myofascial trigger point therapy myotherapy Pittsburgh School of Pain Management

At The Pain Center, Relief Is Just An Elbow Away

by Jane Miller

The following article first appeared in the June 5th, 1996 Pittsburgh Post-Gazette

Two years ago, Susan Mack, 45, was near death. A professional photographer in New York City, she vomited at least three times a day and had become completely bedridden from muscle pain and weakness.
"I was misdiagnosed by the best," said the petite woman with white hair and dark-rimmed glasses. "People said I looked like Andy Warhol on a bad day."
Her sister knew of work done at the Center for Pain Treatment on Pittsburgh's South Side and called to talk to a therapist. Over the phone, the therapist gave directions for muscle therapy on the diaphragm, which stopped the vomitting immediately. Her family flew her to Pittsburgh and carried her into the center, where she received more muscle therapy similar to the kind President Kennedy received as a young senator for a bad back and other health problems.
For the next month, Mack underwent three hourlong treatments a week. She returned to New York but continued a regimen of muscle-stretching exercises while also eating a high-vitamin diet, including raw vegetable juice.
Within four months, the patient whom doctors had written off felt like her old self. And she had decided to switch careers, learning how to perform the techniques that had made her well again.
Mack recently graduated with the first class of the Academy of Myofascial Trigger Point Therapy, located above the Center for Pain Treatment. Now she uses her hands, elbows and body weight to provide muscle therapy to people who are in pain in a method known as myotherapy.
The nine-month program, one of only two in the country, teaches methods pioneered by Dr. Janet Travell, 94, who as President Kennedy's personal physician modified the famous rocking chair to ease his chronic back pain.She also co-authored with David Simons one of the top books on the discipline of myotherapy.
"Myotherapy is a respected modality with doctors who are in the know when it comes to pain," said Richard Finn, the school's director, a board-certified trigger point myotherapist. "We're very much mainstream medicine, even though a lot of people haven't heard of us."
Myotherapists are quick to point out that their work is not massage. Fully clothed patients sit or lie upon a portable table as the therapist applies pressure to the knots, or trigger points, of specific muscle groups.
For approximately 7 seconds, pressure is applied while the therapist stretches the muscle, stretching the muscle more fully as more trigger points are treated. For delicate muscles, such as in the neck or head, a therapist applies pressure with a thumb or finger. On larger muscle groups, such as in the back and legs, a therapist may apply pressure with an elbow.
Patients feel temporary pain throughout the length of a muscle. But upon release of the pressure, the muscle becomes more flexible and softer.
Trigger points are tears in the muscle fibers where muscle tissue has jammed together, Finn said. It causes a muscle to tighten, or shorten, and gradually leads to pain in other parts of the body, which often causes misleading symptoms.
In an auto whiplash injury, for instance, the trigger points caused by injury to the neck muscles may refer pain to the shoulders, forearms and eventually the fingertips. The pain is relieved when pressure is applied to the knot in the muscle, and the muscle gently stretched, said Tasso Spanos, who started the pain center and brought Finn to Pittsburgh from a myotherapy practice in Colorado.
Spanos first learned about myotherapy more than a dozen years ago. He taught himself to treat his wife, Becky, who had polio as a child, and always walked with a cane. After several treatments, she gave away the cane, he said. Spano later received formal training as a myotherapist. Their son, Mark, is also a certified myotherapist.
Many of the academy's students began as patients. Others came because they saw it work.
"It works. It works fast. They know it immediately. You see peoples eyes light up," said Martha Bell, a recent graduate from Hickory.
She watched Spanos treat her husband after he had injured his shoulder shoveling snow. Her husband had gone through X-rays, a CAT scan, and was scheduled for exploratory surgery when the Bells heard about myotherapy.
"A friend said, "You need to go see Tasso. It sounded to us like voodoo," Bell said.
But the treatment made her a believer.
"He was fine after that. A lot of muscle pain can be fixed," said Bell whose former profession was in the visual arts and dance. Myotherapy is also beneficial to performers, such as athletes, dancers and musicians, whose abilities can be restored or improved, she said.
Dr. David Goldstein, a North Hills specialist in physiatry, has seen myotherapy work for his patients and himself.
"I deal with people who have muscular-skeletal problems. I learned about myotherapy in residency, but never found anybody who treated quite as effectively as Tasso and his group."
One of his patients discovered the pain center two years ago.
"This particular patient found (Spanos) on her own and came back and said her pain was tremendously better, and she had had this pain for years. I perked up and took notice. Anything that helps the patient feel better is a tool that can be used," said Goldstein, who has received myotherapy treatments for his back problems.
"It's this whole field of soft tissue medicine that is poorly understood by most physicians. It doesn't show up on X-rays or tests, and can be really frustrating to treat. But if you know what to look for with trigger points and patterns of pain that show up at a distance, it makes sense."
Why isn't myotherapy better known? Although muscles make up 50% of the body, there is not a specialty in this field, says Spanos.
"The information is out there, but the texts often languish in medical libraries."
In the fall, Finn and Spanos will speak at the American Academy of Pain Management, which will be attended by 13,000 physicians from all over the country. Their mission, they say, is to spread the word about the healing benefits of trigger point myotherapy and to teach Travell's techniques.
The causes of trigger points vary. A trauma injury, such as an auto accident, is common. For some people, muscle weakness and pain can be caused by stress, a high sugar diet, food sensitivity or repetitive motions such as typing. Mack believes her severe muscle weakness resulted from chemical poisoniing during the renovation of a building where she lived and worked.
Before students enter the academy's program, they must do rigorous studies in anatomy and physiology. During their training, they practice myotherapy techniques on community volunteers. Finn says prime candidates for his treatment suffer from chronic pain that has not responded to other treatments, drugs or surgeries. Aflictions include carpal tunnel, migraines, tennis elbow, and low back pain.
"We treat numerous patients who have had doctors give up on them," Spanos said.
That would include Mack, who plans eventually to return to New York City and open a practice as a myotherapist. For now, she's living on Mount Washington and helping out at the clinic and school.
"Photography didn't save. This did," she said.

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