The day started with heavy, heavy neuroanatomy and pain physiology from the world expert and co-author of the definitive book Muscle Pain, Dr Siegfried Mense from Heidelberg.
Don’t buy this book!! It’s eight years old and a 2nd edition is due out later this year.
People balk at the deep science of pain, but I find it fascinating. Knowledge of the anterior cingulate gyrus and the periaqueductal grey (PAG) needs to be understood. (One is the unique cortical structure that is active only with muscle pain and the other is the modulation or inhibition system needed to reduce the perception of this same muscle pain.) Dr Mense is a genius and very funny and a very approachable guy too. Can’t wait for his new edition; we’ll sample from it often in our teaching.
Next on the podium was Dr Jay Shah, the bestest trigger point researcher from the NIH, Bethesda. He was mobbed at the end of his presentation (and remember this place is full of DCs) demonstrating the power of his information. Being totally accomplished with powerpoint means he could inform, entertain and enthrall. Biased, me? Yup.
Thanks the publications by him and his colleagues there are now chemical and visual proofs of myofascial trigger points (TrPs). Vibration sonoelastography imaging (external vibrator in combo with Doppler technique) has shown areas of hypoechogenicity indicating blood vessel compression within palpable TrPs (Sikdar et al. Arch Phys Med Rehabil 90: 1829-1838, 2009). We’re on the map, but don’t expect Medical Schools to be teaching this stuff within the next decade.
The last lecture slot was filled by the organizer Michael Schneider DC, who’s borrowed some of Steve Carell’s ‘The Office’ style of presentation technique. It was hoped that David Simons would be able to attend and lecture but sadly his widow Carol McMakin told of DGS’s recent demise. I will post a memorial blog devoted to David very soon and reveal some of his deathbed confessions because each participant was given a CD of his most recent work.
Schneider’s job was to trawl and sift through the literature to help explain and distinguish Myofascial Pain from Fibromyalgia (whatever that is). He did a great job on this most important topic, recommending multidisciplinary approaches as promoted by the American Pain Society (APS). This prestigious body supports anything that minimizes pain, improves sleep quality, and enhances self-efficacy and a positive mood. Modalities singled out as beneficial by the APS included hypnosis, biofeedback, manipulation, therapeutic massage and balneotherapy (water-based therapy). This all sounds like what do and what we would love to do at 360NMT.
The afternoon was filled with more practical stuff as outlined in the previous blog and I’ll say it again ‘all presenters had a strong belief that their particular modality was theanswer to myofascial pain and dysfunction.’ This despite the fact that not one of these sessions introduced or promoted any form of trigger point therapy and many had no, zero, nada to offer in the way of research backing.
Our work is still not done.