The Placebo Effect: Part 1

The placebo effect is just now beginning to be studied and understood. However, the placebo effect does not indicate that "all things can be healed by the mind". Part of any type of therapy is the placebo effect. Understanding the placebo effect can go a long way in helping someone begin a healing process.

The opposite of the placebo effect, so to speak, is the nocebo effect. When someone expects negative side effects from a medication, even if the medication is a sugar pill, they often have those effects (such as nausea or pain).

This video from TheProfessorFunk comes to us from YouTube:

Massage, as with all therapies, can trigger a placebo effect. Is massage better than placebo? Massage studies are notoriously difficult to design because you cannot create a "sugar pill massage". Any touch could have an unforeseen effect. In addition blinding massage studies is impossible because the therapist must know what kind of massage they are delivering.

So then, is massage effective? Is it better than a placebo. There are certainly many myths that surround massage therapy. On the other hand, any massage therapist will tell you that they have sometimes seen amazing almost miraculous results from massage. Science will ask questions like how consistent are these effects or how long do the effects last?

As a massage therapist and a skeptic I often witness therapists making what I believe to be outrageous claims about massage (and other alternative medicines). Many massage "modalities" being promoted today are nothing more than good PR sometimes backed by very shoddy research. Much of what is promoted by massage educators is, at the very least, bogus. In my personal opinion, any therapy with someones name attached to it is more marketing than medicine.

In general, massage often feels good. I believe there is significant research to say that massage is relaxing to the body. In the end, massage may effect a person more mentally than physically. The jury is still out.

PAIN

Here is a nice video summarizing what we know from current research about pain. Simple and straightforward.

The Trigger Point Therapy Workbook

Here is a link to the book I recommend to everyone who suffers from pain: The Trigger Point Therapy Workbook by Claire Davies.

Trigger points and Carpal Tunnel

Trigger points in many muscles can cause symptoms that are often misdiagnosed as carpal tunnel syndrome. The scalene muscles are at the top of this list. (Scalene Trigger Point Diagram)

The scalene muscles can cause a lot of problems for their size. The three scalenes (sometimes 4) are located in your neck. They run between your top ribs and your spine. The nerves of the arm, the brachial plexus, run between your scalenes, under the clavicle and down your arm. When the scalenes become tight they can pinch the brachial plexus in two ways. First, the nerves can be pinched between the scalenes. The nerves can also be pinched between the first rib and the clavicle when the scalenes become tight. When pinched, pain, numbness, tingling and swelling are likely to occur. If trigger points in the scalenes are released, these problems can often be solved.

Although the scalenes are the number one culprit the nerves of the arm can also be compressed in other places by other muscles such as the serratus posterior, teres minor, pectoralis major, triceps, coracobrachialis, brachialis, supinator, pronator teres, as well as some flexors and extensors of the wrist.

Carpal Tunnel Suggestions

Currently, any kind of pain, numbness, or tingling in the wrist or hands is quickly labeled carpal tunnel syndrome, but what is carpal tunnel syndrome? Carpal tunnel syndrome occurs when the median nerve is squeezed as it enters the hand from the wrist. In true carpal tunnel syndrome, this is caused when the area through which the nerve travels, the carpal tunnel, shrinks, leaving less room for tendons and nerves to move through. As a result, inflammation occurs, making the problem worse.

Now, this is where it gets tricky, and I want to highlight this because it is so important: many other problems, such as thoracic outlet syndrome, or myofascial trigger points, can create a state similar to and mistaken for carpal tunnel syndrome. Carpal tunnel can occur as a secondary problem from restrictions in the thoracic outlet, the place where the nerves and blood vessels enter the arm. Many muscle trigger points, from the forearm to the neck and shoulder, can send pain into the arm, wrist and hand, mimicking carpal tunnel pain. None of these problems can be solved with carpal tunnel surgery. If you suspect you have carpal tunnel syndrome here are some suggestions you might want to try:

1. Begin with a conservative approach, visit a massage therapist, specifically a neuromuscular therapist (NMT). Ask your therapist if they do "neuro" or trigger point work. Be warned. good Trigger point work will keep you coming back. Bad trigger point work will turn you away from massage forever. Do your homework: ask for recommendations; check your therapists credentials; make sure you find someone who knows anatomy and trigger point pain patterns. A good massage therapist will check your forearm, upper arm, shoulder and neck for trigger points that may be causing or adding to the problem. Remember that good trigger point massage is neither comfortable nor painful and ideally should be performed on the boarder of pain, not beyond. Your first treatment should give you some immediate relief, but you may still need several treatments to improve. (Note: My personal preference is for a massage therapist who understands anatomy and uses methods rooted in science based research.) I personally prefer a massage therapist who has a healthy skepticism of the claims of treatment to one who believes massage is the cure for all problems.


2. Begin self-treatment. In conjunction with massage learn about stretching your forearm flexors and strengthening your extensors. Stretching alone my aggravate symptoms. Muscle manipulation, either by self treatment or massage should be joined with stretching. Learn how to treat yourself. Get The Trigger Point Therapy Workbook by Clair Davies and learn to use it. Take this book with a grain of salt. I personally think some of the claims are a little over the top, but the self treatments can be useful.

3. Change aggravating activity. Look for repetitive motion activities that may be creating the problem and modify or eliminate them. Postural problems may exacerbate the problem, so become aware of how you use your body and make appropriate changes. If you need help doing these things then seek it out.

4. Use orthopedic tests to check for positive signs of carpal tunnel syndrome. Here are two tests that you can try. The first is Phalen's test and the second is Tinel's sign or the tap test. Check with a doctor or orthopedist to make sure you are doing the tests correctly. If your doctor is not familiar with orthopedic testing then find a doctor who is.

5. Find a good doctor. Some people are diagnosed with carpal tunnel by doctors who NEVER touch them. If this is the case, you need to find a new doctor. If you can, find a doctor who knows orthopedic testing. In addition to carpel tunnel tests, make sure your doctor checks for thoracic outlet syndrome. Be aware surgeons recommend surgery. If you do have true carpal tunnel, surgery can help. If I were in the situation, I would never have surgery without a second opinion. Remember that sometimes, even with surgery, offending activities can cause the pain to return, so they must be modified or eliminated.

Headaches and Trigger Points

The majority of headaches are caused by trigger points in muscles. These trigger points can be treated with massage and muscle manipulations. The muscles that cause headache pain are rarely located in the area that the pain occurs. For instance, trigger points in the trapezius, a muscle of the back and shoulders, send pain up into the back of the head, the eye and temple area. To find out more about the relationship of the Trapezius and the Sternocliedomastoid muscles to headache pain check out this page from Dr. Perry in Houston Texas: Headaches- The Trigger Points That Cause Headaches.

For more information about headaches and trigger points visit here: Trigger Points and Headache: Fakery or Fact from the Blog Headache and Migrane News.

Muscles and Pain

"Voluntary (skeletal) muscle is the largest single organ of the human body and accounts for nearly 50% of body weight." --Travel and Simons "Myofascial Pain and Dysfunction: the Trigger Point Manual"

If you have a skin problem you go to a dermatologist. For a heart problem you'd want to visit a cardiologist. Even feet have their own doctor, the podiatrist. What doctor would you see for muscle problems? There is no type of specialty in the medical field.

Problems with muscles can cause widespread pain. One simple way of addressing this pain is with medication. However, medication often only masks pain which returns when the medication wears off. Another solution is surgery which sometimes only produces short term relief. More conservative methods of treatment, such as muscle manipulations (massage), can often manage pain effectively and in many cases eliminate the pain completely.

We often neglect muscles as our cause of pain or discomfort. It seems almost counter intuitive that muscles can cause such widespread pain. In one study of 96 patients seeking pain relief from a neurologist, 93% of the patients had some part of their pain caused by muscle dysfunction. In a full 74% of those patients muscle dysfunction was the primary cause of pain.

If you're seeking massage for pain, not all types of massage are equal. In my experience, a massage therapist with training in neuromuscular therapy (NMT) and a sound knowledge of anatomy is the best option for tackling pain. In addition to finding a therapist, a person must be willing to learn to work on their own problems by addressing neuromuscular trigger points (in fact, you can get a great deal of benefit without a therapist if you learn to treat your problems yourself). There are two tools I recommend for anyone seeking relief from muscle pain. The first is The Trigger Point Therapy Workbook by Clair Davies and the second is the body back buddy or the theracane (I prefer the trigger point pro by theracane but it is no longer made). Tennis balls are another good thing to have (I'll go into why in a later post). I don't get any money from these recommendations (though I wish I did, because I recommend them all the time). Good luck!

To be clear, some of the claims made by trigger point research and by trigger point therapists should be taken with a grain of salt. People selling a therapy are often over zealous in their promotion of that therapy and I have so say many claims made regarding myofascial trigger points are shaky at best. However, I do find that addressing points of pain with mental focus and relaxation, seems to offer therapeutic results in many clients.