Richard Finn is a graduate of the Academy of Myotherapy and Physical Fitness. He is Board Certified by the National Association of Myofascial Trigger Point Therapists and has served as president from 1992-94. He is the Director of the Pittsburgh School of Pain Management and serves on the Board of Advisory of the Fibromyalgia Research Foundation, and on the Executive Committee of the National Association of Myofascial Trigger Point Therapists. He is an excellent and leading instructor who is set to teach PT-1: Myofascial Trigger Point & Proprioceptive Therapy on June 2nd-3rd, 2018. We had the opportunity to sit with Richard and discuss with him some common questions Physical Therapists had regarding Trigger Points.
Interview With Richard Finn
Q: How long have you been performing Myofascial Trigger Point therapy?
A: “I actually learned about it while I was in the army in 1985 studying to be a Physical Therapy specialist in the army reserve. Found a book on Trigger Point therapy and immediately started practicing as a student in school. In 1989 I went to school for advance Trigger Point therapy and have been doing it ever since. I practiced it while studying for it just from medical journals. I must have read the last 10 years of medical journals before even having gone to school for it.
Q: How long have you been teaching this method?
A: I’ve been teaching since 1995. After having gone to school for certification.
Q: What are some common ailments you see that trigger point therapy can ease? Such as headaches etc.
A: The thing that got me interested in trigger point therapy was my own headaches. I love trigger point therapy for headache issues. I found for a lot of upper extremity issues like carpal tunnel, these respond very well to this type of therapy, so I use various things that I have learned at Hands-On Seminars and add on neuro-dynamic work. What we learn in PT-1 is absolutely foundational for learning anything else in the other courses to follow. All the courses are integrated. Trigger point relates to everything else we do and makes a fantastic foundation for a lot of other skill sets. I do a lot with trigger point for low back pain issues and I like to use it on pain on the knee, it yields great response. Most people don’t understand that pain in peripheral joints is common and needs to be looked at as well as muscles. I check the muscle length of the muscle that crosses that joint, and calming that muscle has a major effect on the joint experiencing pain or discomfort. There is no one thing that fixes everything, it’s a combination of putting all the right things together and learning to assess the patient, the situation, and your own skill set.
Q: Explain which body parts you will focus on during the PT-1 course coming up this first weekend of June. Any particular reason why you will focus on these? Are these harder or easier to resolve?
A: PT-1 is a course that goes through the whole body. We spend a lot of time on the neck and shoulders which I really like because I dislike headaches. We spend a lot of time on the low back and it increases the of the other techniques. It is sad that people think that painkillers can just resolve a problem like this. We learn a lot of things that we can teach our patients to ease their pain without having them rely on painkillers. As physical therapists, we give them their own skill sets to fix these issues which is why WE master these skill sets.
Q: what is your favorite aspect of this course or treatment? What is your favorite part about being able to teach it to others?
A: The thing I absolutely love is that this information comes across as so new when I present it. I rarely have a student who already knows it and it’s a life-changing course. You go to work on Monday and you have an entirely new skill set. That’s what I love about it. People email me after a course to thank me because it makes such a huge difference. I love the feedback.
Q: What is the difference between this method and deep tissue massage seeing as both use deep hand motion techniques? Especially for those who believe they are one in the same?
A: Well, number one they are not one in the same. I have certifications in both so I can say that. Deep tissue massage is a regular Swedish massage applied deeper and harder with less finesse. With trigger point teaching we do a muscle length test before we do any treatment so we know what it is we have to treat. We do assessments and then treatment so we can see the effect of the treatment. Again, I’ve taught massage therapists and Physical therapists and there’s a fundamental difference in the understanding of the body, in physical therapy we get them out of pain and give them independence to effectively understand the medical treatment. This is medical intervention. My approach is if the patient has to tighten up or change their breathing than I am applying too much pressure and will lighten up, this further separates this technique from deep tissue massages because we don’t need to give them pain in order to ease their discomfort in the muscles. We want our patients to feel better and move better.
Q: What are common modalities you lean towards or favor for trigger points? Heat, electrical stimulation etc.
A: When I do use modalities I use frequency specific micro current. I don’t use ultrasound or e-stim, they are not as effective as my own two hands and I like to just use my hands.
Q: In a book written by our founders, they discuss the Progressive Pressure Technique, do you use this technique as well? Do you use any other techniques geared towards trigger point that you like?
A: There are a number of treatment techniques and I use different techniques at different times. When we find a trigger point, when we place our fingers there, I wait until I feel a softening then I sink down to the next barrier. I think of it as a barrier softening and following up with going deeper and deeper. Hands-on teaches what is usually the best technique. I was trained to hold the trigger point for 10 seconds and move on but these results don’t last as long as they would if you use the progressive technique. Don’t add more pressure, but sink deeper into the tissue as these tissues relax. This is a neurocentric explanation.
Q: Do you treat trigger points (TP) that do not reproduce a patient’s pain or do you just treat the point that does produce pain or painful symptoms once you’ve located it?
A: In my personal practice my goal is to calm down the entire nervous system. If I have someone with a stubborn problem I don’t want to just treat that trigger point, I want to treat the spinal segment that supplies that trigger point. When I do this the nervous system is calmed and makes the trigger point itself much more responsive to the therapy I’m giving. Once I’ve done this neurological approach, I have to go into this area I have to go back and asses the biomechanics and treat other parts in the area before I treat the specific trigger point for long-term treatment. Many don’t think neurologically, if you don’t apply biomechanics to the area, if you aren’t integrated in the technique of course it won’t work long term.
Q: If a therapist treats a trigger point, what are some things they can do in order to maintain the treatment to avoid the pain returning for the patient?
A: You can do a couple of things. When we do our assessments, we do a range of motion for muscle length test so we can feel where the tightness is located. If it occurs on the belly of muscle it’s a trigger point but we have to also think of joint technique. Some people think only of the trigger point but you cannot overlook the joints. Sometimes neuro-dynamic techniques are needed for nerves supplying the trigger points so they can calm down. You have to look at all neuro and biomechanic aspects. We demonstrate various stretches they can do at home for each muscle we work with. I like to have people go right into gentle movement with as much available range of motion. Going right to the edge of where it is painful and then coming back. The brain has learned how to hold the body in a particular position and once we can push our range of motion it allows the body to push a little bit further.
Q: Latent vs. Active trigger points, what is the difference? Is one worse than the other? Which one is easier to treat?
A: I don’t worry about the distinction much. A lot of people think they need to go to latent first to resolve pain but it is short lasting. There have been times that I have treated latent then the active turns latent.
Q: If a therapist is limited with treatment time for each individual patient, how can he/she maximize efficiency of their techniques of the trigger point release?
A: What I teach is the muscle length test, from this the therapist can tell where the tightness is in the tissue and go directly to that spot. That saves a lot of time, you can press that spot and the patient feels better. I do quick fix work in 15 minutes and knock it out. Making it last longer is going to take more time to deal with other perpetuating factors but we need to send patients home with homework to do in order to stretch the relief.
Q: Are there any tools specific towards helping a therapist with trigger point release? Any tools you favor in particular or that you think are most beneficial to trigger point release?
A: I prefer my own hands. When I treat a patient, the backnobber is a self-treatment device. It is good for getting deep parts of the body, I love that. While there are great devices, I hardly ever use a tool. I’m a fan of the hands.
Q: Is there a proprioceptive connection related to Trigger point?
A: One of the things I find with the treatment we are doing is it changes the position of the body in space, often times without proprioceptive connection the patient gets dizzy. If I make any big postural change, I want to follow up with proprioceptive connection. The work won’t last if you don’t do this, there is no part in our training that gets wasted, and we use various aspects to do a full treatment.