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Trigger Point Injections

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Dr. Hanson now has several locations in the Vancouver, BC area where he routinely provides trigger point injections.

 

Physical pain can often be caused by a mechanical source, which is why pills don’t always work.  Trigger points are painful sites inside our muscles or connective tissues. They behave like a burr caught in the moving parts of our body. Trigger points are defined as having the following characteristics:

  • Pain related to a specific point inside a muscle (like a knot in a wooden plank) or in the tight fascial layer covering the muscle. These are not caused by an obvious local injury or infection.
  • Palpable nature: these can feel firm, like a small walnut embedded in muscle, or they can be palpated as a thin sheet of tenderness in the overlying fascial layer. 
  • Reproduction of symptoms: Direct pressure over the correct trigger point will reproduce the symptoms, often not in the same place.
  • Invisible on images such as x-ray, ultrasound or MRI.  As such, they are often missed. 

 

Commonly, pains present in one or more parts of the body, while the root cause comes from a distinct trigger point. For example, pains in the arm could be coming from a trigger point in the neck. Or a tender trigger point in the sacro–iliac joint (low back) can cause a person to “walk funny”.  This can shift the burden of weight- bearing, thus setting up myriad muscle pains in the back or limbs. We usually do not need to treat each of these extra sore spots, just the one or two that are the root cause.

For decades, doctors have used cortisone shots into trigger points, with some good effects. However, the cortisone itself carried considerable risk of side effects in the local tissues, such that it could be only used three times a year in the same site. Happily, it turns out that the shape of the needle was more important than its contents.  Researchers found the same results injecting plain saline, or using a dry needle, as long as it passed through the trigger point.

 

The trigger point needle is hollow and has a beveled edge, which makes it possible to mechanically break down these painful spots.  We only treat one or two spots at a time, to maximize benefits.   The needle tip is used to gently explore around the area of pain through a single point of entry, using a drop of local freezing if needed.  Through touch, the needle will detect areas of inflammation, scar tissue, or calcification. Once discovered, these targets are then microdissected with the tip of the needle.  This allows restoration of normal blood supply and function.

  

The procedure takes only a few minutes and, with a few drops of local anesthetic, is basically painless.  Results are usually quick, although a few patients may experience a temporary soreness for several hours before improving.  It is helpful to drink lots of water following the treatment, and to be moving rather than resting or sitting for the next while. One can go straight to the gym or yoga class or back to regular activities.

Examples of acute and chronic cases we treat: back pains, from upper to lower, rotator cuff and frozen shoulders, tennis elbows, and tendon pains in wrist and hand.  In the lower limbs we treat hip pains and stiffness, sciatica, sacro-iliac strain, knee, calf and iliotibial (lateral thigh) pains, ankle and foot issues including plantar fasciitis.

 

Permanency:

This depends on the root cause. If the injury is recent and unique, a few visits may be all we need.  If the root cause is a recurring one, such as bad posture or poor ergonomics, then the complaint is likely going to come back.


Side Effects:

The technique is done with the usual sterile protocols. Because there is no cortisone, there are no drug interactions, nor any problems interfering with current medications. If you are on blood thinners – please consult your doctor first. We do use a few drops of local anesthetic, Xylocaine 1% (Lidocaine). This is only injected if the patient feels discomfort. In case of allergy to local anesthetics, treatment can be done with nothing in the needle.

Other treatments: Trigger Point Injections work well in conjunction with other disciplines such as physio, acupuncture, IMS, therapeutic massage, yoga and chiropractic treatments.  Indeed, by restoring blood supply to trigger points, simple medications like Advil will work better, and stretching and exercises will be easier to do. 

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Health hacks for help on a budget

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Drugs, both prescription and over the counter, can be very expensive, and may cause side effects.  Many of my patients are pleased to learn there are some economical options with products that they may already have in their home.

Here are a few examples, straight from your local grocery store:

Baking soda: For generalized itching, including the healing from sunburn, put a few big spoonfuls of baking soda in a lukewarm bath.

 

For smaller areas, use “soda-soaks” with a bowl of water and soda powder, and use it to wet a towel to cover the involved area. Sit in front of a fan or open window breeze, and the red itchy skin will feel much better in minutes. Use cotton ovals to apply over swollen eyelids.

For small spots, like insect bites, you can make a paste of mainly soda and a few drops of water, and apply as needed.

Salt: Just ordinary table salt will do. In solution with room temperature water, it has great curative powers for inflammation. You may remember a school science demonstration where a potato is placed in a pot of extremely salty water. The water inside the potato is relatively salt-free, so it rushes across the membrane (skin) to help dilute the overly salty water in the pot. Give it a little time, and the potato starts to shrivel like a prune.

The same thing happens across the membrane of the cells in a sore throat, or across the cells of the skin during a bite, burn, abrasion, or infection. For sore throats, do not use this mouthwash more than a couple of times a day, or you can change the pH of your mouth, and possibly engender a secondary infection, ending up with a blue or white tongue.  

For severe sore throats, try to gargle several times a day with enough salty water to provide three or four mouthfuls. Gargle for as long as you can, spit it out and repeat. You can rinse immediately after with regular water, and you can stop as soon as your throat is no longer sore.  

For inflamed skin, use salt water in a bowl, and soak a small towel or, for small areas, cotton balls or ovals. Then squeeze out excess moisture, and lay the towel or cotton against the skin.  

Coconut oil: One of nature’s great natural healers, coconut oil can replace many items in your first aid kit.  

It can serve as a moisturizer. Coconut oil starts out looking greasy, like Vaseline. But, unlike petroleum products, the underlying skin sucks up the coconut oil quickly. It’s a great choice for right after the shower. It’s good for your face, nails and even hair/scalp. A small container can also make a good portable lip balm.

Coconut oil is also a great mouthwash. A spoonful held in the mouth until it melts is an excellent trick to whiten teeth. This “pulling” technique simply involves swishing the oil around your teeth for as long as you can, then spitting it out. Not only is this a great whitening trick, but the oil has anti-bacterial and anti-fungal properties, killing many of the germs that can cause gum disease and bad breath.  

Try it as a wound dressing. Instead of antibiotic ointments that have a Vaseline base, you can use a dab of coconut oil over an abrasion, scab or scratch, or even to cover sutures after the first dressing change.  

Other uses for coconut oil include: removing makeup at the end of the day, as a shaving cream and, for babies, it makes a great treatment for diaper rash, instead of using cortisone-based creams every time.

Naturally, the above are intended as options for self-help, not for self-diagnosis. Please see your doctor or walk-in clinic for a more specific assessment.

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Caring for Sore Throats

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One of the most common reasons for patients to visit their doctor is the common sore throat.  For many years after the age of antibiotics began over a half-century ago, most doctors reached for Penicillin or Sulfa drugs, and most patients expected this prescription to be the “miracle” cure.  Which it might well be, if the underlying organism is a strep bacteria, and not a virus. 

However, times are changing, and so are bacteria.  

No longer will the common antibiotics guarantee complete recovery, even if the infection is purely bacterial.   In fact, the overuse of antibiotics has been not only in doctors offices, but in the food industry.  Mass-produced  livestock, such as  cattle, pork, chickens,  and even fish are kept in unnaturally close quarters, where they are basically bumping into each other, or the perimeters of their cages/fences. If they show superficial infections, they will not pass inspection.  So rather than have more space around each animal, it turns out to be a lot cheaper to dump antibiotics in with the feed.   This even shows up in eggs and milk in areas where this practice is not regulated. 

As a consequence, the bacteria are so used to antibiotics that they frankly are not impressed; and the infections are mutating with such speed that we cannot make new families of antibiotics fast enough. 

So with this as background, you will not be surprised when your doctor today is much less likely to dole out these medications.   Even if you have green or yellow discharge from your nose or in the back of your throat, and even if you have bright red tonsils the size of golf balls.

Instead of reaching for the prescription pad, doctors now will suggest a throat swab to test for strep, before prescribing any antibiotics.  This can be done as an instant test (which may be an extra charge, depending on your insurance), or as the kind that takes two days for the lab to report.  Over 80% of the time (in my practice) these are negative for any treatable bacteria, meaning the infection is caused by an untreatable virus.

So how do we deal with these painful viral episodes?  Here are a few tips that may help:

  1. Consider holding back on dairy products for a few days.  Milk products in many people will have an effect (not an actual allergy) to thicken mucus.   That’s why singers never drink warm milk between songs.  As soon as the mucus clears, you can happily resume your favourite milk, cheeses, or ice creams.  If milk does no such thing to you, don’t worry about this step.
  2. Grandmother’s Chicken Soup: turns out to be an excellent choice to help thin mucous discharge from the nose, throat, and airways.  Keep a few boxes of chicken stock handy, or use boullion cubes to fill your mug with a nice hot drink.  Remember to rehydrate your body with water.  Lemon and honey can prove soothing in a mug of hot water, as can herbal teas or ice water. 
  3. Saline gargles: Do NOT use commercial mouthwashes more than a few times a day, or you can change the pH, as well as the  ecosystem in the mouth, and end up with a fungal infection, with a  blue or white tongue.  If you have a really sore throat, including swollen tonsils, you need to gargle a lot, even hourly.  The best way is to use saline, stirring a few spoonful’s into a half-glass of warm water, until no more will dissolve.   Gargle as long as you can with the first mouthful, then spit it out, and repeat a couple more times.  You can immediately take a swig of something tastier, so you don’t need to endure the salt for long. 
  4. Treat symptoms with off-the-shelf medicines.  For fever, sinusitis, and pains, something like an ibuprofen or aspirin based cold/sinus pill will help. 

If the above is not working, go back and see your doctor.  Even if it turns out that your case is caused by a bacteria that will respond to an antibiotic, the above steps are still very useful.

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