Myotherapy

This specialized form of deep muscle massage is said to quickly relieve virtually any sort of muscle-related pain. Examples include strains, sprains, back pain, headache, repetitive motion disorders, fibromyalgia, shoulder pain, carpal tunnel syndrome, sciatica, and temporomandibular joint disorder. Also remedied by myotherapy are many conditions caused by muscle spasms, including certain types of foot and leg pain, incontinence, and abdominal pain.

Although mainstream physicians regard myotherapy as a plausible approach to treatment, it has only one major advocate: Bonnie Prudden, the person who originated it. It's also worth remembering that, despite an impressive collection of successful case studies, myotherapy has never been validated through controlled clinical trials.

Expect your first visit to a myotherapist to last about 90 minutes. The therapist will begin by taking an extensive history. You'll probably be questioned about your birth (birth trauma is believed to underlie some types of muscle pain in both baby and mother), past and current occupations, sports, accidents, injuries, and presence of diseases.

The therapist will then evaluate your muscle strength and flexibility, searching for the "trigger points" that myotherapists blame for most types of muscle pain. To relieve the problem, the therapist will apply pressure to each trigger point for about 5 to 7 seconds, using his fingers and hands. This pressure will be painful, but is likely to provide almost immediate relief from at least some of the pain that led you to seek therapy. It can also result in a virtually instant increase in the mobility of tightly contracted muscles. Finally, the therapist will stretch the affected muscles and show you a set of corrective stretching exercises to do at home.

Subsequent sessions will last about 1 hour. They usually focus on eradicating the trigger points, re-evaluating corrective exercises, and teaching you how to prevent pain through self-help myotherapy and exercises. The average patient needs 5 sessions, and few require more than 10. After the treatments are finished, you'll need to do exercises on a daily basis to prevent spasms--and accompanying pain--from returning.

The trigger points that myotherapy seeks to eliminate are nothing more than damaged, tender spots in the muscles. When these irritable points are "fired" by physical or emotional stress, they throw the surrounding muscle tissue into painful spasms. Repeated spasms can keep the muscle tight and foreshortened, not only causing pain but also interfering with function, posture, and balance. If the cycle of spasms and pain continues long enough, the muscles will become permanently shortened.

Trigger points are thought to be the remnant of a trauma such as the physical stress of birth (either giving birth or being born), accidents, injury, or repetitive stress. They can lie dormant for years, then be activated by substance abuse, age, or disease.

It's not clear why a few seconds of pressure is enough to correct a trigger point. Bonnie Prudden, the technique's originator, believes that the pressure denies oxygen to the spot, causing the muscle to relax. Physicians, however, respond that lack of oxygen is often the cause of a cramp. What ever the truth of the matter, once the point is relaxed, myotherapists use exercises to re-educate the foreshortened muscle back to its original, relaxed position, allowing it to once more function normally. According to Prudden, this combination of trigger-point pressure and corrective exercise cures pain of muscular origin 95 percent of the time.

Myotherapy is an offshoot of the trigger point injection therapy developed by Janet Travell, MD, the White House physician under President John F. Kennedy. Travell treated trigger points by injecting them with saline and the anesthetic drug procaine. While working with Desmond Tivy, another physician interested in trigger point injection, Bonnie Prudden found that simply pushing on a trigger point in a patient's stiff neck was sufficient to loosen it up. After similar results with two patients who had a sore elbow and shoulder, respectively, Prudden began refining the technique that was to become myotherapy.

Myotherapy is so simple that almost anyone can learn it; therapists usually train patients and family members to do it themselves. The trigger points are easy to find because they're relatively painful. You simply press each muscle with your finger at one-inch intervals until you hit a tender spot. You must then continue the pressure until it becomes painful, releasing it as soon as the pain begins. Once the point has released, simple exercises serve to keep the muscle relaxed.

Although myotherapy has never been scientifically validated, it did receive a sort of ad hoc trial over a 5-year period at a General Motors assembly plant. There, the medical director gave myotherapy to 1,000 workers with muscle injuries or other muscle-based pains. He reported a greater than 90 percent success rate, including symptom relief, elimination of lost work time, and reduction of medical costs for x-rays and physical therapy. The majority of patients required only one treatment.

If you have any condition that could be aggravated by deep pressure, it's best to avoid this therapy. For example, if you have fragile blood vessels due to leukemia, you should probably seek another form of therapy. It's also wise to avoid pressure on a tumor, a recent fracture, or a surgical incision.

Pressure on the trigger points is temporarily painful. Bruising is also an occasional problem.

It makes sense to seek out someone trained by the inventor of this form of therapy. A "Certified Bonnie Prudden Myotherapist" receives 1,300 hours of training during a 9-month course at the Bonnie Prudden School for Physical Fitness and Myotherapy in Tucson, Arizona. Certified therapists must also pass a board examination given by the Bonnie Prudden Pain Erasure clinic, and must receive an additional 45 hours of training every 2 years to maintain certification. The school has been licensed by the state of Arizona. In some states, myotherapists must obtain a massage therapy license.

To use a Certified Bonnie Prudden Myotherapist, you will probably need written clearance from your doctor (an MD or DO), your chiropractor, or, in the case of temporomandibular joint disorder, your dentist. (In some states, clearance from a physical therapist is sufficient.)

Myotherapy almost always works very quickly. Therapists can usually tell after one treatment whether the method will help. If it does not seem to be effective, the therapist will probably refer you to a physician who can check for a non-muscular cause of the problem.

After completing the treatments, you'll need to continue corrective exercises at home. They may be needed indefinitely, depending on your particular problem. At age 84, Bonnie Prudden still does them every day.

For anything other than muscle-related pain, you'll need to see a standard physician. For example, if your back pain is due to a spinal tumor or your headache is caused by a subdural hematoma, myotherapy is not going to help. Other conditions that clearly require standard care are a fracture, tuberculosis, or an aneurysm.

For some conditions, it makes sense to see a conventional doctor and a myotherapist at the same time. The myotherapist can provide symptomatic relief of pain while the doctor treats the underlying disease.