Muscle News Vol I.34:  Perpetuating Factors
 
Don't Live With These 5 Causes of Chronic Pain:
Chronic pain is not a small or joking matter.  Living in pain can drastically affect your life, not only physically, but also your emotional well-being and your relationships. 

Students and practitioners of the Myofascial Trigger Point Therapy field look to the brilliant work of Dr. Janet Travell (President Kennedy's personal physician) for insights into the causes of chronic pain many patients are dealing with.

This issue of Muscle News is based on Dr. Travell's powerful statement that if there was only one thing we could do for anyone in chronic pain, it would be to check for and correct a specific set of Underlying Perpetuating Factors (UPF's). 

This handful of UPF's causes extensive suffering and physical compromise to our bodies, yet are frequently overlooked in modern medicine, probably because it is hard to believe that intense lasting pain could be caused by such simple faults.  Lives are being changed and the cycle of chronic pain is being turned around every day since Dr. Travell published her work by doctors and therapists who know how to look for these underlying perpetuating factors.

For example, a congenitally shorter leg and/or a smaller hemipelvis on one side are two perpetuating factors everyone with chronic pain should be evaluated for.  Certain chronic migraine headaches result from the spinal tension caused by these inequalities from left to right and can often resolve with a simple $5 heel or gluteal lift.

Repeatedly, these perpetuating factors prove to be more potent than one might believe at creating pain in the body.  The good news is that they are fairly easy to check for and quick and inexpensive to correct.  The trade-off of effort and cost to benefit is so great that even if you don't experience pain on a regular basis, it would behoove you to see if you have these UPF's and correct them to prevent the possibilities of pain and deterioration down the road.

We are going to cover the Top 5 physical perpetuating factors below.  It might be good, if not fun, to partner up with someone you feel comfortable with and check each other for each of the five.  If you have any questions, or if you want a professional opinion on your findings, of course, a good myofascial trigger point therapist would be extremely helpful!

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.
UPF #1 (From Top to Bottom):  Paradoxical Breathing

Cost:  $0
Benefits:  Neck Tension, Neck Pain, Shoulder Tension, Shoulder Pain, TMJ, Headache, Anxiety, Stress

It is important to realize the most consistent pattern of movement that goes on all day in your body is breathing.  There are a number of reasons why we develop faulty patterns of breathing, meaning that we breath with our chests and neck muscles instead of our abdomens.  Some reasons can be stress / anxiety or trying to suck our bellies in to appear more fit.  When faulty breathing patterns exist, overuse of muscles in the neck and chest over months and years can lead  to extremely painful tension in our upper bodies.  Additionally, the breathing pattern of stress can reinforce anxiety, whereas proper breathing is relaxing.

Here is a video example of faulty breathing, sometimes referred to as Paradoxical Breathing: 

Paradoxical Breath
Paradoxical Breath
 

Here is a video that describes a couple of self-tests you can perform to check for disordered breathing:

Correct Breathing - MYOBALANCE Self Test
Correct Breathing - MYOBALANCE Self Test


Proper Diaphragmatic Breathing can be very useful in relaxing the nervous system and the muscles of the neck and chest.  Here is an exercise we recommend:

1.)  Lie down on your back with your knees bent.
2.)  Place one hand over your belly and your other hand at the side of your neck, pressing in lightly.
3.)  Relax your abdomen and allow your belly to rise as you slowly inhale, breathing through your nose with your tongue pressed against the roof of your mouth.
4.)  Use the hand on your neck to feel whether your neck muscles tighten as you inhale.  If they do, try to relax them and breathe without causing them to contract.
5.)  Next, focus on your breathing as you exhale slowly and without strain.  Your belly should feel like it is deflating.  Everything else should remain relaxed.

Incorporate this technique into your daily practice up to five times per day for 5 -10 minute periods.  Try different positions, such as seated, lying down, standing, and walking to make sure you can breathe properly in your daily activities.  Put on some relaxing music for sleeping or meditation to ease the anxiety and start a new pattern of breathing and relaxing.  Don't try to be perfect.  Just practice and enjoy the peace it can bring.


UPF #2:  Short Upper Arms
Cost:  $0 to a few bucks for some duct tape and hand towels
Benefits:  Neck Tension, Neck Pain, Shoulder Tension, Shoulder Pain, TMJ, Headache

Some people are born with short upper arms (Dr. Travell treated President Kennedy for this condition).  This Underlying Perpetuating Factor causes the arm to hang instead of being able to rest the elbow on an arm rest when seated.  The extra tension from this continuous hanging without rest can cause remarkably severe shoulder, neck and head symptoms.

Follow the instructions below to test whether your upper arms are disproportionately short compared to your torso.

TEST 1:  Elbow to Hip Test
 
                 PASS:
While standing, find the top of your hip bone, called the Iliac Crest. The easiest way to do this is to walk your fingers down the side of your rib cage until you fall off the lowest rib into the soft abdomen.  Just below this point you will find the bony prominence of the Iliac Crest.  You can mark this point on your body with a pen if you like.

Now, drop your elbows to your side, letting them hang naturally and see where they fall.  If your elbows reach to your Iliac Crest, you have Passed this test. 

                          Not PASS:
If your elbows do not reach your Iliac Crests, then you have short upper arms.  You can measure the difference between the bottom of your elbow and your Iliac Crest, if you like.  Your chances of having mild to severe pain in your neck and shoulders is increased greatly by this condition.
                              
TEST 2:  Arm Rest Test

Sit in a chair you use and rest your arms on the arm rests.  A Passing result is being able to rest your elbows on the arm rests, allowing the weight of your arms to be supported.  This support allows your neck and shoulder muscles to relax, which is especially important when seated.

A Not Passing result is if your elbows hang above the arm rest (as shown).  This result indicates that you either have short upper arms or your chair has inadequate arm rests and should be corrected.  (In the case of the model shown, since she passed Test 1, it is her chair that has arm rests set too low, rather than her upper arms being short.)

If arm rest height is not corrected, you will often find yourself leaning to the side in your chair or leaning forward to give your arms a break to rest on the arm rests.  Both of these unhealthy postures have damaging effects in the long run to other parts of your body such as your spine.
 

The Solution:  Elevate Your Arm Rests and Use Your Pockets!

These days, office chairs can be purchased with adjustable arm rests.  Adjust these settings until your elbows are fully supported on both sides.  Some chairs have naturally high arm rests, such as chairs for nursing mothers and many older style rocking chairs. 



Homemade adjustments using sponges and tape can be made as well to just about any chair you may be using.  And finally, simply using pillows under the elbows can be enough to correct for having short upper arms.  Additionally, when standing, it is helpful to put your hands in your pockets to relieve the pressure caused by the weight of your arms.  

Don't be fooled by the simplicity into thinking that these small changes won't make a large impact.  Just have a look at President Kennedy's photos to see him standing with his hands in his pockets to keep his shoulders, neck, and head at rest!  Here he is in his famous rocking chair, featuring elevated arm rests custom designed by Dr. Travell to ease the President's chronic pain.




UPF #3:  Small Hemipelvis
Cost:  $0 to $10 for an Ischial Lift
Benefits:  Low Back Pain/Injury, Functional Scoliosis, Neck Tension, Neck Pain, Shoulder Tension, Shoulder Pain, TMJ, Headache


Having a Small Hemipelvis means that one half of the pelvis is slightly smaller than the other.  When you sit, you sit on two bones at the bottom of your pelvis - your "sit bones" - technically called the Ischium on both sides.  Like a short leg, a Small Hemipelvis means that the Ischium on one side is higher than the other, causing the base of the spine to tilt, especially when sitting.  This can cause all sorts of spinal problems, including Functional Scoliosis (shown to the left).  However, again, it is easy to correct with a simple technique:


(3) Steps of Self-Assessment and Correction for a Small Hemipelvis:

STEP 1:   Self-Questionnaire

Ask yourself the following questions:
  • Do you often sit with one foot tucked under your buttocks?
  • Do you have a hard time sitting for long periods or finding a comfortable seated position?
  • Do you cross one leg over the other frequently?
  • Do you prefer standing to sitting?
  • Do you have any back pain when sitting?
  • Do you have headaches?
  • Do you have TMJ?
  • Do you have a scoliosis-type curve in your spine?
Answering yes to any of these questions may indicate that you have a Small Hemipelvis.  


STEP 2:   Seated Curvature Assessment

For this step, it is best to have another person assist you, but you can also perform this assessment using a mirror if no one can assist you.

1.)  Sit on a hard surface without a backrest (such as a piano bench) with the clothing removed from your upper body so your spine is visible.  A board can be placed on top of a softer surface, as well.  If performing alone, have your back facing a large mirror and hold a small mirror in front of you so that you can see your spine in the reflection.

2.)  Now have your helper check for the following 5 Signs of Asymmetry that indicate a Small Hemipelvis:  

(If performing alone, look in the small mirror without turning your head)
  • Is the head tilted (one ear higher than the other)?  If so, note to which side.
  • Is one shoulder higher than the other?  Note which side.
  • Is one shoulder blade higher or stick out more?  Note which side.
  • Is one skin fold at the top of the hips larger or deeper on one side? 
  • Does hip seem higher than the other
  • Does the spine appear curved from side to side?  (The tips of the vertebrae can be marked with a pen to see the alignment more easily.)  
 

STEP 3:   Ischial Lift Correction

If you found any asymmetries, the next this step is to place a small lift under each sit bone individually to see if it makes the symptoms and asymmetries better or worse:

1.)  Stay seated in the same position as Step 2.  Have a stack of a few magazines within reach.

2.)  Place a magazine about 1/8th inch thick under the right buttock (sit bone/Ischium)

3.)  Note how you feel.  Is there any tension relieved in the muscles of your spine from your back to your neck, shoulders and jaw?  Do you feel more balanced? Or do you feel worse?  Now remove the magazine from the right and place it under the other side / left buttock.  Note how you feel.  When you place the lift on the corrective side, you should feel less inclined to want to cross your legs if you do that habitually.

4.)  Next look at your back.  Are any of the asymmetries corrected with the magazine under the right side?  Add another magazine or two to increase the height of the lift.  Look to see if the asymmetries even out or get worse.  Now remove the magazines from the right and switch them to the other side (Left).  Which side is better, Left or Right?  When you find which side is better, increase the height of the magazines on the corrective side until symmetry is achieved.  In the diagram below, Picture B indicates symmetry with the Ischial lift on the right side.



5.)  Switch back and forth a couple of times to experience the difference with the lift on the correct side versus the incorrect side.  The incorrect side should emphasize even more the tension and discomfort from having a Small Hemipelvis.

6.)  Sit with the magazine(s) on the correct side for 5 to 10 minutes.  Take note of how you feel again and how your back looks.  If the improvements last, you know you have made the proper correction.

7.)  Take the magazine(s) out and measure their thickness.  This is the thickness of the ischial lift you will need to use whenever you sit for any length of time.  You can purchase ischial lifts from your Trigger Point Therapist's office or order them online at bmlbasic.com.  You will need the same height lift for hard surfaces as in the above test.  However, you will need twice this height if the surface you are sitting on is soft, and three times this height if the surface is cushy, such as a couch.
 

UPF #4:  Short Leg

Cost:  $0 to $10 for an Heel Lift
Benefits:  Hip & Low Back Pain/Injury, Neck Tension, Neck Pain, Shoulder Tension, Shoulder Pain, TMJ, Headache

 
Having a Short Leg is similar to a Small Hemipelvis, except that it causes the curvature in the spine and asymmetries while standing, rather than sitting.  The procedure for evaluating a Short Leg is similar, therefore.

Stand upright, either facing away from a mirror and holding a small mirror in your hand to see the reflection of your back, or with someone behind you to evaluate your asymmetries.

In these pictures shown here, the male has a short left leg after a poorly performed hip surgery.  As you can see, his pelvis is tilted to the left with compensating shoulder and head tilting to the right.  

This curvature can cause severe muscle pain and joint deterioration over time.

When a lift is inserted beneath the left foot (book used again here for flexibility of thickness), see how the spine returns to straight with more level pelvis, shoulders and head.


When a lift is inserted beneath the right foot, notice how the asymmetries all worsened, as expected.  This person would definitely benefit from spending a few dollars to get a heel lift on the left side! 



The thickness of the book that results in the most balanced feeling from side to side and the most symmetry is the thickness of Heel Lift that would be a good place to start.  A thorough evaluation by a professional would be best to ensure the proper measurement and best heel lift brand.  

Additionally, the amount of heel lift can change over time, especially with trigger point work.  Many times, as muscle function improves, asymmetries start to resolve to a certain degree, so re-evaluation is needed every few weeks.


UPF #5:  Morton's Foot / Long Second Toe
Cost:  Pair of Posture Control Insoles - Best $50 to $80 You've Spent in a While
Benefits:  Bunion Prevention, Plantar Fasciitis, Knee Degeneration, Hip & Low Back Pain/Injury, Neck Tension, Neck Pain, Shoulder Tension, Shoulder Pain, TMJ, Headache
 
Mother Nature is certainly beautiful, but not always perfect.  A large portion of the population has genetically inherited a deficit where our big toes don't develop fully, leaving them shorter than our second toes.  This causes us to have to roll our ankles inward when we push off the big toe to walk.  This creates a whole slew of problems from bunions to bruxism (teeth grinding).

We have covered this subject in detail in a previous issue, so we will briefly describe a simple test here.  If you want more details, refer to our previous newsletter or request the information by email.  You can also find information at www.mortonsfoot.com.


Toe, Callus & Shoe Inspection

In Morton's Foot, a longer second toe is common, but not always present.  What is important to notice is that the second metatarsal head (the "knuckle" of the foot) is longer than the first.  To see the metatarsal heads, bend your toes downward, exposing the white bony heads of the metatarsals where the toes attach.  As in the picture to the left, the second metatarsal head may protrude out further than the first, indicating Morton's Foot.  Also, take note if there is any sign of the big toe starting to bend toward the second toe, as in the picture shown.  Bunion formation can begin to form as well from this condition.  


Calluses that indicate Morton's foot will develop underneath the second toe metatarsal head, and often also along the inside of the big toe and big toe metatarsal head, the outside of the foot along the fifth metatarsal, and the outside of the heel.  Calluses in any of these areas, especially under the second metatarsal, is a good indication of dysfunction caused by Morton's Foot.

If you have this condition, which by genetic default, many of us do, it is one of the wiser things you will ever do for your physical health to invest in a pair of insoles to keep your entire skeleton straight.  You will not regret the saving of many joints, the reduced pain or the better balance.


Summary

You may likely have one or more of the above Underlying Perpetuating Factors.  It isn't necessary to live with these conditions when they are so easy to correct and will save you time, money, and quite a bit of pain over the course of your lifetime.

We hope you find this information valuable and you are having wonderful holidays!

Happy self-care!
  
  
Sincerely,
  
Your Friends at The Pressure Positive Co.
Follow us and Share with others
 
Like us on Facebook Follow us on Twitter
 

Find a Certified Myofascial Trigger Point Therapist near you. Click on the link below to learn more about these highly trained manual therapists:

NAMTPT LOGO National Association  of Myofascial Trigger Point Therapists

________________
Join Our Mailing List

 Self Care

Starts Here!


    

Our goal is to help people manage muscle discomfort by providing safe, simple, and inexpensive massage tools to help facilitate trigger point and myofascial release.

Contact Our Team
Let us know how Pressure Positive can help you manage your muscle tension.