When he first came into my office, he was
disheveled. Not his outward appearance necessarily, but the look in
his eyes was that of a man crestfallen by a pain he carried with him
like a pebble in his boot. But there was something else I saw in his
eyes, too, something that had smoothed the proverbial pebble like
waves and sand smooth beach glass. It was a glimmer of hope. He
explained to me that several years before his wife had seen one of
my colleagues for treatment when she was having terrible TMJ pain (Temporomandibular
Joint or “jaw” pain). Based on her experience with Myofascial
Trigger Point Therapy, he knew that we would be able to confront his
pain together and find the solution. And we did.
His pain had started several weeks previously while taking care of
his children who had the flu. He became violently ill himself and,
that night when he was throwing up, felt what he described as “an
odd sensation” in his chest. The pain had been present ever since.
He also had pain in his shoulder and chest that was migrating down
his arm. In fact, he was beginning to experience numbness and
tingling in his thumb, index and middle fingers. The pain was severe
enough at that point that he was having trouble getting a full night
of sleep and it was difficult for him to pick up his children. This
was a frustrating change from his daily norm in which he was
typically active in his children’s lives and activities.
I told him I was confident that we could address and resolve this
problem. While the trigger (vomiting) was particular to his
situation, the pain was something that I had worked with many times
in other patients. What makes Trigger Points unique is that they
tend to cause pain in a location(s) distant to the area that is
actually dysfunctional. This can be tricky to comprehend if you are
not familiar with the referred pain patterns of Trigger Points. I
explained that I suspected his pain to be stemming from Trigger
Points that had developed in the scalene muscles in his neck. This
was a problem that I’d seen many times in people with desk jobs or
high stress situations who tend to wear their shoulders like ear
muffs. The referral pattern of the scalenes can cause pain into the
back by the shoulder blade, down the arm into the thumb and first
two fingers and into the chest. The symptoms can be so intense they
can even mimic a heart attack. In fact, some people have sought
emergency care because of heart attack-like symptoms but checked out
healthy. Turns out they may just be having problems with their
scalenes.
With just these first brief descriptions of the possible cause of
his pain, I watched the man’s crestfallen appearance transform into
one of interest and fascination. Simply by learning about the source
of his pain, he was already beginning to feel empowered and in
control. We discussed a variety of different habitual life style
patterns that could have set him up for that horrible night when his
symptoms first arose and how they could be the very same patterns
getting in the way of his recovery.
One of the big patterns we talked about was paradoxical breathing —
for this is something that the great majority of us do. In a normal
healthy breath, the diaphragm muscle moves down, pushing our organs
downward and bulging our belly a little bit. When we routinely tense
our stomach muscles (such as to appear thinner), our diaphragm
doesn’t have anywhere to go, so our tiny little helper muscles above
our lungs become stressed by taking over the job of breathing,
especially the scalenes! I shared a very simple breathing exercise
whereby this client could help retrain his muscles to work for him
instead of against him.
Over the next few months we worked diligently together on breaking
up the adhesions that had formed in his muscle tissue and examining
the progress of his recovery in daily life. He became more excited
every day as he sensed how his body was moving — and how different
activities or situations would affect his muscles for better or
worse. We were able to relieve the great majority of his pain within
the first couple sessions. After that, each little victory just
encouraged him more. For example, we were able to reduce the
tingling in his hand to just a tiny bit around the nail bed of his
index finger. We also discovered new ways for him to use his mouse
at work that previously had been hindering his recovery. Each
session he would go home with new ideas for things to try at home
and come back the next time with stories of success.
Then one day his symptoms mysteriously came back with a vengeance —
and for no apparent reason. We were both left scratching our heads.
The following weekend I attended a seminar on Myofascial Pain and
Dysfunction in Chicago and discussed the peculiar situation with a
friend and mentor, Mary Biancalana, who happens to be a leading
expert on the subject. When she explained the possible solution, a
light bulb went off in my head. She explained that the scalene
minimus, a tiny muscle that lives underneath the large scalenes,
will sometimes cause scalene problems to come back. Why? Because it
can only be accessed after the larger scalenes’ problems have been
resolved. Mary explained that the minimus was attached to the sac
that surrounds the lungs and internal organs (light bulb!) — and
right then I knew that when my patient had been ill this little
muscle might have been pulled violently by his vomiting. BINGO,
there was our solution!
I was excited to return and discuss this with my patient, and he
fairly jumped off his seat in excitement when I told him. I treated
his scalene minimus that day and taught him how to find it and treat
himself when he was at home. Within a couple weeks the problem was
completely resolved and he was back to business as usual. His kids
were just as happy as he was to get Dad back into the swing of life
and play.
This is a perfect example of why I really love what I do and love
the network of medical professionals that I work with everyday. It
truly is a joy and a blessing to be given the opportunity to help
Alaskans get back to their happy lives and wonderful families —
without worrying about a pebble of pain stuck in their Sorels.
Brendan Van Valkenburgh,
CMTPT, NCLMT, practices Myofascial Trigger Point Therapy and Massage
at Avante Medical Center, 915 W. Northern Lights Blvd. Anchorage,
AK. Call (907)-770-6700 or visit
www.avantemedicalcenter.com.
