Perpetuating Factors (PF's)
A perpetuating factor to muscle pain is the same as gasoline to a fire.
This analogy describes what generally happens to keep the pain cycle going in those who have pain do to trigger points. A person realizes there is pain (fire) and then they try to extinguish it using different types of therapy (water). However, if the person spends 3-5 hours on the telephone during the day without using a headset (gasoline) there is a good chance the therapy they are receiving only works for a short amount of time. Because of this, no resolution is attained. This cycle tends to continue for some time, but can be averted by simply realizing what the "gasoline" is and eliminating it!
Eliminating or modifying perpetuating factors is what makes any therapy successful in a short amount of time. It is the goal of this practice to help those in pain find, not only a solution to the perpetuating factor, but a practical one as well. This type of approach assures a person is not in therapy for longer than needed.
The three main types of factors (PF) that perpetuate pain and dysfunction are mechanical, nutritional, and/or systemic.
Mechanical PF's
A mechanical PF is a force of some type which is generally repetitive, such has how we work and sleep. Whatever keeps a muscle in a shortened and tightened position for prolonged periods of time is a mechanical PF. In the case of the trapezius muscle, its action is to elevate the shoulders (shrug) as well as flex the head from side to side (ear to shoulder). It would then be important to avoid activities which keep the shoulders elevated for long periods. Stretching exercises are also important to help the muscle relearn to be in its fully lengthened position.
Prolonged telephone conversation where a person holds the phone up to the ear may cause activation of the upper trapezius. Phone conversation does not have to be eliminated, but modified so that the muscle may relax. A simple solution would be to obtain a hands free headset for the phone. Another typical situation that would put the trapezius into a shortened position is working at a computer where the keyboard is elevated too high, thus causing the person to have to lift the shoulders to reach the keyboard. Keeping the shoulders elevated may cause any latent trigger point to become active and refer pain. This is why many people who work in office settings tend to get headaches and why deactivating the upper trapezius is important to eliminating them.
Aside from actual positions that will cause problems, the trapezius is where the majority of people "carry" their stress. People tend to walk around with their shoulders elevated, as well as drive and sleep in that position without even knowing it. In these cases a simple note in the car or on the computer monitor may help to remind a person to relax their shoulders so they do not activate any trigger points and induce a headache.
Other mechanical factors would include watching TV while lying on the side and propping the head up with the hand which will flex the neck to one side. A tilted or destabilized pelvis may cause compensations to occur up the back and influence the trapezius muscle. A short leg may also cause problems that may be reflected as tension headaches.
Systemic PF's
A systemic PF is a condition which affects the entire body. These include hypothyroidism (low thyroid), hypoadrenia (low adrenal function), viral, bacterial, or parasitic invasions.
Hypothyroidism many times goes unnoticed in patients. Since the thyroid hormone controls the level of metabolism of every cell in the body it can cause a vast variety of symptoms, including muscle pain. Some of the more common symptoms are cold hands/feet, hair loss especially the lateral 2/3 of the eyebrow, depression, dry skin, irregular menses (women), low libido, and foggy thought. A simple test for the thyroid is the basal metabolism test where the underarm temperature is taken first thing in the morning for several days to determine an average. When that average is below a certain number (usually 97.3F) then the person may want to explore further thyroid testing. A person suspecting hypothyroidism may need to seek out a practitioner who is familiar with sub-clinical treatment. The most likely doctors for this are "Holistic Doctors" and are certified by the American Board of Holistic Medicine. Look for links that will take you to an expanded understanding of hypothyroidism in the links area of this site.
Low adrenal function may also influence the body by causing muscle pain. The symptoms are very similar to low thyroid function and a temperature test may also be done. Refer to the "Tests" portion of this site for more details. Also, the adrenals are your "stress" glands. They sit on top of the kidneys and secrete hormones, such as cortisol, which is an anti-inflammatory. When under stress, the hypothalamus, a gland in the brain, signals the adrenals to secrete more cortisol to provide a physiological response to the stress. After being stimulated for prolonged periods of time the adrenal cortex may "burn out". This is when symptoms begin to occur. Many times the subtraction of caffeine, found in coffee and soft drinks, will help to rebuild the adrenals along with the addition of B vitamins, and a good night of sleep (going to bed before 10:30 at night) helps restore adrenal function. For more information and an excellent explanation of adrenal function with regard to stresses, please refer to the book Adrenal Fatigue - The 21ST Century Stress Syndrome by James Wilson.
Other Systemic PF's are bacterial and viral infections. Anytime our body is fighting a sickness such as the flu, we tend to notice a wide variety of symptoms including a soreness all over the body, especially in the joints. This is an example of a viral or bacterial infection that can cause pain. Sometimes the infection will cause a deep, dull, aching pain as the only symptom and once the infection is eliminated by the immune system the pain will dissipate.
Nutritional PF's
A nutritional PF is generally a vitamin/mineral deficiency that is associated with proper muscle and nerve function. Some common deficiencies include, but are not limited to, B complex, vitamin C, calcium and magnesium. These vitamins and minerals are essential as they provide the fuel to the muscular system as well as insuring proper nerve conduction.
Nutritional concerns are usually determined by blood testing and/or examining other symptoms such as muscle spasms or twitching as well as the overall subjective complaint of the patient. Once determined the patient may be advised to seek nutritional counseling or prescribe for themselves the needed supplements.