Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 04-26-2012, 02:58 PM #1
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Default How I got my trigger points under control

There is a great informational thread stickied at the top of this forum - Sticky: Trigger point information {TrPs} for short

I have suffered from chronic pain from TrPs long before I was ever diagnosed with cervical neuropathy or TOS. I decided to make this thread to list all of the things I have tried, their effectiveness, and how I finally got things under control. I have been to 5 physical therapy centers (multiple therapists), a chiropractor, and close to 10 massage therapists. This is simply my experience I am sharing and may not apply to you or your condition.
  • Deep Tissue Massage: made TrPs worse for me
  • Swedish Massage: helped to relieve TrPs, but TrPs always started to return the next day
  • ART - Active Release Technique: helped to relieve TrPs, but TrPs always started to return the next day
  • Kenisiotaping: decent postural retraining, but tape starts to peal off after a couple of days
  • IntelleSkin postural garment: much more effective than kenisiotaping, but still developed TrPs with strengthening/stretching exercises.
  • Graston Technique: very painful therapy at first (with bruising), but relieved TrPs after several sessions and kept TrPs away until I started strengthening/stretching exercises.
  • Vacuum Cupping/MEDICUPPING: similar effects to graston (with bruising), kept TrPs away until I started strengthening/stretching exercises.
  • TENS/Ultrasound combo therapy: combo therapy relieved TrPs better than either modality alone.
  • Backnobber/Therecane/tennis balls: great for calming down annoying TrPs but doesn't really get rid of them.
  • Neuromuscular Massage Therapy: easily the best massage modality for TrPs/TOS I've experienced.
  • Accupuncture: seemed to help, but can't be sure as I was having Neuromuscular Massage at the same time which was so helpful.

Quote:
Originally Posted by DiMarie View Post
The last time at the pain management the PA was working on trigger points to inject marcain etc, to calm down....
He was shocked at the amount of spasms and said a trigger is the "one" start of the spasm, he could not locate one...

DUH, with TOS, there is no "one" I gave him the ones that are the butcher knife by the wings to work on and it helped. Some of the cycle was broken.
This mirrors my experience with TrP injections.
Lidoderm patches were less effective than TrP injections.
Ice made my TrPs worse.
Heat helped (hot showers, hot tubs, and Thermacare patches offered the best relief).
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Old 04-26-2012, 03:15 PM #2
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I had cervical fusion (ACDF) C5-C6-C7 surgery 2/28/2011 which relieved some of my symptoms but many of my TrPs came right back. I was determined to get better so I started going to physical therapy 3-4 times a week and massage therapy 1-2 times a week. It took me a while before I realized that the stretches and strengthening exercises from PT were making me worse. I also noticed that driving exacerbated my symptoms as did computer work. I stopped going to PT completely. I informed my job that I could no perform and started on disability.

I continued seeing my chiro for ART, Graston, cuppping, and TENS/Ultrasound combo as well as a massage therapist for neuromuscular therapy. I also purchased a TENS/Ultrasound combo unit for use at home. I was able to eliminate most of my TrPs without them returning. It was only then that the subtle signs of neurogenic and vascular TOS became obvious and I sought out the proper medical specialists.

I was able to retrain myself to drive and type by keeping my elbows at my side (while wearing the IntelleSkin garment) to prevent exacerbation of the TOS symptoms.
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Old 04-26-2012, 03:24 PM #3
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After I met Dr. Arthur Ando, he helped me understand why my previous attempts at PT only made me worse. Here is his 5-Step Functional Approach to Phyiscial Therapy:


STEP 1: True Source Evaluations. Finding the root problem is the 1st and most important Step. Our training as CFMTs allows us to look beyond just what is painful or what has been assessed by x-rays.

STEP 2: Skilled Joint Mobilization. Getting the joints to move is a critical step in regaining mobility and preparing the body to exercise successfully.

STEP 3: Skilled Muscle and Nerve Mobilization. Hands-on manual therapy to muscles and nerves decreases pain and completes the body's preparation for exercise.

STEP 4: Therapeutic Exercise. Neuromuscular re-education through individualized exercises is the 4th Step. Core strengthening in spine cases uses time-honored methods such as Pilates. All patients are trained in their home exercise program, receive them in writing or video format, and are encouraged to do them responsibly.

STEP 5: Body Control Training. Education and training in posture and body mechanics is the 5th and final Step. This allows patients to regain basic functions such as pain-free sitting, walking and lifting or, if a patient desires, more vigorous activities like gardening or sports. Patients that understand how to use their body safely and efficiently in functional activities have the best chance of maintaining their health and lifestyle of choice.
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Old 04-26-2012, 03:36 PM #4
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All of my previous therapists wanted to give me some pain relief then go straight to muscle stretching and therapeutic exercise. Because I had some true disfunctions (multiple rib subluxations and nerve disfunction), the exercising was counterproductive.

Another thing he taught me is that nerves get tight just like muscles and often it is all considered muscle tightness. He showed me areas in which my muscles and joints had proper mobility but my nerves did not.

The fact that lower ribs were pushing up on my first rib from below explained my TOS and explained why the scalene block procedure had failed on me. Dr. Ando was not able to adjust my 1st-rib down which gave the me full confidence I needed to have the rib resection surgery.

I hope everyone can learn from my experience and find someone who can truly evaluate the source of their TOS and design a proper plan for therapy so we aren't all stuck trying to run through a brick wall with fruitless stretches and exercises.
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Old 04-26-2012, 03:42 PM #5
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Useful info:
Quote:
Originally Posted by nospam View Post
I have always found relief from TENS (Transcutaneous Electrical Nerve Stimulation) as well as ultrasound. I started seeing a chiropractor in 2010 who utilized a combo unit which does TENS and Ultrasound simultaneously. This combo gave me much more relief than the two separate therapies. I think the dynamic TENS vs static gives much better relief. I went on a search to find a home unit.

Ultima® UTC 1000 Portable Ultrasound TENS Combo

I purchased from OTCWholesale (OTC's website also has a PDF of the manual). While you can use it on yourself, probably not the best idea for those of us with TOS (my hand & arm tires quickly). My wife has been great about treating me whenever I need it. Nightly use of this did wonders for my rotator cuff bursitis and really helps my scapular & trapezius pain. Unfortunately for me, I can't use ultrasound on my neck because of the hardware from my cervical fusion.
http://en.wikipedia.org/wiki/Graston_Technique
http://www.grastontechnique.com/
http://medicupping.com/
http://en.wikipedia.org/wiki/Active_Release_Technique
http://www.activerelease.com/
http://www.intelliskin.net/
http://en.wikipedia.org/wiki/Neuromuscular_therapy
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Old 04-26-2012, 04:53 PM #6
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Ok now I will sound like a mother hen...
are you searching & typing all this out???

Please don't overdo anything while recovering, even though you are feeling good.
None of us want you to put yourself at risk when you are doing so well.
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Old 04-26-2012, 07:03 PM #7
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Quote:
Originally Posted by Jo*mar View Post
Ok now I will sound like a mother hen...
are you searching & typing all this out???
I cheated. Much of this is cut and pasted from my previous posts. I'm also a pretty fast typist.

Getting my TrPs under control was important in my decision to have surgery vs trying to continue conservative treatments. I suspect it is also an important component of my post-surgical recovery.

I'm still resting/sleeping most of my days away. I haven't slept this comfortably in years.
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Old 04-26-2012, 07:23 PM #8
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Quote:
Originally Posted by nospam View Post
I cheated. Much of this is cut and pasted from my previous posts. I'm also a pretty fast typist.

Getting my TrPs under control was important in my decision to have surgery vs trying to continue conservative treatments. I suspect it is also an important component of my post-surgical recovery.

I'm still resting/sleeping most of my days away. I haven't slept this comfortably in years.
Thanks Marc This is all great info. I wonder if Trigger pt massage is the same as any of those. Graston technique looks like something an acupuncturist of mine did. I am thinking of going to see dr. Ando when my sessions with Joyce run out if not before.It sounds like he has a great understanding of TOS. It seams to be about an hour drive for me.

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Old 04-26-2012, 07:31 PM #9
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Quote:
Originally Posted by nospam View Post
I had cervical fusion (ACDF) C5-C6-C7 surgery 2/28/2011 which relieved some of my symptoms but many of my TrPs came right back. I was determined to get better so I started going to physical therapy 3-4 times a week and massage therapy 1-2 times a week. It took me a while before I realized that the stretches and strengthening exercises from PT were making me worse. I also noticed that driving exacerbated my symptoms as did computer work. I stopped going to PT completely. I informed my job that I could no perform and started on disability.

I continued seeing my chiro for ART, Graston, cuppping, and TENS/Ultrasound combo as well as a massage therapist for neuromuscular therapy. I also purchased a TENS/Ultrasound combo unit for use at home. I was able to eliminate most of my TrPs without them returning. It was only then that the subtle signs of neurogenic and vascular TOS became obvious and I sought out the proper medical specialists.

I was able to retrain myself to drive and type by keeping my elbows at my side (while wearing the IntelleSkin garment) to prevent exacerbation of the TOS symptoms.
I also have C5-6 disc degeneration,stenosis and osteophytes,but all of the TOS dr's have told me that my pain is probably not coming from the disc. I was treating the disc for 8 months with pt,chiro and acupucture b4 I got the TOS diagnosis, but I still wonder if some of my symptoms could be coming from the disc.I had surgical consultants with 3 neurosurgeons who were ready to do surgery on me.Two recommended posterier disectomy and one recomended fusion.But they all said my disc bulge was not that bad and that most people at my age have it. I dropped the idea of it after I got the TOS diagnosis.

If you knew about TOS would you still have done the fusion? How do you tell if the pain is coming from the disc or the brachial plexus?
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Old 04-26-2012, 07:49 PM #10
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Quote:
Originally Posted by jkl626 View Post
If you knew about TOS would you still have done the fusion? How do you tell if the pain is coming from the disc or the brachial plexus?
Yes, I would have still have had the fusion. I had a congenitally narrow spinal canal and kyphosis, along with an intense pain coming directly from the cord from compression. I had immediate relief of some symptoms after the fusion. I had the scalene block prior to the fusion surgery so the hope was all of the symptoms were from the spine and not TOS.

Unfortunately, having both conditions complicate things as the source of the pain could be from both (double crush).
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