The Tantalizing Balance Between Treatment & Exercise

Achieving treatment balance is very important and can sometimes be a little bit confusing. Here’s a letter from one of the sincere readers which we gladly answered.

HI Jonathan
I just read your passage on weak core muscles and I totally agree. The one question I have and have asked several times recently while attending a Pain Management Course is: Don’t you want to first release any trigger points in the core and make sure that they are completely relaxed and gone (waiting up to 10 days) before exercising those muscles? I have had physical therapist have me exercise that area only to find an immense increase in pain while having more trigger points “pop” up. Would it be best to not have trigger points in that area and to exercise the core as preventative not curative for them? A good analogy that comes to mind is that when you wake up in the middle of the night with a charlie horse in your calve muscle your first instinct is to rub and stretch the constriction not jump out of bed and take a run down the street to strengthen it. Could you please elaborate on this subject? I really love and respect your website, it has been most helpful. Both my daughter and I read your articles regularly. Thanks for taking the time to post them. Sincerely, Krista

The answer

Hi Krista,

This is an interesting question. Often core muscles will harbour Trigger Points [TrP]. This is because they are primarily posture muscles made up of type 1 fibres [grunty workhorse fibres] which are more vulnerable since they are constantly used & abused by us during normal activities. Therefore jumping in and exercising these muscles to ‘strengthen your core’ will often turn the TrP’s on and increase your pain and spasm.

So it makes perfect sense to first switch them off and then stretch the muscle to length [resetting the tight band that the TrP resides in]. That’s the key for treatment balance. Once they are relatively quiet, you can start the process of exercising and strengthening.

The TrP is merely a reflex spasm which is fed by a simple reflex arc. So in theory, once it is switched off, the muscle should function normally. However often there are more than one TrP and our ability to switch them off may require a few treatments. There is really no need to wait ten days or any prescribed time after a treatment before you start strengthening.

This is a case of feeling your way and using your inner sense. Once you have treated the obvious TrP’s in your core muscles and your back feels better- then gently start a few gentle strengthening exercises. All the time you are monitoring how your back feels and checking to see what has happened to the TrPs. Often the exercise may feel slightly uncomfortable and when you recheck – you find 1 or 2 TrPs have turned on. Then treat those for a couple of days and then try again. You should find that as your muscles become stronger and more healthy, the TrPs stay away. If they recur they will be easier to treat.

Essentially you are treating & strengthening the posture muscles so they can do the job they were designed to do. The entire treatment balance is all about this.

You can do this process on your own or with the help of a switched on the therapist.

Always remember – You are the one with the Inside Information.


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(2) comments

Sandra May 15, 2011

Hi Jonathan,
I am finding all your information extremely helpful.Especially the answer to Krista as I think I am at this stage in my recovery at the moment. After 2 years of pain in my leg and having spent $1000’s of dollars in treatment for multiple theories I came across your website and instantly recognised my problem. No thanks to pain specialists and other practioners with no knowledge of trigger points. After the first treatment I noticed a difference. Now I am able to sit down without having to jiggle around in pain. Because I have multiple trigger points that are still causing pain it is taking a while and I would really like to return to the gym. So to treat triggers as well as light exercise sounds great to me. Thank you very much. I will continue to read up on your website and I send all your information to my son who is a personal trainer in Sydney. He didn’t know about these either.
Regards Sandra

Link January 5, 2014

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