Common Pain Diagnoses Frequently Unrecognized as Originating from Myofascial Trigger Points
List Of Conditions
Arthritis Pain (Osteo)
Back Pain, Low, Middle
Carpal Tunnel Syndrome
Epicondylitis (Tennis-Golfers Elbow)
Facial Neuralgia (atypical)
Fluid on the Knee
Headache (Occipital) (Tension)
Irritable Bowel Syndrome
Lower Back Pain
Myofascial Pain Dysfunction
Post Surgical Pain
Tennis & Golfer's Elbow
Thoracic Outlet Syndrome
Upper Back Pain
One or more scapulas are pointing dorsally.
Why Choose Indy Myopain Relief Center?
Indy Myopain Relief Center's Myofascial Trigger Point therapists work to support medical practitioners and specific condition-based outcomes in at least three ways:
By being a good resource for the drug-free
least invasive and least expensive option for possibility of soft tissue/trigger points being a source or contributor to the patient's pain or dysfunction. If it is found that the treatment at our clinic can or does eliminate the pain or symptoms, then no further surgical or testing measures need to be taken
If surgical/procedural intervention was deemed necessary
the manual trigger point therapy can be a post - operative support to help achieve post-op healing and fascial health along with full range of motion and strength
Into the future
regular myofascial therapy treatments can help the patients retain a high level of pain-free function, even into a high level of exercise or sports participation
Indy Myopain Relief Center is located on the Northside of Indianapolis, Indiana. We specialize in a unique and highly effective non-surgical, non-drug approach to a pain free life. We relieve chronic and acute musculoskeletal pain and dysfunction with a non-invasive treatment known as myofascial trigger point therapy. By identifying and treating the underlying causes of muscular pain and teaching self-care techniques, we help patients relieve their pain problems and prevent recurrence. We strive to make our clients feel comfortable and well-informed throughout the entire treatment process, from the initial visit to our movement classes to ensure full soft-tissue recovery. In fact, our treatment approach can be broken down into four easy-to-follow steps:
We undertake a comprehensive review of our client's physical condition and identify the most probable muscles harboring Myofascial Dysfunction and Trigger Points
Through a detailed history, we uncover key factors such as: hyper-pronation and poor work/sleep postures that need to be changed in order to fully eliminate pain
Using our hands-on Trigger Point Therapy Protocol, we treat and eliminate muscular dysfunction and reduce and eliminate pain caused by myofascial dysfunction and trigger points
We believe "Education is Power". As advocates of empowerment through self-treatment training, we teach our clients what to do at home and at work so as to prevent the problem from returning and thereby maintaining a high level of pain-free function as well as a high sports-performance level
Myofascial Trigger Point Therapy?, Indianapolis, I
Myofascial Trigger Point Therapy is the art and science of treating the myofascial dysfunction in muscles, fascia, ligaments, and tendons due to the presence of Trigger Points.
Trigger Point Therapy is performed without drugs, surgery or other invasive techniques
One of the most popular techniques for treating Trigger Points is the use of manual compression techniques.
This might appear to be similar to deep tissue massage - however a Trigger Point therapist is trained to assess the overall muscular health of their patient, identify myofascial pain and dysfunction, and precisely locate and treat the associated Trigger Points - this is not a spa massage!
Trigger Point Therapy also involves the use of various other techniques including active contract/relax and postisometric relaxation, vapocoolant spray and stretch and ultrasound.
Recently, the use of an advanced medical device, the PiezoWave 2, which delivers extra corporeal shock wave therapy to the dysfunctional muscle's taut bands. This device uses pulses of sound waves to provide "acoustic compression" as an alternative to manual compression techniques. It is an extremely effective leading edge technology for the reduction of pain from myofascial dysfunction and trigger points
If you're suffering from headaches, all too often you may be diagnosed
with general terms such as tension headache, migraine, or TMJ pain without the true cause being identified. Often the cause are trigger points in one or more muscles, but the diagnosing practitioner is unfamiliar with trigger points. Trigger points can play a very large role in most types of chronic and acute headaches, as well as temporomandibular joint problems, which means you may be able to get a great deal of relief, or even complete relief, by working on trigger points and eliminating perpetuating factors
Your headache, migraine, and TMJ pain is likely treatable.
Indy Myopain Relief Center treats the trigger points, discovers the perpetuating factors in your life and body responsible and teaches you how to care for yourself. We do not inject or prescribe medication. Our treatments sessions usually require about 3 to 5 to really achieve complete and lasting relief. Some longer and some shorter. If your life is your trigger, then we have a maintenance program to keep you pain free
Symptoms and Causes of Headaches
A headache is defined as aching or pain in one or more areas of the head or neck. Both the frequency and pain level can vary greatly. About 90 percent of all headaches fall into three categories: tension headaches, migraines, and cluster headaches. The remaining 10 percent fall into the category of secondary headaches (Healthcommunities.com 2002)
Tension headaches are by far the most common type of chronic headache. People who experience migraines typically also have tension headaches in between their migraines
Symptoms of Tension Headaches
Tension headaches usually affect both sides of the head and last from thirty minutes to several days or more. They're usually characterized by a mild to moderate level of "pressing" pain or a dull, steady ache, though the intensity may also be severe. They may affect your ability to sleep soundly. They are not accompanied by the additional symptoms listed below that distinguish migraine headaches. Women are more likely than men to have tension headaches
Causes of Tension Headaches
The most common causes of tension headaches are muscular problems and associated postural problems. Tension headaches are often aggravated by stress, anxiety, depression, fatigue, noise, and glare, but they can also be associated with arthritis, disc problems, or degenerative bone disease in the neck or spine. Temporomandibular Joint Disorder (TMJD),(TMD) can also cause tension headaches... Usually this will be a tension-type headache, but sometimes it will be a combination of migraines and tension headaches. A 1996 study reported that when subjects were asked to clench their teeth for a prolonged period, it induced a headache in 68 percent of the subjects who had chronic tension headaches. When, chewing muscles and other muscles of the body are treated for trigger points, headaches symptoms usually lessen in a very short time frame
Trigger Points and Central Sensitization in Tension Headaches
A study by Dr. Lars Bendtsen (2000) confirmed the role of central sensitization in chronic tension headaches... Certain muscles were tender even when the subject was not experiencing a headache at the time. Bendtsen theorized that long-term inputs from trigger points eventually lead to central sensitization in specific areas of the spinal cord and brainstem, which in turn causes additional changes in the affected muscles, a self-perpetuating cycle that converts periodic headaches into chronic tension headaches. Because of this, even if the original initiating factor causing episodic headaches is eliminated, the trigger point-central sensitization cycle can continue and worsen on its own... This means that whatever causes the lower pain threshold in some people may also cause them to have chronic headaches
Great News: Treating Trigger Points Can Help!
Indy Myopain and other studies have shown that people who have headaches are almost twice as likely as healthy control subjects to have postural abnormalities
including head-forward posture, and to have trigger points in the back of the neck, particularly the suboccipital muscles. Interestingly, people with migraines were shown to have the same prevalence of postural abnormalities and number and location of trigger points as people with tension headaches, even when they tend to have one-sided migraines (Marcus et al. 1999)
People who suffer from both migraines and tension-type headaches are far more likely to have a greater number of active trigger points (Marcus et al. 1999)
The greater the number of active trigger points, the more frequent and severe the headaches. With one-sided headaches, a greater number of active trigger points are located on the same side as the headache. Trigger points will be more tender during a headache and will probably be more tender just prior to and immediately after the headache
This means that the probability of trigger points being part or all of the problem in the majority of headaches is likely to be high
and there are estimates that the majority of headaches are due at least in part to trigger points (Simons, Travell, and Simons 1999). So the great news is that you can probably relieve much or all of your headache pain with a combination of trigger point self-treatments [Chapters 10-18] and identifying and eliminating all the perpetuating factors [Part II] to the extent possible
Treating Headaches with Trigger Point Therapy
If you have headaches, you are likely to have trigger points in your neck, back, leg, arm and head muscles that
when pressed, will refer pain to the areas where you normally feel your headaches... In all likelihood, trigger points in more than one muscle of the neck and head are causing overlapping referral patterns, so it is important to locate all of the trigger points involved
Indy Myopain Relief Center believes it is important to treat trigger points when you don't have a headache
thus preventing their re-occurrence. We really want to see you when you have a headaches so that we can find the cause and eliminate it in the first visit
Migraine Headache Therapy, Indianapolis IN
Indy Myopain Relief Center treats migraine type headaches using non-invasive and drug-free therapies. These therapies include Trigger Point, Kinetic, Neuromuscular and muscle activation, Myofascial Acoustic Compression, and Extracorporeal Shock Wave therapies. We serve the greater Indianapolis community, offering 2 nationally certified trigger point therapists. Let's get a better understanding of how trigger point therapy helps migraines go away
Migraines usually first begin between the ages of ten and thirty-five and decrease after age fifty. Frequency varies greatly, from infrequent to several times per month. Approximately one in ten people get migraines, and about 75 percent are women (American Medical Association 1989). Some women experience symptoms just before or during their period (menses), indicating a hormonal role. At Indy Myopain Relief Center we have successfully treated an individual that experienced chronic, daily migraine headaches for 15 years! She now has her life back and comes back occasionally for maintenance
Symptoms of Migraine Headaches
A migraine headache is characterized by throbbing, pounding, or pulsating pain that lasts from hours to several days. Intensity of pain alone is not a symptom of a migraine, since tension headaches can be as or more painful than migraines. Some migraines may be pain free but begin with the visual effects. In some people, the pain may not be pulsating or it may vary in quality. Migraine pain is often only on one side, but it may occur on both sides or move from side to side. Pain can be intensified by movement, coughing, straining, or lowering your head. Migraines are usually accompanied by one of more of the following symptoms: Migraines may be accompanied by an aura, but more commonly this is not the case. A migraine without an aura (common migraine) may be preceded by mental fuzziness, mood changes, fatigue, and an unusual retention of fluids... Auras may also be non-visual, consisting of dizziness, vertigo, speech or language abnormalities, weakness of movement, or tingling or numbness of the face, tongue, or extremities...
Causes of Migraine Headaches
Though there are theories about the causes of migraines, the mechanism is still unknown. Most studies have attempted to explain migraines in terms of one particular causative factor and have failed to provide an explanation for the complexity of the symptoms and clinical observations. It's likely that a combination of factors provide input in varying proportional degrees and result in a particular set of symptoms for any type of headache. These input factors are trigger points in muscles, emotional stimuli triggering the limbic system (part of the brain) to increase muscle contractions, and substances such as serotonin, prostaglandins, interleukin 1 and 6, substance P and other neurotransmitters) that affect the blood vessels and other tissues in the brain (vascular system input), causing them to become inflamed and swollen, and result in a headache. It is theorized that the sum of the vascular system input plus the input from trigger points and emotional stimuli determines whether or not pain is a symptom, and if so, how intense the pain is. This could explain how some people can have trigger points or experience emotional duress without having headaches or migraines, while others get severe headaches. People who tend to have migraines and tension headaches that occur at the same time are likely to have a very strong input from emotional factors, or possibly abuse drugs (Olesen 1991)
Trigger Points and Migraine Headaches
Indy Myopain Relief Center shown through our treatment success, trigger points play a far greater role in the perpetuation of migraines than previously thought. (Calandre, et. al. in 2006 published at study comparing patients at a headache clinic suffering from frequent migraines with both non-clinic subjects with fewer migraine attacks and healthy control subjects who, at most, had infrequent tension headaches. The researchers examined specific muscles for trigger points and found that 93.9 percent of the migraine subjects had trigger points with referred pain patterns that reproduced the their migraine pain and other symptoms. By comparison, only 29 percent of the healthy subjects had pain referred to the same areas, and the pain was not migraine-like in quality. Pressing the trigger points of migraine subjects could reproduce the location of pain, the throbbing quality, light and sound sensitivity, and other symptoms that were common for that person. In 30.6 percent of migraine subjects, pressing muscles with trigger points actually caused a full-blown migraine that required immediate treatment. The researchers discovered that the longer the history of migraines and the more frequent the attacks, the greater the number of trigger points the person had in their muscles. About 74 percent of the trigger points were found in the masseter and temporalis muscles. The researchers theorized that the trigger points themselves could be responsible for the changes in the nerves and blood vessels in the brain, rather than the vascular system necessarily being a separate and distinct input system on its own. It is well-known that trigger points can cause symptoms other than referred pain, such as dizziness, vertigo, diarrhea, painful periods, colic, heart palpitations, and other conditions that wouldn't normally be thought of as caused by trigger points in muscles... So which came first? Did the trigger points in certain muscles lead to the development of migraines and then a self-perpetuating cycle began, or did the migraines come first and lead to development of an increasing number of trigger points? In any case, this discovery is very heartening, as it means treating trigger points can have a significant impact on reducing or eliminating migraines
Cluster headaches primarily affect men between twenty and forty years old. They come on suddenly and are severe, and occur for a series of days, weeks, or months and then disappear. They may recur seasonally or randomly
Symptoms of Cluster Headaches
Onset occurs most frequently within two to three hours of falling asleep, during a REM phase of sleep, when dreaming occurs. The pain is typically steady and feels like a sharp, burning, or boring pain on one side of the head or in and around one eye, but it can involve a whole side of the face from the neck to the temples. The pain quickly gets worse, peaking within five to ten minutes, with the peak pain lasting from thirty minutes to two hours. It may be accompanied by a red, flushed face. A runny nose, nasal congestion, swelling under or around the eye, or a red or teary eye with a small pupil may occur, usually on the same side as the headache
Causes and Triggers of Cluster Headaches
Alcohol, tobacco, and drugs that dilate or constrict blood vessels are known to trigger cluster headaches, suggesting that changes in the walls of blood vessels of the head and/or around the eye area may be at least partially responsible. This may be due to a sudden release of histamine or serotonin by body tissues (histamine is released in response to allergies, but there may be other triggers as well). Note that the triggers and causes of cluster headaches are the same as some of the triggers and causes of migraines, and of trigger points. Oxygen deprivation of muscles cells plays a role in causing cluster headaches, and it also activates trigger points. Though the role of trigger points in activating and perpetuating cluster headaches has not yet been studied, treating trigger points and eliminating perpetuating factors will likely help resolve these type of headaches
Headaches from Trauma
Neck injuries are the most common cause of post-traumatic headaches.
In a study of patients following rear-end motor accidents, 62 percent of people reported feeling neck pain within six to seventy-two hours, and of those, 82 percent also reported headache symptoms. Twelve weeks after the accident, 73 percent still had headaches (Packard 2002). Even accidents that may seem minor at the time may cause significant damage; in fact, there is little correlation between the damage to the vehicles or the speeds involved in the accident and the amount of injuries to soft tissue and the cervical spine. Slip and fall injuries can cause damage similar to whiplash. Whiplash injuries can lead to TMJ dysfunction, affecting the muscles in the face and causing headaches due to referred pain
These types of injuries can cause long-term damage and ongoing problems.
Because injured tissues are repaired with dense connective scar tissue, they lack the strength and elasticity of the original, normal tissue. The damaged area is easily reinjured due to weakness and limited range of motion, and the muscle is also more easily fatigued. Damage to muscles, ligaments, joint capsules, and other tissues in the neck, including the sternocleidomastoid and scalene muscles, can lead to central sensitization and thus to chronic headaches (Packard 2002)
Though symptoms from whiplash injuries generally improve over a period of weeks or months
up to 40 percent of people have symptoms that last for more than six months and a small percent become disabled (Packard 2002). Often symptoms disappear after a short time, then recur later...
also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers
The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas
sometimes distant from the trigger point itself. Practitioners claim to have identified reliable referred pain patterns which associate pain in one location with trigger points elsewhere. There is variation in the methodology for diagnosis of trigger points and a dearth of theory to explain how they arise and why they produce specific patterns of referred pain
Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response.
The local twitch response is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle contracting whereas the local twitch response also refers to the entire muscle but only involves a small twitch, no contraction
Focused sound waves are used for the management of acute and chronic pain in muscles, tendons, ligaments and joints
Aimed directly at your pain.
The sound waves generated by the PiezoWave2 MyACT cannot be felt as they enter and pass through the body. They converge at a controlled point within the soft tissue to produce an intense, extremely short in duration, pressure pulse that delivers therapeutic massage in areas difficult to reach by other methods
Clinically focused pain relief.
Pain is very complex and can sometimes seem to radiate from areas far from the actual generating source. This is referred pain and can make treatment more difficult
Are there know side - effects of MyACT?
Side - effects are limited to reddened skin and / or minor soreness in some cases
What to expect during your MyACT treatment
Your therapist will identify the treatment site or sites. They may mark these sites with a pencil.
They will then apply a thin coat of coupling gel.
This gel helps to translate the acoustic sound waves generated by the therapy head to the body
The therapist will start the treatment at a very low output setting and increase the power to a level that you help define and is best suited for your condition.
The output level and acoustic wave frequency rate may vary from location to location based on the depth and type of tissue being treated
As the therapist move the therapy source around the treatment area
you may feel a deep, dull ache that is familiar to you as being like the feeling your condition produces. The therapist will ask you to report when you feel the ache and will adjust the output source to the appropriate level for your treatment. They may also ask you to confirm that the therapy source is still creating the ache and may adjust the location of the treatment based on tour feedback. If at any time the treatment becomes uncomfortable, mention this to the clinician and they will adjust the output level
After the treatment is completed, the coupling gel will be removed and you can return to your normal activities.
You may experience some minor aches or discomfort after treatment. It is not unusual for patients to notice flushed or reddened skin around the treatment site
How Long does a course of treatment last?
An individual MyACT treatment takes between 10 and 20 minutes
Normally, 1-2 treatments per week are performed
A total of 5-8 treatments may be necessary to achieve lasting improvement.
Plantar Fasciitis Treated
Foot Pain such as Plantar Fasciitis is best treated with a combination of Trigger Point and MyACT (Myofascial Acoustic Compression Therapies. According to Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, myofascial trigger points (tiny contraction knots) in overworked or poorly conditioned muscles are the most frequent cause of pain in the ankles, feet, and toes.
Misdiagnosis of Plantar Fasciitis
Travell and Simons believe that a diagnosis of plantar fasciitis or heel spurs is often mistakenly applied when physicians are uninformed about myofascial pain.
Trigger points typically refer pain; that is, they send pain to some other site. Physicians and other healthcare workers are commonly led astray by this phenomenon
Few practitioners are aware that this spot is where you will find trigger points in the flexor digitorum brevis and quadratus plantae muscles of the foot.
These trigger points are typically quite tender to pressure. Their pain referral is to the bottom of the foot, particularly to the heel. When not mislabeled plantar fasciitis, heel pain is often falsely blamed on heel spurs. Heel spurs can be present and actually not be the cause of the pain. Indisputable evidence of the harmlessness of a heel spur is when trigger point therapy stops the pain
Trigger points in the soleus muscles of the calves are the primary cause of heel pain, and therapy by means of self-applied massage is amazingly simple, quick, and long-lasting.
Doctors Travell and Simons point out that the eleven muscles of the lower leg are actually foot muscles. Anatomists call them "extrinsic" foot muscles, meaning they operate from outside the foot.
The muscles in the foot itself are "intrinsic" foot muscles, meaning they work from inside the foot
The implication of these facts is that foot pain may not be coming from the feet themselves, but may be referred pain from trigger points in muscles of the lower leg.
You can waste a lot time rubbing and soaking your feet, if your foot pain is coming from somewhere else
Examples of Pain Referral
Most of the familiar pain in your arches comes from trigger points in the gastrocnemius muscle of the calf. These same trigger points cause calf cramps. Pain in the toes frequently comes from trigger points in the flexor digitorum longus and extensor digitorum longus muscles of the lower leg. The extensor hallucis longus muscle in the front of the lower leg is the most common cause of pain in the big toe joint that is so often misdiagnosed as gout. When your feet hurt at the end of the day, it may not be foot massage that you need, but lower leg massage!
The tibialis posterior, a very deep muscle in the calf, is the true source of the disabling pain and stiffness in the back of the ankle so often mistakenly labeled Achilles tendinitis.
Interestingly, trigger points also weaken this muscle, allowing your ankle to turn inward and making it appear that you have fallen arches
In Travell and Simons's view, "tendinitis" is largely a wastebasket diagnosis, employed when the true cause of the problem isn't clearly understood.
Pain in or near a tendon is almost always simple referred pain from trigger points in associated muscles
Trigger Point Therapy
Trigger points should be at the top of the list during any examination for pain, numbness, and other abnormal sensations in the lower legs, ankles, feet or toes.
When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat.
In fact, there are ways to treat them yourself quite effectively. Indy Myopain Relief Center will teach you to treat yourself as part of our self care program
A trigger point in the tibialis posterior muscle, which is the most common cause of pain in the back of the ankle, so often misdiagnosed as Achilles tendinitis.
Trigger points in other lower leg muscles cause pain in the toes, arches, heels, and the front of the ankles.
When plantar fasciitis is prolonged, it is known to reduce blood circulation around the plantar fascia, and subsequently cause a thickening of the plantar fascia.
Previous studies [15,37] noted that ESWT revitalizes tissues by increasing angiogenesis and nitric oxide mediated anti-inflammatory effect, which thereby decreases the thickening of the plantar fascia by stabilizing inflammation. ESWT promotes faster healing of muscles, tendons and fascia
Indy Myopain Relief Center
Indy Myopain Relief Center is Indy's number one Trigger Point Therapy Center
with two of the three nationally certified Trigger Point Therapists. (CBMTPT.org) in Indiana. Our staff has received additional training with Stew Wild, Katie Adams and Sharon Sauer
We are Indy's only Trigger Point Therapists that combine Travell's muscle rehabilitation protocols
with Extracorporeal Shock Wave Therapy (ESWT) to provide the midwest's most advanced pain relief and muscle rehabilitation capabilities. Trigger Point therapy eliminates the stress and referred pain of distant muscles pulling on the fascia of the feet. We know of no other therapy that works more effectively. We do this without medicine or surgery. Plantar Fasciitis relief can be accomplished in 1-6 treatments. And it lasts!
Gout, treatments both traditionally and a Novel Treatment
Gout, treatments both traditionally and a Novel Treatment using Trigger Point, Diet and Extracorporeal Shock Wave Therapies. Indy Myopain Relief Center approaches gout differently than most traditional modalities. We want to work directly in conjunction with your physicians as we do not prescribe medication that may be necessary to prevent future episodes
But during the acute phase of a Gout attach, we are very effective.
Our methods focus on reducing the pain, inflammation, disintegrating and dissolving the uric acid crystals present in the tissues of the of the affected joints. We use trigger point therapy techniques to relieve taut bands and trigger points that are squeezing the circulatory and lymph systems, preventing the body from ridding itself of the fluid building within the synovial bursa. We then follow up with the Extracorporeal Shock Wave Therapy (ESWT) to disrupt the uric acid crystals that are present in the synovial fluid and deposited within the joint tissues. Additionally the ESWT has an analgesic effect that relieves pain and mobilize the angiogenic and nitric oxide substances to promote rapid recovery from the pain, swelling and redness
Our clients report immediate relief that continues to improve over the next few days.
Most clients require one treatment while others may require 3 to 12. This is all done in 30 minutes to one hour and the cost is usually $100 per treatment
Long term solutions involve a proper diagnosis and lower the blood uric acid levels.
Below are the recommendations of the American College of Rheumatology and John McDougall, MD. We believe the most effective solution is found through a lifestyle change of eating habits
2012 American College of Rheumatology Guidelines
The American College of Rheumatology (ACR) recommended multiple modalities (NSAIDs, corticosteroids by different routes, and oral colchicine) as appropriate initial therapeutic options for acute gout attacks. 2012 American College of Rheumatology Guidelines for Management of Gout are described below:
Gout Is on the Rise by John McDougall, MD
Over the past 20 years the incidence of gout-a debilitating arthritis caused by eating rich food-has doubled in the USA.1 Not surprisingly, this is an increase that parallels the growing epidemic of obesity.2 Although gout is the most common form of inflammatory arthritis in men, affecting 1 to 2 % of men in Western countries and as many as 5 million men in the United States3 -this painful arthritic condition is essentially unknown in parts of the world where people consume a diet based on starches.4-6
I see many people who believe they suffer with gout, but they don't. They may have joint pains, and some may have an elevated blood uric acid level, but their problem is usually degenerative arthritis (osteoarthritis). Gout is suspected if a joint-classically, the base of the big toe-becomes suddenly swollen, red, and painful. However, the definitive diagnosis is made by examining, under the microscope, fluid extracted from a painful joint and finding uric acid crystals (monosodium urate crystals)
The inflammatory process in gout is caused by the accumulation of uric acid crystals in a joint. Excess uric acid in the body can be caused by an increase in production by the body and by under-elimination by the kidneys. However, the most important cause is an increase in the intake of rich foods, which are high in uric acid precursors, known as purines. These molecules are the building blocks of genetic materials-DNA and RNA. The muscles of animals-meat, poultry, fish and seafood-are the most important sources of purines. Vegetable sources of purines do not contribute to the risk of having an attack of gout. According to an article in the New England Journal of Medicine, "Higher levels of meat and seafood consumption are associated with an increased risk of gout...Moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout."7 Other lifestyle habits, like alcohol consumption are also believed to encourage the deposition of uric acid crystals in the joints
Weight Loss from Any Cause Can Start Gout
I have seen a couple of my patients develop gout after changing to our diet.8 This is caused by the release of uric acid from their dissolving body fat. These molecules can move to the joints where they may form crystals. I worry about this happening only with patients with a history of previous gout. Even for these people, the risk of an attack is very small. However, for some patients any risk is too much and they may choose to add a further measure of protection by taking a time-honored gout medication-colchicine .05 mg daily for about 6 months-in order to eliminate the possibility of an attack while losing weight. Not surprisingly, gout attacks have been seen more frequently since the popularity of high protein diets (Atkins, South Beach, etc.).3 The foods recommended by these low-carbohydrate diets are very high in purines. Second, these diets cause rapid weight loss and thereby facilitate the release of uric acid from the body fat. Lastly, these diets cause dehydration and place added stress on the kidneys, which might make people more sensitive to the rise in uric acid
The Medical Treatments
Early treatment, within 24 hours, is the key to resolving an episode of acute gouty arthritis. Colchicine, the traditional agent used, is more specific for gout than are the NSAIDs, which are also effective. Although elevated levels of uric acid in the blood are a major risk factor for the development of gout, acute gouty arthritis can occur in the presence of normal serum uric acid levels. Patients suffering with on-going damage from elevated uric acid levels may need treatment with medication that lowers uric acid in the body (like allopurinol). Just having an elevated uric acid level without chronically active arthritis (or recurrent kidney stones) is not a cause for treatment with medication (you still need to change your diet)
All dietary recommendations for the prevention of gout attacks strongly recommend avoiding the use of muscle foods. Some authorities also warn against high protein vegetable foods, like beans, peas and lentils. Actually, higher intake of vegetable protein is associated with a lower risk of gout.3 Therefore, if a patient avoids the animal foods, including some of the higher protein vegetable foods mentioned above will cause no trouble. Based on population studies and the well-established cause-and-effect mechanisms between animal muscles and gout, I believe the common form of diet-caused gout cannot occur in people who follow a McDougall-type diet. However, most people have large storages of uric acid in their tissues which may take months of healthy eating and associated weight loss to dissolve away
Arromdee E, Michet CJ, Crowson CS, O'Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002 Nov;29(11):2403-6.
Lyu LC, Hsu CY, Yeh CY, Lee MS, Huang SH, Chen CL. A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr. 2003 Oct;78(4):690-701.
Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Curr Opin Rheumatol. 2006 Mar;18(2):193-8.
Torralba TP, Bayani-Sioson PS. The Filipino and gout. Semin Arthritis Rheum. 1975 May;4(4):307-20.
Johnson RJ, Titte S, Cade JR, Rideout BA, Oliver WJ. Uric acid, evolution and primitive cultures. Semin Nephrol. 2005 Jan;25(1):3-8.
Roberts-Thomson RA, Roberts-Thomson PJ. Rheumatic disease and the Australian aborigine. Ann Rheum Dis. 1999 May;58(5):266-70.
Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004 Mar 11;350(11):1093-103.
Antozzi P, Soto F, Arias F, Carrodeguas L, Ropos T, Zundel N, Szomstein S, Rosenthal R. Development of acute gouty attack in the morbidly obese population after bariatric surgery.
Obes Surg. 2005 Mar;15(3):405-7
To Schedule An Appointment
Please call the Indy Myopain Relief Center 1.317.973.0888.
Use our ONLINE scheduler.
Use Contact Us tab located above to send us a message.
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What is the length of an Appointment?
The first visit is usually scheduled for 90 minutes, allowing for the initial evaluation, treatment and self-care training.
Subsequent treatments are often scheduled weekly for 60-90 minutes.
When patients travel long distances to visit Indy Myopain Relief Center
we prefer to schedule longer and more frequent sessions to permit as much treatment and training as is possible
Cost of Treatment
Treatments are billed at a rate of $120 for each 60-minute interval. During our session evaluation, we may suggest items to purchase such as self-care, insoles, etc. to purchase. Below are a few additional cost-related details to consider:
Duration of Treatment
After your initial evaluation, your therapist will provide you an estimate of the number of treatments required to resolve your ailment. Patients are often able to achieve their goals within 6-8 treatments, but depending on your specific condition presented. It may take fewer or more treatments
Reducing Your Total Costs
Patients can reduce the extent and total cost of treatment by taking a proactive approach to self-care treatment. The more conscientious you are with self-care, the faster your body can begin to heal. This often reduces the overall therapeutic treatment sessions you require
Forms of Payment
Treatments are to be paid at time of service by major credit card, check or in cash
Indy Myopain Relief Center does not accept insurance directly. However, we will provide receipts in the form of a super-bill that documents the appropriate treatment codes for the services performed. You may submit this documentation for insurance reimbursement. Since every insurance company and coverage plan is different, we cannot guarantee that they will reimburse you. Please contact your insurance company directly to confirm your coverage and the process required. Many Flexible Spending Accounts (FSA), Health Reimbursement Arrangement (HRM) and Health Saving Accounts (HSA) will repay you for our therapies. We will provide to you a Super-bill for you to submit to your insurance provider
Charge for Missed Appointments
A minimum charge of $120 will be billed for confirmed appointments when the patient does not cancel within at least 24 hours of the appointment time
disclaimer:pricing and availability subject to change.
Indy Myopain Relief Center is specialized in advanced, problem solving, trigger point therapy clinic. We treat pain and dysfunction originating from soft tissues of the body, such as muscle, fascia, tendons, ligament, and nerve entrapment.