Claire Davies Saves My Life--Again!

What one book would I want with me if I were stranded on a desert island? Right now, that book would have to be The Trigger Point Therapy Workbook, by Claire Davies.  I've been working with a chronic pain condition for the past four years.  Self-administered trigger point massage is one of my primary tools.  It's relieved my pain and given me back my mobility.  Without it, I'd probably still be standing when I ride the bus, unable to drive for more than a few miles at a time, and swallowing handfuls of ibuprofen throughout the day.

And I wouldn't have healed enough to get back out on my bike last summer.  My wife loves to bike, and she's missed me for the past couple of years.  But last summer, I finally felt whole enough to dust off my bike helmet, pump up the tires on my Trek, and pedal.  We had a great time riding around Iowa City on weekends.

On Labor Day, we were flying downhill on Dubuque Street toward Waterworks Prairie Park, when the lip of the pavement caught my front wheel.  I crashed down onto my left shoulder and skidded along several yards of concrete.  Di said I was going about 30 when it happened.  I left a lot of knee and elbow on the road and had a lovely bruise on my left hip for quite awhile, but I didn't break anything.  And my bike was fine!  I had a little stiffness and pain in my left shoulder, which I figured would improve with time.  But gradually, the pain has worsened, and my range of motion has become more limited.

My theory about my pain condition is that it's primarily a mental disease.  The problem stems from the idea that the mind is primary and is the master of the body, that will alone can whip the body into line.  When pain flares up, the mind goes to work, trying to solve this problem, trying to diagnose and cure, trying to fix things.  But this approach almost never works with my chronic pain condition, and in fact, it can lead to worse pain and more limited motion.

After I'd been using trigger point massage awhile and had reduced chronic pain to a manageable level, I began seeing an ease of movement therapist.  She's helped me unlearn some of the body patterns that contributed to my pain condition, which has improved my life considerably.  With her help, I came to see that I'd been stretching incorrectly, tensing instead of relaxing into the stretch.  I've had great success with stretching the way she has taught me; I'm probably more limber now than I was before the pain condition developed.

So as the pain in my shoulder grew and my range of motion decreased, I decided to try to stretch my way back to wholeness.  I made what I thought to be an educated guess as to which muscles might be causing the problem and began stretching.  I should have known better.  This was my old mental pattern sneaking up on me again, convincing me that I could diagnose and fix myself.  In fact, I was most likely making things worse.  The pain continued to worsen, and I was having trouble putting on my coat or reaching for dishes in the cupboards.

Yesterday, I was on the road for four hours.  As I got ready for bed last night, I knew I'd be up again in the dark, knocking back some ibuprofen and sitting down with the heating pad.  And I was right.  As I sat on the sofa and waited for the heat and the pills to kick in, I dug out my Claire Davies and flipped through the section on shoulders.  For some reason, I spent some time with the section on the subscapularis.  And there were all my symptoms--why hadn't I seen this before?

I looked at the treatment diagrams and worked my fingers into my armpit.  A flash of excruciating it-hurts-so-good-I-can't-stand-it pain, and I knew I was onto something.  After I'd worked on my subscapularis for a few minutes, the pain was gone.  Remarkable!

So, of course, I've diagnosed and fixed my problem, right?  Wrong!  The tricky thing about trigger points is that the referred pain can create trigger points in other muscles, creating a complicated web of tension and pain.  The pain and limited motion affect the way I hold and move my body, which can overwork other muscles and lead to more problems--which can feed back into the original painful area.  I've learned from hard experience that searching for a single cause and a single fix is pointless and can in fact worsen the situation.  What works much better is a sense of curiosity and exploration, a sense of acceptance of the body as it is in the present moment and a willingness to work with it just as it is.

Right now, I'm typing this blog relatively pain-free.  My shoulder feels great!  I'll continue working with the subscapularis.  But I know I also need to continue massaging my other shoulder muscles, continue exploratory and tension-free passive stretching, continue checking in with how I'm using my body, with how my thoughts and emotions are interacting with my muscles.  It's a way of life, not a quick fix, like a pill, but a very interesting and remarkable journey.

But Claire Davies, you have saved my life again!  Thank you, thank you, thank you!

Tooth and Consequences

About nine years ago, I had my first and, so far, only, root canal.  Of course, beforehand, I had to hear everyone's horror stories.  But I was pretty sure that, compared to my early experiences with dentistry, the procedure would be a walk in the park.  When I was a boy in rural Iowa, my old country dentist drilled without administering novocaine!  I was relieved that the root canal was anticlimactic.  As expected, the procedure went smoothly, and I had very little pain.  It took some trial and error to get what felt like a pretty good fit for the crown.  But eventually all seemed well.  The tooth occasionally felt a little odd, but not painful.

But earlier this year, I began to notice increasing pain in my jaw when I bit down on the tooth.  I tried to chew on the opposite side of my mouth, but whenever I accidentally bit down on the tooth, a stabbing, hot, agonizing pain would shoot up into my cheek, as if someone were jamming a red-hot ice pick up through my molar and into my eye socket--or as if my old country dentist were drilling my molar again.  The pain would last for a couple of hours.  I finally had to admit to myself that I needed to have the tooth examined.

My dentist x-rayed the tooth and saw what seemed to him to be a little bit of swelling between the root and the socket, so he referred me to a periodontist.  But the periodontist saw nothing unusual in the x-rays.  He said he could redo the root canal and it might relieve the pain--or it might not.  Back home, I decided I didn't want to undergo another root canal if there was little certainty of a good outcome.  I returned to my dentist and asked him to smooth down my crown to try to get a better fit.  He did, and I had some relief for a few weeks.  But then the pain came back.

I was stuck.  I was facing the prospect of having to live with increasingly excruciating pain, without any hope of an effective treatment.  Fortunately, or unfortunately, this was a very familiar situation.  A few years ago, I was diagnosed with chronic pelvic pain syndrome--constant untreatable pain in the hips and groin and low back.  Thrown back on my own resources, I found ways of working with the condition that eventually resulted in my being able once again to be fully active without pain.  I knew from personal experience that undiagnosable, untreatable chronic pain can be workable.  So I sat down and began to puzzle through this tooth pain.

I used my mindfulness training to try to avoid chewing on the affected side, and to stay with the pain when I did mistakenly bite down on the tooth.  As I sat with the pain, I tried to release any thoughts it spawned and to relax into the physical sensations.  I gradually came to see that part of the pain involved muscle tension in my jaw and face.  I tried to be mindful of this tension, even when I wasn't in pain.  I soon saw that this tension was the result of a mistaken response to something my Alexander Technique teacher had tried to teach me.

I've been seeing my Alexander Technique teacher for nearly two years now.  She's been helping me recognize and release places where I habitually hold tension in my body.  My pelvic pain condition has melted away, and my sense of well-being and ease has increased.  In the course of her lessons, she pointed out that I tense the muscles that make my lips thin.  I responded by trying to force my lips to purse out more than they had, instead of trying to relax my facial muscles.  This increased muscular tension in the face and jaw was what seemed to be associated with my tooth pain.

I massaged my jaw muscles and used the tools I'd learned from my Alexander Technique teacher to relax my face and jaw.  The result was miraculous!  The pain melted away, to the point where now, I can bite down on my molar and only occasionally feel a little, short-lived twinge.  I remembered reading something about tooth pain in Clair Davies's book, The Trigger Point Therapy Workbook.  I looked it up, and sure enough, Davies wrote that trigger points in the jaw muscles can cause sensitivity in the teeth.

I'm increasingly amazed at the interplay among my mind, body and emotions.  Incidents like this are like windows into the connections among these aspects of self.  I'd rather not have had to deal with chronic pain, but I have to admit that it's given me new insights and opened new possibilities of health and well-being.

The Muscle De Jour

The muscle of the day is: the infraspinatus! I worked it with the tennis ball this morning, and wow, it felt so good! I can usually tell when I'm working an active trigger point. The pressure reproduces some of the pain, along with a kind of energetic rush or tingling sensation.

I'm coming out of my latest step back, in the two-steps-forward-one-step-back rhythm of my dance with chronic pain. I've been through this cycle so many times that now I do not become too anxious or upset when the downward swing happens. I know that I will pull through, and undoubtedly, I'll learn something valuable in the process.

This latest episode started the same day that I had a fantastic session with Rachelle, my ease of movement therapist. I'd felt incredibly light and loose that morning, on top of the world. But that afternoon, my boss handed me an assignment that boiled down to "justify your position." Times are tough economically here at the U, as elsewhere, doubly so because of the flood damage. As I worked on the assignment, I could feel the tension tightening my back like a guitar string. The pain also fed back into the tension. Every twinge seemed to birth a litter of anxious thoughts and emotions. By the end of the day, the last trace of the morning's bliss had evaporated.

Over the next several days, the situation worsened. The pain and tension affected my stretching routine. Releasing muscles was nearly impossible. I felt a strong desire to pull against the already too-tight muscles, which aggravated the pain whenever I mindlessly gave in to the urge. I could tell that a new stretch Rachelle had suggested was triggering something in my left shoulder that sent waves of tension outward, into my low back and hip. I knew I would have to back off, but easing up proved to be a struggle against a rising sense of failure.

Throughout my descent, I managed to continue my mindfulness practice, staying with all the sensations and emotions and thoughts as best I could. I continued practicing the inhibiting and directing I'd learned from the Alexander Technique. I knew that, as bad as I felt, I still felt much better than I had on my good days a couple years ago. And this time, I was able to consciously see what was going on during the entire episode, what had triggered it, what made it worse, what made it better.

Gradually, I found my way into a less painful, more relaxed state. And now, I have more insight into my condition, more confidence that I can work with it and can continue toward wholeness. And one of the good things that came from this latest bout with pain is the infraspinatus. I dug out my trigger point therapy workbook, got on the floor with my tennis ball, and experimented with my shoulder muscles, and now I know that the shoulder pain I've been living with for years can aggravate pain in my low back and into my hip, and I know how to treat it.

I know how to treat it for the moment, anyway. Dealing with chronic pain is like playing whack-a-mole. I've learned that if I let myself think that I've found the one true cause of my pain, the one thing that I can fix and make myself all better, that is when the trouble starts. The key for me has been to continue to listen to my body, continue to let it talk to me, and not let my mind get in the way. My mind wants to diagnose and cure, but chronic pain does not work that way, and in fact, the mind's need to be in charge and to fix things can lead to worse pain, not less.

So, the muscle de jour is the infraspinatus. It feels so good working with it. But it's just the muscle of the day. There will be another tomorrow.