John F. Kennedy might never have been president if not for an early form of trigger point therapy.
As part of his ongoing saga of health woes, six years before his presidency Kennedy was having muscle spasms so severe in his low back that he could barely walk and felt he was facing the end of his career.
Then he consulted a doctor who offered him a controversial treatment—injections of a local anesthetic called procaine into the foci of the spasms. The treatment is credited with getting him to the White House.
Trigger point therapy, now widely accepted and covered by insurance plans, works because injections break the cycle of pain that causes muscles to spasm.
When the body is injured, muscles contract to protect the area from further harm. However, spasms can beget more spasms and continue long after the initial injury has healed.
“More spasm makes you hurt more, then more muscles get involved and each one of them will increasingly spasm,” explained Dr. Alexander Kulick, an integrative physician who has been treating pain with trigger point therapy for around 15 years.
“Once you’ve broken that cycle, the body resets itself. The natural state of the body when not in pain, is to be pretty relaxed,” he said.
He injects a solution that’s a mix of saline and procaine. Saline is a mild irritant, which causes the muscle to start a series of twitches, some of which are visible but most are too small to notice. The spasms last as long as muscle cells have energy. Once the cellular energy (ATP) is used up, the muscle can no longer contract and has no choice but to relax.
Procaine numbs the area so the twitches don’t hurt, and it dilates blood vessels so the muscle gets the blood it needs to function optimally.
Dr. Kulick said trigger point therapy works extremely well for acute pain, and when patients come within 24–48 hours of onset, they can walk out the door pretty much pain free.
“[With trigger point therapy] I can literally take someone who crawls in on their knees and have them walking,” he said.
Pain Often Not What We Think
Around 20 percent of his patients have pain that is misdiagnosed by other doctors, Dr. Kulick said.
For example, pain around the eyes is deemed sinusitis, and pain in the back of the knee is misconstrued as a knee problem.
But one of the key aspects of trigger point therapy is that muscles have patterns of radiation, so the location of pain won’t necessarily be the source.
He said a patient’s “sinusitis” symptoms can actually be relieved by relaxing the occipitalis muscle behind the ears, and the knee pain can be cured by releasing a contracted calf muscle.
And sometimes when he releases a contracted glute muscle, the piriformis, people find the pain they thought was sciatica disappears.
About once or twice a year, he sees patients like JFK who believes their pain means the end of their career, and are delighted to find out that a few injections can cure them.
Integrative Medicine and Pain Management
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