARTORIUS POPLITEUS GASTROCNEMIUS SOLEUS TIIALIS POSTERIOR, ‘TIBIALIS ANTERIOR PERONEAL MUSCLES LONG EXTENSORS OF THE TOES LONG FLEXORS OF THE TOES eee MERIDIAN PATHWAYS ON CUTANEOUS ZONES ComMonty UseD ACUPOINTS eee PAIN PATTERN INDEX SYMPTOM INDEX BIBLIOGRAPHY 98. 102 106 110 14 116 118 120 124 130 134 138, 142 146 152 156 160 164 168 172 176 180 184 188 190 192 194 198 202 204 208 212 216 221 225 226ACKNOWLEDGMENTS Travell, M.D, whose life work in clarifying and ordering myofascial pain syn- has provided the reality base that has eluded so many others. Her work has beyond any doubt that pain results from muscular dysfunction. So many ical community have, until very recently, disregarded the musculature as a Pain and suffering. Through Janet Travell’ lifelong work—her systematic ‘dentify and chart pain patterns associated with muscular trigger points and means with which to eliminate them—we have been given the basis for ‘of chronic pain suffered by so many for so long, Seem, Ph.D., who has strived to evolve the application of Dr. Travell’s work to fof acupuncture. Understanding the value of acupuncture as physical medicine ment and resolution of pain, Mark has dedicated his efforts to bringing into the forefront of American health care. We would also like to thank Soining the phrase informed touch, which so clearly describes what we seck to through our work. lien, L-Ac., Steven Rosenblatt, M.D., and Robert Ruffalo, D.C., whose das helped in making this book most useful for Eastern and Western practi- i, whose skillful drawings demonstrate stretches that are so beauti Je can feel and sense the stretch of the muscle as we look at them, sbenas and the staff at Polan and Waski, whose graphic capabilities have been the production of illustrations that so clearly identify muscle and trigger widson of Healing Arts Press, who has helped us clarify, order, and evolve Her help, her encouragement, her careful and critical editor’ eye, her her dedication to this project have been invaluable to the evolution of thisINTRODUCTION A GATHERING OF FORCES ‘Toward an Bra of Interdisciplinary Cooperation in the Treatment of Pain / he field of pain management, specifically the treatment of myofascial pain syn- dromes, has become a meeting ground for health professionals. Acupuncturists, ‘medical doctors, and practitioners of various manual and physical therapies who previ- jeusly had litte to say to one another are now collaborating in ways that are unprece- ented in the history of American health care. The reason for the development of such disciplinary communication is the growing recognition that myofascial syndromes the basis of a huge segment of patient complaint, and associated allocation of murces, within our health care system, Patients with myofascial pain syndromes are secking the help of family physicians, nists, orthopedists, neurologists, rheumatologists, osteopaths, physiatrists, psychia~ , and anesthesiologists. Dentists, particularly specialists in temporomandibular joint me, regularly see patients presenting with myofascial pain. In addition, acupunc- chiropractors, physical therapists, occupational therapists, massage therapists, and jotherapists are all encountering patients in pain. Conferences on pain treatment increasingly become polyprofessional experiences. 4s possible that, through health professionals’ mutual interest in the treatment of cial pain syndromes, true complementary medicine may emerge as a reality in ‘United States. Complementary medicine here refers to the use of conventional med- ‘practices in conjunction with recently emerging Oriental and other body-therapy s, providing a coordinated treatment strategy that is best for the patient. This from the alternative medical model, which tends toward a competitive concept th care, ultimately forcing a division between itself and conventional medical es that may not, in the long run, be of the greatest benefit to patients. At thispoint in our medical history the fact is that health professionals from widely varying dis- ciplines are talking to each other with a new~ found respect, and the result may be the fostering of a cooperative spirit that will help millions of people who are in pain. This book, a field manual for any health professional dealing with myofascial syn- dromes, therefore serves a vital purpose. Its aim is to simplify and order the vast amounts of information related to the evaluation and treat- ‘ment of myofascial pain. Utilizing our many years of clinical and teaching experience, we have endeavored to address the concerns and desires of health care providers for a manual that can assist in evaluating a patient, defining, the presenting condition, and guiding treat- ‘ment of that condition. It is assumed that the reader has some knowledge of myology; there- fore no effort is made to replicate the extensive background and theoretical discussion found in seminal works on myofascial pain, such as those of Janet Travell and David Simons and PE. Baldry-* Instead, in addition to the tech- nical core of the manual, introductory chapters discuss topics that will facilitate communica tion among the many professions concerned with this area of study. ‘We begin with a discussion on the nature of muscles and trigger points, useful as review for those who treat primarily from this per- spective and a good introduction for those entering the field. We then examine the phe- nomenology of qi, that elusive concept of “energy” that is the foundation of all Oriental medical practices. Qi is examined fiom the “nee Texel, MD, and David Simons, M0, Miya ain and Dyyfincion: The Tigger Paint Mana, 2 vol, Balior: Wiliams and Wilkins, 1982-92}; Peer E. Bay. Apne Tigger Pains ond Mickel Pa (Edinburg/London, CCharchill Lvingone, 1985). perspective of myofascial syndromes, making it a more accessible and usefill metaphor for all health professionals. It is hoped that an expanded view of the concept of qi will help facilitate, rther than hinder, communication between practitioners of Eastern and Western medicine. Since muscle-palpation skills are at the center of effective evaluation and treatment, ‘we next discuss the nature and process of pal- pation, Because a relative few practitioners are adept in this type of palpation, some guiding principles are offered to help those who are evolving palpation skills. A chapter outlining the fimdamental approaches to evaluation and treatment of myofascial pain syndromes helps establish common ground among health pro- fessionals, in the realization that there are behavioral elements in treatment that are shared, independent of one’s particular train- ing or orientation. Thus the acupuncturist, neurologist, and physical therapist, while dif= fering in perspective regarding myofascial pain syndromes, all ultimately share similar behaviors in evaluation and treatment. A brief overview of how to use the clinical body of the manual, with a description of the infor- ‘mation provided for each muscle, finishes the introduction. In the final analysis, since this is 2 manual for the health professional who encounters patients presenting with pain on 2 daily basis, the approach is pragmatic and behavioral. In the interest of expanding our scientific knowledge, it is enticing to determine under- lying mechanisms for pain that strengthen our theoretical understanding. However, it is far ‘more important that the field ascertain what helps patients, and learns how to effect that help. This book is about how, not why.CHAPTER 1 THE NATURE OF MUSCLES AND TRIGGER POINTS Devens is fiandamental characteristic of life, and the musculature plays the ‘major role in that activity. Motion, both gross and subtle, is an essential body. function resulting from the contraction and relaxation of muscles. 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