A Complex Case of Nerve Entrapment Pain (Post-Surgery)

It's important to know the progression of muscle fiber dysfunction to better understand how to treat and how long it may take to correct the problem.   The analysis of current research provides substantial evidence supporting the progression of muscle fiber dysfunction as a significant contributor to musculoskeletal pain, aligning with the hypothesized sequence: sustained muscle tone leading to long-term muscle fiber shortening, which subsequently culminates in painful myofascial trigger points. The initial phase of this progression is rooted in the transition from normal physiological muscle tone to a state of pathological hypertonia or chronic muscle overload. Sustained low-level muscle contractions, even at submaximal levels, are shown to generate sufficient intramuscular pressure to compromise local capillary blood flow. This circulatory impairment leads to localized ischemia and hypoxia within the muscle fibers, precipitating a critical "energy crisis" due to insufficient ATP production. This energy deficit is pivotal for the subsequent development of muscle fiber shortening. ATP is indispensable not only for muscle contraction but also for the crucial process of muscle relaxation, specifically for the detachment of myosin heads from actin and the re-uptake of calcium ions. When ATP is depleted, these relaxation mechanisms fail, resulting in sarcomeres becoming locked in a state of sustained, pathological hypercontraction. This localized shortening at the sarcomere level forms the palpable "taut band" that is a hallmark of myofascial trigger points. Over extended periods, such sustained pathological shortening can also contribute to broader structural changes like muscle contractures, involving fibrosis and a permanent reduction in muscle length. The culmination of this progression is the development of painful trigger points. The sustained sarcomere hypercontraction, driven by the energy crisis and calcium dysregulation, creates a severely acidic local environment. This acidic milieu, coupled with tissue injury from prolonged ischemia, triggers the release and accumulation of various neuroactive and inflammatory mediators. These substances directly stimulate and sensitize muscle nociceptors, manifesting as the exquisite tenderness and characteristic referred pain associated with active myofascial trigger points. Furthermore, the pathophysiology of myofascial trigger points is characterized by a complex, self-perpetuating vicious cycle. The energy crisis and subsequent acidic environment inhibit acetylcholinesterase, leading to prolonged acetylcholine effects and further sustained muscle contraction. Concurrently, mediators like calcitonin gene-related peptide (CGRP) not only potentiate muscle contraction but also directly activate nociceptors. This intricate feedback loop ensures the chronicity of the condition, as the consequences of muscle shortening directly exacerbate the initial problem of sustained contraction and pain. This comprehensive understanding of the progression from sustained muscle tone to muscle shortening and painful trigger points has significant implications for both clinical practice and future research in musculoskeletal pain. For clinicians, it underscores the importance of early identification and intervention for chronic muscle tension and overuse, aiming to disrupt the energy crisis cycle before fixed structural changes or chronic pain states become entrenched. Therapeutic strategies should not only target pain relief but also address the underlying metabolic and biomechanical dysfunctions, including restoring proper muscle length, improving local circulation, and resolving the energy deficit. For researchers, the identified roles of specific molecules like CGRP and the intricate feedback loops within the "energy crisis" model present promising avenues for developing novel diagnostic markers and targeted pharmacological or rehabilitative interventions that can effectively break the self-perpetuating cycle of myofascial pain.   Online Courses: https://richardhazel.podia.com    

I almost never hear discussion about this muscle for midback pain.    My two cents about this muscle and how to assess and treat it.    Online Courses: https://richardhazel.podia.com    

I'm walking you through how I assessed and treated a complex case of cluneal, sciatic and possibly pudendal nerve symptoms. As well as managing the patient's anxiety when symptoms flare.    Online Courses: https://richardhazel.podia.com    

Have you seen neuropathy and chronic myalgia that patients believe happened after taking Cipro?  I've seen it several times.  This might be one of those cases. Best sleep he's had in 20 years after the first treatment of what looked like Sural Nerve Entrapment. I'm covering the Sural Nerve Entrapment in Sydney at the end of March.   https://chinesemedicineeducation.com/product/motor-point-acupuncture-trigger-point-needling-nerve-entrapments/   Online Courses on Podia: https://richardhazel.podia.com For the month of March (my birthday month) I'm giving discounts. 20% off any courses and bundles with the code MARCH20 50% off the Motor Point Location Video Course with the code BIRTHDAY50  

I had an interesting case this week of NTOS and he also had tinnitus that improved from the treatment.   Online Courses: https://richardhazel.podia.com   IG: @richhazel  

The book Crooked by Cathryn Jackobson Ramin is a must-read book for anyone who works with back pain patients or is considering a back surgery for low back pain.   I talk about research the author mentioned and some other research that will blow your mind.   Crooked is available on Audible if you prefer an audio book.  https://www.cathrynjakobsonramin.com/   The Value of Magnetic Resonance Imaging of The Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects   The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials   Online Courses: https://richardhazel.podia.com  

Anterior shoulder pain on shoulder flexion Anterior shoulder pain on planting a ski pole Pseudo Frozen Shoulder Restricted Shoulder Flexion All cases I saw this week. Pec Major and Lats for the win! (Some dry needling was necessary)   Online Courses and Mentorship Group on Podia: https://richardhazel.podia.com    

Is it frozen shoulder or an impingement? Can we fix a frozen shoulder with acupuncture? Here are my 2 cents.    Thank you, to Feedspot for selecting The Acupuncture Outsider for the Top 15 Acupuncture Podcasts on the Planet.   https://podcast.feedspot.com/acupuncture_podcasts/   Online Courses for Functional Acupuncture:  https://richardhazel.podia.com    

Double Crush Syndrome is mostly seen in the medical field as something rare that happens to people in an earthquake when a building collapses on them.   In the world of successfully treating peripheral neuropathies with Functional Acupuncture it's helpful to take a less restrictive definition of Double Crush.     Online Courses: https://richardhazel.podia.com My website: https://www.richhazel.com  

Why I'm calling my style of acupuncture Functional Acupuncture.   Janda famously said that there are 2 schools of thought in musculoskeletal medicine. Stuctural and Functional. Most are still using the Structural approach (and our patients are paying the price - literally)   Online Courses: https://richardhazel.podia.com