Yes, there is a lot of 'challenging' information in the ebooks. Like you I found the stuff about adhesions really interesting, as it ties in with so much we've all said about the trigger points being so bad and the muscles so much in spasm that it's virtually impossible to find the actual trigger points when you first 'go in', and that with gentle stretching and lots of massage (be it simple massages or specific trigger point / myofascial release) you should see a general relaxation begin and eventually you will start to locate the trigger points and keep progress going.

The thing that got me was reading about doing self massage / working on trigger points at least 5 times a day! That's a lot, way more than I thought, but doing that gently does kind of make sense. As long as it's not so hard it causes a bad flare up.

The opinion on the Davies book is interesting. I think I read that it's good as far as it goes (seeing as how Davies has sadly passed away now and it is unlikely to be updated with all the new information coming out) but is sort of like the tip of the ice-berg; it's just a bit too simplistic in that it sort of says 'press here and all these problems will go' and I do agree quite a lot with that. It promises quite a bit with just the trigger point work when we all know there's unfortunately a bit more to it than that. It's still a very good reference book though.

The other thing that really struck me is that alot of us here on this site are at the really 'extremely bad' end of the myofascial pain spectrum that perhaps most therapists haven't seen many patients quite as bad as we are. It's almost that our treatment plan is the 'standard' plan and then some. And the 'and then some' is almost an unknown quantity. I know that generally muscle relaxants don't come out well on the site but I couldn't function without them. But then, I used the muscle relaxants to work a bit too much and look at what that's done to me! There's so much info on that site It messes with my mind, so I keep reading little bits, try and process it, the a bit more!

Pumpkin, I agree with your observation that many therapists are at a loss on how to treat patients like us who have MPS for a long time. Even the literature describes treatments that might work on ordinary trigger points. It seems to me that the longer a person has this condition, the more the muscles turn into a rat's nest that's difficult to untangle.

Yeah, this ebook talks about the hard cases, for instance those who are "triggery." He mentions:

"a classic case of a triggery patient: someone whose muscles were extremely prone to extreme trigger-point formation for unknown reasons. There was probably some X factor in her case, something about her that predisposed her muscles to this fate. But her doctors had certainly cleared her of any obvious diseases, and having X factors that complicate myofascial pain syndrome is the norm. Almost every case of myofascial pain syndrome is aggravated and sustained by poorly-defined X factors. The problem is that, in her case, she had some crazy perfect storm that resulted in one of the worst cases Ive ever heard of one of the worst that was still clearly myofascial pain syndrome, anyway.

Theres another way to be triggery: instead of being bizarrely intense, trigger points can also be bewilderingly numerous an endless plague of more or less average trigger points. This is particularly striking in the young, who seem prematurely aged by the profusion of pain and stiffness. I have seen many minor examples of this in my own massage practice, and heard about more dramatic cases from readers around the world. They are characterized by common symptom themes for instance, an area like the low back, or the right side of the body, may consistently be the most troubled but also by a steady supply of unpleasant surprises in other areas of the body, and constantly shifting cravings for pressure in different location."

chimerical, since I've studied and learned more about anatomy, about fascia, about muscles, about ligaments, about how everything is connected, and how all sorts of posture/alignment/stress/deconditioning/imbalances etc. can lead to symptoms of MPS, I've realized how NOT bizarre or mysterious trigger points are.
I feel like anyone who has had MPS or still experiences it has a lot of fear of the unknown -- but trigger points don't appear from nowhere...even if a massage or other bodywork therapists makes you feel like you have the "worst" case or whatever.
I'm not saying that makes it easier in terms of coping or unwinding the ball of yarn that is MPS, but the more I've learned the more I've understood that it's not some sort of bizarre mystery, like a weird growth or some unknown cancer of the body. Instead, the various "x" factors (everything from trauma and injury to hypermobility or lack of joint mobility or muscle weakness/imbalance, poor posture, etc.) lead to trauma of sensitive connective tissue that can lead to trigger points of all shapes and sizes -- and sure, I think some people are more sensitive to it than others, but other people end up with other stuff like disc degeneration, spinal stenosis, osteoarthritis or other things.
Again, I'm not trying to downplay the misery that MPS can create, but I do feel like I had a lot of fear about this condition and the more I learned, the more I could calm down about fearing the "unknown" and I could start unwinding the problem and begin to deal with it little by little.
:)
Sharon
www.bodymeow.com

The ebook likens trigger points to acne:

"Both are common. Practically everyone has a few pimples, and a few trigger points. Got skin? Youll have pimples. Got muscle? Youll have trigger points. A few lucky people have very few of either. A few unlucky people have a lot.

Both are dysfunctions. Just like pimples, trigger points are small dysfunctional (sick) patches of tissue. A pimple is a tiny infection, which is certainly quite different than a trigger point. But the infection occurs due to subtle dysfunction of the organ (skin is often considered an organ in physiology). Skin is mostly quite good at preventing pimples, but sometimes it fails. Pimples occur here and there when something goes a little bit wrong. If it starts to happen a lot, something has gone wrong: the skin isnt working quite right, and bacteria take advantage of the situation. Similarly, muscle tissue is mostly good at not getting trigger points. But trigger points occur when something goes a little bit wrong

Both come and go without much rhyme or reason. Some risk factors for both problems are known: muscle fatigue will provoke trigger point formation, excessive chocolate consumption may give you a pimple bloom. This book offers quite a lot of detail about why trigger points may occur. However, in both cases, no one really knows why some people get so many, and others get hardly any at all.

The take-home lesson is that trigger points are a more or less inevitable by-product of having muscle. In the broadest possible terms, I believe that trigger points, like pimples, are a natural consequence of the physiological trade-offs involved in having high-functioning tissue that cant possibly work perfectly all the time, under all conditions.

Both muscle and skin are much more volatile and biologically intricate tissues than most people suspect. They are busy. They do a ridiculous amount of work, just like the more obviously complex tissues. Nothing in the body is really inert or boring and muscle and skin are much more complex than most people suspect. Even physiologists are more or less constantly amazed by their complexity, even after a lifetime of study, even after the last century of surprises."

I just wish I'd realised this way back in the day when I first heard I had MPS. All I had was this weird diagnosis, next to no treatment plan other than analgesia and stretches. It was only doing the pain management course that things came together, only to then fall apart spectacularly from 2009 onwards as stress and overwork took hold. I'm actually going to suggest to the pain management people that they do more on the importance of managing stress next time I go back to do the 'past patient' talk.

I've also realised how wide the spectrum of trigger points and myofascial pain is. What alot of us experience is so far and away from the odd trigger point or not.

Where I am now is waaaaaaaaaay way worse than when I was first diagnosed with the mps. If I'd realised what I was dealing with I could have been more protective and tried to prevent most of the reinjury that happened and made it all much worse. TPs love company, and where there's a few if you're not careful there will be lots and lots and it gets harder to get in control of them.

What this means for me in practical terms is that my goal isn't to find and eliminate all TPs, but to focus on the wider picture of increasing mobility, decreasing pain, reliance on medication and stress. So there's bound to be alot of 'maintenance' of any improvements which is going to make the future 'interesting' but I've just got to accept it and get on with things.

pumpkin, I totally agree -- once I started taking the focus off of specific trigger points and started addressing the wider issues of stability, mobility, alignment, breathing, etc., (as well as pain reduction, as you said) the light bulb went off. Not that every trigger point disappeared right away -- okay, it took years to re-jigger myself -- but there were definite changes over time that gave me confidence to keep going -- and today even the peskiest ones are gone. And the fatigue that accompanies the trigger points (I never even realized how much energy they suck up) has reduced as well.

That reduced fatigue is what I've noticed too and most enjoyed. I've had trigger points flaring for a week. Stress, short and cold days, I think. But no exhaustion accompanying them. No depression either.

You gave a very good analogy, Pumpkin. The perpetuating factors that we frequently discuss include genetics and the individual's body constituion. I do belive the condition goes further than body mechanics as evidence by the large number of accompanying conditons that have nothing to do with MPS, such as Raynaud's syndrome. That's not to say that I discredit anything Sharon is stating. Quite the contrary, there is a maintenance peice to this ailment that is most likely lifelong but certainly beneficial.