Trigger points & afib, an experiment

Recently, Jackie posted on ribose [www.afibbers.org]. In this post Dr. Teitelbaum is quoted as saying, "I strongly encourage you to explore the role of Trigger Points (TrP's)/muscle reflex arcs in atrial fib." In a reply of mine, <[www.afibbers.org];, the location of the arrhythmia trigger point is described.

Now, though I own "The Trigger Point Therapy Workbook", I completely missed this reference to arrhythmia before Jackie's post.

Anyway, last evening I started feeling around & sure enough there was a sore point in the general location described. I was a bit surprised. Since I've not had afib recently, I can't say that massaging it has any benefit. Though I only had 1 PVC and 0 PAC's in 25 minutes of recording my heart this morning. This is low, but not unheard of for me (last night I had 5 PVC's in 25 minutes). I will be interested to see if the average ectopic rate for me decreases.

Here is a more detailed description of the location of this point. It is about an inch below my right nipple and slightly to the right. If I follow the space between my ribs to the center of my chest, it is about even with the zyphoid process. I found this point by using all four fingers and pressing fairly hard in the space between the ribs, and slightly up. I moved my hand back and forth in this space till I found the sore spot. If you want to try to find it, I would suggest moving your had horizontally with the fingers in the space between the ribs. You may want to try several different sets of ribs.

It would be interesting to: 1) see how many of us have this sore trigger point and 2) whether massaging it has any benefit to your afib. You might try this and post your results.

Again, the protocol is to massage this point with 6-12 strokes, 3 or 4 times a day till it is no longer sore.

George

thanks George--am trying it--Found it! Ouch! Still in Afib though, but will con- tinue per protocol, Thanks for the helpful directions.

Louise

George! Good sleuthing. Maybe we have stumbled onto something courtesy of Dr. T. Keep us posted on your readings and the massage in that area. I'll check mine as well for soreness.

Do they describe the massage technique. Back and forth; circular; always in one direction - like always up or down or from outside to inside of the circle... like towards the heart?

I have to comment that a physical sign of iodine deficiency is tenderness along the breast bone (which ends up at the xyphoid process (XP). All along there, if it is sore to press, it is said to be an indication of iodine deficiency. That said, because I also have fibromyalgia, all along the breast bone where the ribs attach, I'm highly sensitive to any inward palpation with pressure. It's extremely tender and that tenderness extends all along the whole area of the XP so I probably am not a good example of what's normal tenderness and what's not.

So, I'll just be interested in what your massage technique on this particular topic does in terms of your monitor etc. You are the chief experimentor!

Good job.

Jackie

Hi Jackie,

More info can be found on Clair Davies's website [www.triggerpointbook.com].

I will note that in my experience, their is a "point" that is sore, not like "all along the breast bone where the ribs attach."

I'm at my office, where I don't have the book, so can't give more detailed description of how to massage. Davies does say to be careful not to hurt your fingers when massaging & recommends tools like these: [www.triggerpointbook.com]. I don't worry about this too much with one or two points, but you could have an overuse problem if you were going after a lot of points. I do press pretty hard on the points.

As I've stated before, Davies's book is based upon Travell & Simons' book, but is really meant for self treatment and spends a lot of time talking about self-massage. Davies' helped himself by studying Travell & Simons, then went and became trained as a massage therapist (at age 60!). He originally was a piano tuner/rebuilder. Obviously Dr. Simons thought highly of what Davies did as he wrote the forward to the book. Davies's story is here: [www.triggerpointbook.com].

Jackie FYI here is a bit on fibromyalgia and chronic pain [www.triggerpointbook.com].

Hope this gives people a bit more to go on.

George

Here is another description of the trigger points:

"a palpable nodular or band-like hardness in the muscle, a highly localized spot of extreme tenderness in the band, reproduction of the patient's distant pain complaint by digital pressure on that spot [referred pain], and relief of the pain by massage or injection of the tender spot."

From: "Janet G. Travell, MD, A Daughter's Recollection,Virginia P. Wilson [www.pubmedcentral.nih.gov].

An interesting anecdote from the above - Dr. Travell was appointed the White House physcian under President Kennedy. Here is the quote: "After President Kennedy's assassination in 1963, his successor, President Lyndon B. Johnson, asked my mother to stay on in the White House as his physician. A year and a half later, she resigned to return to private practice and to write her autobiography. At the occasion of her farewell party on 25 March 1965, the Johnsons gave her a small framed document that said, 'Prescription for Happiness' from 'Drs. Johnson & Johnson & Johnson & Johnson, 1600 Pennsylvania Avenue, N.W., Washington, D.C., Office Hours Day & Night, BAckache 0-0000. 1 large dose of Dr. Janet Travell. Take frequently. A sure cure for aches, pains, occupational hazards, and general complaints on and off whistle-stops, in the White House and out. Lyndon B. Johnson and Lady Bird Johnson.'"

I would say that Davies's contribution was to focus on addressing trigger points with massage rather than vapocoolant spray to the skin over the trigger point or an injection of Procaine Hydrochloride at the point as Dr. Travell did.

George

Thanks to Jackie and George N for sharing their knowledge and raising this topic.

I certainly am going to try the trigger point described by George, though I hope the reason for doing so never presents itself. Applying point pressure to that area now as a test showed it be rather sore.

For whatever it is worth, I have apparently terminated active bouts of afib and other arrythmias by applying deep, persistent massage/pressure to certain places on my body. I say 'apparently' with purpose; coincidence is not necessarily cause and effect. Having said that, it has always worked for me in conjunction with a quick acting benzodiazapene tranquiliser such as lorezapam.

One of the key words in this technique is DEEP -superficial application of pressure will not suffice. It is also more effective and with faster effect when another person is doing it to you, though I have stopped episodes of afib by myself. Patience and persistence are also keys. It takes time for me, as long as several hours of working the areas described below, to finally revert to NSR.

One area to treat is located about the middle, outside full length of the thigh. If memory serves correctly -and it might not- the muscle of primary interest here is a relatively narrow one named the fascia lata. Massage this muscle (and later those nearby) deeply with the knuckles of the hand along the entire length of the thigh. You are likely to feel knots, ie, groups of muscle fibers in spasm and/or quite tender spots as you traverse the muscle and those nearby; apply extra massage to these areas until you relieve them. I have found it beneficial to then work all the muscles of the thigh, anterior, medial etc.

The other area is located along the edge of the shin bone and the adjacent muscle on the *outside* of your leg. Look at the outside of your leg and find the top of the shin where it is bounded by the muscles on the side of the calf; it is located below the bony processes beneath the knee.

Deep pressure applied to this junction and continuing downward several inches towards the ankle may well produce surprising tenderness. You may have to dig around a bit to find the proper area. It is important to note that the massage/pressure is not applied on the shin bone itself but instead in the boundary between the edge of the bone and the adjoining muscle.

I have found this point to also be helpful with GI disturbances. As a number of posts in these fora have indicated, there may well be a meaningful relationship between GI disturtances and afib in certain people.

[en.wikipedia.org]

George - thanks again for all the information. My fibromyalgia is mostly under control. I have a massage therapist who does trigger point therapy and deep tissue massage if I need it. It's fairly painful, but effective.

Because of the protocols I've learned from Dr. T and my own FM MD - plus the ribose, I'm about 95% better than I was at the worst phase.

I'm still very interested, though, in the use of this therapy for afib and while I hope I never get to try it out, it will certainly be on my list of 'to do immediately.'

Thank you, Mako for you input as well.

Jackie

I would be grateful for any reports in this thread of success or failure in terminating afib by deep pressure/massage of the 2 body areas I described above -and also of course would like to know this regarding the trigger point suggested by George N.

PS the full correct name of first area I described above is the Tensor Fascia Lata. It is pictured at:
[www.rad.washington.edu]

Mako,

Thanks for your input.

George

GeorgeN wrote:

>
> It would be interesting to: 1) see how many of us have this
> sore trigger point and 2) whether massaging it has any benefit
> to your afib. You might try this and post your results.
>
> Again, the protocol is to massage this point with 6-12 strokes,
> 3 or 4 times a day till it is no longer sore.

Found it easily after reading the other thread - just as you describe and very obviously a sore spot - don't know whether this stopped the 'jumps' as I'd also already taken some extra magnesium and potassium .... but thanks for the info.

Joyce

mako wrote:

One area to treat is located about the middle, outside full length of the thigh. If memory serves correctly -and it might not- the muscle of primary interest here is a relatively narrow one named the fascia lata. Massage this muscle (and later those nearby) deeply with the knuckles of the hand along the entire length of the thigh. You are likely to feel knots, ie, groups of muscle fibers in spasm and/or quite tender spots as you traverse the muscle and those nearby; apply extra massage to these areas until you relieve them. I have found it beneficial to then work all the muscles of the thigh, anterior, medial etc.

Mako,
is this left, right or both?
TIA
Joyce

Joyce,

Thanks for the response!

George

Mako,

Are your thigh & shin areas sore all the time, or only when you are in afib? Also could regular attention to these areas be preventative?

George

>Mako,
>is this left, right or both?
>TIA
>Joyce

Hi Joyce,

Jolly good question. My natural inclination is to be on my left side with the outside of my right thigh facing up and attend thusly to the right thigh first and for the longest time. (Maybe because I am right handed?) Then I eventually roll over and do the left thigh (with my left hand) So for me it is both thighs but always the right first and definitely the more extensively worked over. In summary I get relief from both but primarily from massaging the right tensor fascia lata and surrounding muscles. The same degree of 'sidedness' applies to my 'shin area'.

Why? I do not know, it is a natural sequence for me. If it is different for a left handed person or if a right handed person has a different sided response, I would very much like to know.

Also of great interest to me is why this works at all -at least appears to work for some people. Is it a general relaxation effect via beneficial brain neurochemical release, placebo (the same thing only for a limited term) or is a beneficial stimulation of specific neural reflex pathways being effected, or does it stimulate nerves in the brain which are adjacent but have completely different organ innervation? Or, none of the above?

I don't think, for me at least, it is just a general relaxation effect as the same results are not forthcoming from deep massage of other areas, I also tend to discard a placebo effect because of the long term efficacy in me for tachycardia, PVCs and GI travail. But then I have only had a few EKG confimed episdoes of afib, the one where I was unable to apply the techniques described lasted 6 times longer than those several where I did treat the described areas. But I am just an experimental body of one with a limited set of events. We must also consider the possibility that the termination of these events was going to happen when they did with or without deep massage of these areas. I do not think that is the case but have no means of proving it by myself.

>Mako,

>Are your thigh & shin areas sore all the time, or only when you are in afib? >Also could regular attention to these areas be preventative?

>George

Hi George

All the time to a small degree, ie, not noticable unless palpated deeply, but definitely much more tender when any type of arrythmia and/or GI tract disturbance is present.

Because I have not tested it, I cannot opine save in a very general sense on whether there is any preventive value of stimulating these areas. I suspect there might be value. One thing I do know is that the beneficial effect -however it actually works- of the 'laying on of hands' is fairly well accepted in medicine these days.

Thanks for the extra detail Mako.

My own inclination would be massage of my right thigh, partly because I get some discomfort in that leg anyway. [both hips are resurfaced repairing OA joints] and I am right handed.

Joyce

has anybody tried these yet? Fail or worked good?

I used the rib point last Sun/Mon night when I woke with tachycardia at 1am didn't flip into afib and I went back to sleep so assume my heart settled down.

Joyce