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Professional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : You don't have to live with muscle pain

You don't have to live with muscle pain

March 06, 2006

Sharon Sauer, CMTPT, LMT (Certified Myofascial Trigger Point Therapist, Licensed Massage Therapist) attended the Bonnie Prudden School of Physical Fitness and Myotherapy in Lenox, MA, in the 1980s. Today, she is president of the MYO Pain Relief Center in Glenview.

She wants dental team members who are in pain to speak with her.

I interviewed Ms. Sauer about what myotherapy is, and the kinds of muscle pain that are often part of the lives of those who chose the practice of dentistry.

The Interview

Janyce Hamilton (JH): Describe your work.

Sharon Sauer (SS): I specialize in a unique and highly effective non-surgical, non-drug approach to the relief of chronic and acute pain and dysfunction in the muscles and soft tissues.  By identifying and treating underlying causes of muscular pain and by teaching self-care techniques, I help patients achieve pain relief and prevent recurrence.  I also teach other healthcare practitioners, including dentists, how to do the same.

JH: How many dentists and dental team members have you treated for pain?

SS: Lots! I have been treating dentists and hygienists since 1984.  It is not uncommon for us to have them coming in for treatments.  Ever since I did a workshop for The North Shore Dental Group in 1987, I have been treating about six dentists per year.

JH: What are the most frequent pain complaints by the dental worker?

SS: A lot of times dentists feel that they don't have any muscular problems.  Then, all of a sudden, they find that they have a big, career-threatening dysfunction.  The problem was always there, but just didn't manifest itself yet.

Dental workers frequently complain the most about pain in the shoulder, rotator cuff, arm, elbow and hands.  Because they are constantly reaching across their bodies for patients' mouths or for tools, certain muscles become over flexed or over shortened.  I find that anterior arms of dentists are always short.  Dentists always overstretch the posterior muscle structures of the rotator cuff.  Also, the constant grabbing of small tools leads to dysfunctions of the forearm and hand; finger flexors become overused; finger extensors become overstretched; it becomes more and more difficult to grasp things.

Moderately seen are problems from dentists sitting, which they do 90% of the time.  They assume some unnatural postural positions when they continually lean or rotate to one side.  They overuse “anchor” muscles to stabilize themselves when sitting.  Many dentists don't move their muscles enough and don't have sufficient range of motion.

Less frequently seen are problems that occur from the dentists who are not sedentary and often play sports and get injuries resulting from these sports.  Surprisingly, some dentists that I have seen actually have jaw dysfunctions themselves including TMJ, dysfunction of the masseters, or pterygoids, small mouth opening or noises in their joints.

By the way, I have noticed that the average dentist is more aware than the average medical doctor about the phenomenon of referred pain and myofascial trigger points.  But they don't usually know how to correct myofascial dysfunction.

JH:  Explain exactly what you would do to treat each type of pain.

SS: For any type of pain, factors that perpetuate muscular pain and dysfunction and predispose the muscles to trigger points are addressed first.  These may include poor body mechanics, poor posture or a non ergonomical workstation. 

There are 12 muscle groups that may refer pain to the back of the shoulder--the subscapularis, deltoid, scaleni, supraspinatus, teres major, teres minor, serratus posterior superior, latissimus dorsi, triceps brachii, trapezius and iliocostalis thoracis.  The most dysfunctional muscle for dentists is usually the subscapularis.  When it is chronically compressed, the underarm muscle in the axilla does the work (all day long) that the subscapularis is supposed to do.  I assess the range of motion for each of the 12 muscles to determine which muscles are shortened.  Then I locate active (painful) and latent (not painful unless compressed) myofascial trigger points.  Once found, they are inactivated. 

An important component of myofascial trigger point release is compression in which the therapist presses on and stretches the muscles to ensure that they have full ability to lengthen and shorten, thus preventing them from referring pain to other regions of the body.  This is combined with other techniques including bimanual digital deep massage, post-isometric stretching and heat application.  The dentist would come to my office once a week for two months or so. 

Therapeutic exercise, including both passive and active stretches, is integral to the treatment plan and brings the treated muscle back to its full normal length.  This is important because it disengages the shortened muscle fibers and retrains the myoneural unit.  A specific daily home exercise rehabilitation program, including stretches, appropriate strengthening and heat, will maintain pain relief and allows dentists to participate in their own recovery.  I have had excellent success at getting rid of this problem in 2 1/2 months or so, as long as the dentist adheres to the home exercise program. 

Dentists should try to notice when their muscles are getting short and make time a couple times per day or even between patients to treat themselves.  Sometimes they come to me not being able to use their arm or are on lots of pain relievers.  When we are done, they can get off medications.  Once the pain is gone, I have the dentist undergo a strengthening program to get up to speed and be able to hold his/her arm up without overusing certain muscles.

Forearm and hand pain. The same process mentioned above is used.  I treat all flexors and extensors of the forearm, wrist and fingers and treat all muscles that refer pain to the forearm and hand (there are a lot of them).  I can have them grasping and holding tools without pain in 2-2 1/2 months.

Hand numbness. Numbness in the hands is either caused by 1) myofascial trigger points in the scalenes from turning the head from side to side a lot, 2) trigger points in the supinator caused by little twisting and turning movements of the forearm or 3) trigger points in the interossei of the hands.  There are nine muscles in the arm that can compress the nerve.  I deactivate trigger points in these muscles and make sure that my patient is stretching the relevant muscles multiple times per day.

Jaw pain. If more dentists could learn how to treat jaw pain and dysfunction, they would take dentistry to a new level!  When I do a workshop for dentists, I teach them how to diagnose myofascial pain of the jaw and how to correct common perpetuating factors such as long or short toes, short pelvis and head forward position. TMJ dysfunction can be fixed by easily by dentists.  A small mouth opening can be fixed easily by treating the suprahyoids and infrahyoids.  I have a whole program to curtail bruxism by teaching the patient to relax their muscles before bed time.  Results happen fast.  The dentist would be wise to always consider myofascial dysfunction before doing a root canal–tooth pain could be referred pain from a dysfunctional temporalis. 

JH: This weekend's You Don't Have to Live Pain workshop offers dntal health care workers and others insights into what they are doing wrong so they can avoid doing it, and will be repeated over time—correct?

SS: I offer both free workshops for the general public and professional training courses on techniques of myofascial trigger point therapy.  In each workshop, I teach about the importance of referred pain patterns and why trigger points in muscles that you hadn't suspected may be the underlying cause of pain. I explain why dysfunction of the muscles may be mistaken as tension headache, migraine headache, earache (normal drum), nausea, dizziness, toothache, torticollis and more.  I explain how to deactivate trigger points on yourself or another person using compression, range of motion and posture muscle strengthening techniques. Students practice on themselves and learn how to treat their own repetitive overuse injuries and prolong their careers.

JH:  Do you ever make house calls--go to a dentist's office and evaluate ergonomics of height of chairs, bending, reaching, etc, to try and evaluate the repetitive movements that are wreaking havoc with their muscles?

SS: Yes, and I would be glad to do that for dentists.  Whenever I visit dental offices, I learn a tremendous amount about how to move forward with their ideal treatment, but it is not always necessary.  Sometimes I ask for pictures to be taken on the job to see how they use their bodies.

 JH:  Why should a dentist/hygienist/assist take their pains seriously? I mean, don't they just flare up and go away? Can't they be easily controlled with OTC medicines?

SS: Aspirin and other NSAIDs are too often considered the “standard of care” for musculoskeletal conditions despite their inherent risks and the fact that they commonly exacerbate joint destruction and compromise gastrointestinal integrity. 107,000 (1) U.S. patients are hospitalized annually for NSAID-related GI complications such as gastrointestinal bleeding and increased intestinal permeability. Femoral head collapse and acceleration of osteoarthritis have been well documented in association with NSAIDs. At least 16,500 (1) NSAID-related deaths occur each year among arthritis patients alone. There are more deaths each year related to NSAID use than AIDS related deaths (2). That's serious!  Over-reliance on NSAIDs deters people from using treatments that address the underlying systemic problem(s) commonly associated with musculoskeletal dysfunction. You have to treat the underlying cause of the pain or else it will keep coming back, and 90% (3,4) of the time, the underlying cause is related to myofascial trigger points. Medications don't affect trigger points. I don't teach “pain management”–I teach “pain relief”. Nobody should be living in pain. Dentists must learn how to overcome muscle overuses and under uses so they can prolong their careers.

JH:  Some dentists, like some physicians, may be a little skeptical of non-doctor pain therapists, if they've never used one or heard a testimonial from someone who has that they know. What can you tell them to placate their suspicions enough to try it?

SS: Much of my training came from assisting Janet Travell, MD, with a number of workshops in the late 1980s and early 1990s.  Dr. Travell was the brilliant personal physician for Presidents John F. Kennedy and Lyndon B. Johnson and was well known for helping President Kennedy overcome his back pain.  Dr. Travell discovered that myofascial trigger points or irritable tight spots in the muscles, fascia and other soft tissues are “laid down” in the tissues when they are traumatized through accidents, sports injuries, overload, occupation or disease.  Once trigger points are laid down, they can trigger pain and dysfunction in nearby muscles for life unless properly treated.  From the work of Dr. Travell, a new treatment protocol for musculoskeletal pain emerged.  This protocol, Myofascial Trigger Point Therapy, is a unique and comprehensive treatment for myofascial pain and dysfunction. 

In recent years, it has been scientifically proven that myofascial triggers do, in fact, exist and that myofascial dysfunction is a neuromuscular disease (5) with an etiology (6) that is beginning to be understood.  The biochemical composition of muscles with trigger points is different (7).  These myofascial trigger points can be diagnosed and treated successfully.

Also, here are some testimonials about my work:

“The theory is that if one muscle goes out of balance, then the rest of the muscles try to protect and accommodate.  This will make pain show up somewhere else. . . . I had a bad back which had been recurring year after year.  Trigger point therapy at MYO Pain Relief Center fixed it.  It's the only thing that fixed it.

--Emily Gottlieb, MD, internal medicine physician

“After working with Sharon Sauer on a professional as well as a personal level  for the treatment of my own  health related problems, I can safely and most assuredly state that her intricate yet exact knowledge of the human body, its muscles and nerves, trigger points and treatment thereof are unmatched and unparalleled.  She is not only devoted to her work but examines and studies each case individually so as to come up with the personalized therapy and/or treatment of each particular situation for the successful control or resolution of the problem. 

It is not always that you find someone so knowledgeable yet so dedicated to her profession and her mission that they are willing to share their professional secrets with their patients only so that those patients may find relief from their pain.  So many in her profession lead their patients on through prolonged and expensive treatment sessions that bring the patient on the threshold of final relief but never to its total elimination.  They are more interested in creating an emotional and financial dependency of their patients to them.  This is not the case with Ms. Sauer, though.  As a caring provider, she treats and coaches her patients through the therapy so that they can then do it themselves eventually independent of her services.  Imagine that!  A professional who truly cares about the well-being of their patient yet is confident enough to let them go with superior results! 

Ms. Sauer is an asset to her profession and a treasure to be utilized so that many may find the relief they need. Through her extensive knowledge and understanding of the neuromuscular system and its trigger points acquired from years of meticulous education, her dedication to tie all that knowledge together in a cohesive way so as to make it user friendly to patients and finally her true dedication as a medical professional for the treatment and well being of her patients all make Ms. Sauer an invaluable resource and ‘investment' for anyone smart enough to take advantage of her qualities.”

--Antonia Koulis, DDS

“Sharon Sauer has been a major contributor to a better appreciation of, and understanding of myofascial trigger points (MTrPs) by health care professionals for some 18 years.  She has done a remarkable job of keeping up with progress and knowing what others are doing in the field.  Current clinical research literature is still remarkably void of appreciation of MTrPs so training programs are the best continuing education source at this time, and Sharon's is highly recommended.  Since musculoskeletal pain is by far the most common cause of pain in humanity, and since MTrPs are THE most common CAUSE of that pain, the patients of any clinician who deals with musculoskeletal pain (who doesn't?) will benefit by that clinician attending one of Sharon's courses.  It will also help to reduce the treatment-frustration level of the clinician.”

--David G. Simons, MD, co-author, Travell & Simons' The Trigger Point Manual

“Mrs. Sharon Sauer is the leading myotherapist in the field with many years of experience in private practice.  She also has successful extensive teaching experience.  Sharon is an expert in diagnosis and treatment of Trigger Points (TrPs) and Myofascial Pain Syndrome (MPS).  She was trained by Dr. Janet Travell and is one of the best students of this world- renowned pioneer in trigger point management.  I have witnessed Sharon's excellent teaching skills at meetings.  Sharon also developed innovative and very useful teaching materials for identification of TrPs.  I am convinced that Sharon is superbly qualified for teaching trigger point management in curriculums of osteopathic physicians, as well as massage therapists.”

--Andrew A. Fischer, MD, PhD, developer, Segmental Neuromyotherapy Approach