A patient came in recently for acupuncture with terrible upper and mid back trigger point pain that began one day recently after taking a nap. In fact, he had woken from this nap with such bad chest and back pain that he rushed to the ER, fearful of a heart attack. His cardiovascular system checked out fine, and the doctor, who examined him, actually did a physical exam and noted that his back was extremely tight. He also discussed the issue of anxiety, and this patient left the ER with a prescription for Valium. Upon this he came to see me.

When I examined him I could feel painful tender points all through his upper back in the upper trapezius, the rhomboids, and even on his forearms. I could not help noticing he seemed unusually anxious, and even had some mild twitching on his face. His puls was also very wiry (bowstring), indicating a great tension in his nervous system. Taking the case history I learned that he is undergoing great stress, including both work and marital problems, and also is dealing with some major issues involving his two children, both of whom live at home, one a 22 year old boy living with Autism, and the other a teenaged girl. In fact this has been going on for a very long time, and he has even developed non-epileptic seizures in the past ten years.

I could not help notice, too, that this patient’s back and chest pain began after taking a nap. We know that when you sleep unconsious conflicts rise to the surface in the form of dreams, and that, as the nervous system is undistracted by waking tasks, nervous tension builds in sleep, which is why people grind their teeth at night and have nightmares and insomnia. Given the amount of pressure this person feels and how much they have to repress or disassociate from in order to function, ironically, as a mental health professional, i was not at all surprised he might wake up out of a nap in a panic with terrible anxiety induced trigger point pain.

And this is the key point. This patient knew about trigger points, but was confused about their cause. Trigger points are focal points of inflammation in the muscles. But it is inflammation that has as its primary cause chronic sympathetic nervous system drive, also known as the “fight or flight” response. A secondary cause can be overuse of a muscle in the service of a task, such as working at a keyboard for long periods, which is why ergonomics and posture are so important. A third cause can be sudden false moves, such as having your dog bolt while you are holding her leash, as well as sudden overexertion, like lifting a heavy object.

But what this patient said to me was, “how can i have trigger points, I am on an anti-inflammatory diet.”  Key point. I am all for the anti-inflammatory diet. But an inflammatory diet does not cause trigger points. It may increase your propensity for inflammation, but you can not get trigger points from that. It might make your trigger points even worse, and will probably affect osteo-arthritis and many internal disorders like heart disease. But no-one gets active, painful trigger points without one of the above three causes–
1. Chronic fight or flight response: sympathetic nervous system drive
2. Muscular stressors of poor posture and ergonomics or unusual work such as lifting.
3. Sudden false moves, such as being pulled by a bolting doggie.

I think this is really important to understand, as I have observed what I feel to be a trend among people to want to blame so much on diet and to try to cure so much with diet, without regard to lifestyle.Both Chinese Medicine and Ayurveda are very clear on the subject. Diet and Lifestyle are two of the main internal causes of disease. And lifestyle is equal to diet. You can affect your emotional states a little with diet, for example by avoiding caffeine if you are a nervous anxious type, but your excessive propensity for anxiety is part of your bodymind type, the caffeine did not create it and its avoidance, while very useful, will not cure it entirely.

Chinese Medicine is very specific on the affects of the emotions as causes of disease, so much so that long before Freud it had  a name, Affect Damage, and it refers not to the processing of normal feelings, but to the lack of processing of normal feelings so that they build up and become pathological. Anger, Joy, Worrry, Grief, Fear–these are normal emotions we all feel. It is when we don’t face these emotions and admit we are feeling them, that they build up and cause disease, through the endocrine and nervous system’s effect on every single physiological process of the body from circulation to digestion to elimination to muscular tension. We are each of us, too, prone to deeper expressions of particular emotions.

Ayurveda is equally clear, explaining it in a slightly different manner, namely that the three Doshas, Vatta, Pitta, and Kapha, are each increased (and it is this pathological increase that is at the root of disease in Ayurveda) are each damaged by a surfit of a particular emotion. Vatta is increased by fear, Pitta by anger, and Kapha by avoidance.  Also, it says that the Vatta type will be more prone to nervousness, anxiety, and  fear, the Pitta type to intensity, tightness, irriability and anger, and the Kapha type by to lethargy, sloth, and an inability to stand up for oneself. This corresponds exactly to how the fight or flight system works. Actually the fight or flight response is really the fight, flight, or freeze response. When a prey animal like a deer is about to be chased by a mountain lion, it may choose to freeze as well as flee. Most people can remember as a child being so frightened by something that you froze in response. We even have this in our English language, that someone was frozen by fear. The freeze response differs from the flight response both psychologically as well as physiologically. People with the flight response have a fast metabolism, whereas the freeze response usually is associated with a slow one. They reflect two different personality types.

Acupuncture, when done in the Myofascial Trigger Point release style, is a very effective treatment for acute and chronic trigger point pain. It de-activates the trigger points very effectively, and at the same time moves the nervous system out of the fight or flight response into the relaxation response, out of the sympathetic nervous system drive, into the parasympathetic nervous system release. Acupuncture, Ayurveda, and Herbal Medicine can also create the conditions, the open space as I like to put it, for us to change how we respond to the stressors that cause trigger poinnts and all the kinds of pain associated with them–tension headach, migraine, TMJ, jaw pain, neck and shoulder pain, low back pain. In fact, there are many kinds of trigger point pain that actually get misdiagnoised. Often, for example, what gets labeled TMJ is actually simple trigger point pain from the temporalis and mandibular muscles. Acupuncture is far less invasive treatment that orthodontics, which is valuable if the bite is actually in need of correction.

But ultimately, the buck stops with each one of us. Developing the skill set to deal with our innate aversion to stressors is going to be the ultimate key that unlocks the door of trigger point pain. The more you develop the sklls that you get from Mindfulness meditation, skills like progressive relaxation and awareness, the less you will produce the trigger points in the first place. None of us can help the fact that we are human. Even caterpillars have a primitive fight -flight -freeze response. The problem for us humans is our cerebral cortex. When the deer escapes from the mountain lion, first she shivers and shakes, discharging the adrenalin from the experience. Then what does she do? She starts grazing again. Why? Because her brain is less complex. She still fears mountain lions and wants to live, and she will still run or, if cornered, fight for her life. But what she does not do is walk around going, “That damned mountain lion. Why does he pick on me. I am a good deer. If only my mother had loved me I would be better at avoiding that damned mountain lion…etc etc.” Whereas what you and I bring to the table of stressors is all of the rest of our lives with our wounds and complexes. And it is these wounds, complexes, neuroses, unresolved emotions, etc, that, according to our natural unchangeable body/mind type, called dosha by Ayurveda, cause us to add unneccessary responses to stressors, to respond unskillfully to simple things.

You neighbor yells at you because you ask him to move his car so that you can get out of the driveway with your car.  A reasonable request. You have no idea what triggered his inappropriate response to your normal and polite request.  The Pitta type in Ayurveda, when unbalanced, may response in kind, by yelling back. When balanced, the Pitta may use her penetrating intellect to analyze the situation and decide its not worth it, or, even to empathically ask him if he is OK. The Vatta type, when unbalanced might be left shaken by the experience, and when balanced, might make a joke out of it and defuse the situation. The Kapha type when unbalanced might be angry or scared by just avoid dealing with it. When balanced the Kapha type might be very empathically concerned, or might just not care, like water on a ducks back. How these pan out really is also a function of the complexity of your dosha, whether you are Pitta Vatta or Pitta Kapha, for example The above are simplified demonstrative examples.

The key point is that the neighbor’s unreasonable reaction to a neutral request that somehow triggered him, has nothing to do with the request and everything to do with his psyche, his past, his personality type or dosha that all combined to trigger him, like a value added tax VAT. When he yelled at you he was in the fight aspect of fight or flight and this created certain predictable physiological responses. Maybe he has high blood pressure. Maybe you can tell by his body language that his  muscles are very tight. We have the capacity to create great suffering for ourselves or to reduce the suffering that is automatically going to be there. Our mind is like an emperor. It has the capacity to create great joy and rejoicing or great suffering. Mindfulness meditation teaches you how to try to take each step as if it were a royal decree. None of us is perfect, but at least we can try, and it really makes a huge difference, a life changing one, when we do.

So, let’s pay diet its proper due, and have a healthy diet with lots of vegetables, but don’t imagine that that will be  the single solution to all of life’s ills, or that you can treat with food what is created by the mind. Then you would be a body, not a body-mind, or a body-mind-soul. Food is critical, I am an advocate for the role of diet in the treatment of disease. You can’t cure with a drug what you have created with a lifestyle. But lifestyle in Chinese Medicine and Ayurveda includes everything you do with your mind, what is called Mental Culture in the east, so a true detox diet includes detoxifying our mental processes. Happy Spring!

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