By John-David Kato
Chiropractor and Clinical Exercise Physiologist

If you have been to a chiropractor before, you may have heard the word “subluxation.” This word often has a lot of confusion around it because it can mean two or three different things depending on who uses it.

If you dissect the word into two to find its origins, you have “sub” and “luxation”. “Luxation” is a medical term which means “a total loss of articular contact”, in other words, a “dislocation” of a joint. “Sub” in this case means “less than”. Therefore combined the word “subluxation” means a partial loss of articular contact – the two bones of the joint are still in contact, but just not as much as normal. This condition often occurs when the muscles or the connective tissue of the joint has been torn or stretched and the joint ends up being loose.

When chiropractic was first developed, chiropractors used the word subluxation to help describe their theories. One of the main premises of Chiropractic was that the joints in the spine became misaligned, and that chiropractic treatments put the joints back into place. Here the use of the word subluxation is an extension of the original meaning of a partial loss of contact of two joint surfaces. The focus of the term, however, is that as a bone loses some of its connection to the adjacent bone it will also be “out of place”. The adjustment that chiropractors developed was intended to fix these misalignments called “subluxation”. Many chiropractors still hold the philosophy that their treatments are fixing misalignments of joints.

As things in science change and evolve so have some ideas in chiropractic. Many chiropractors believe that the joint gets stuck, or fixated, and that basically much of the benefit of adjusting these joints is the restoration of motion. The adjustments here may not look any different than before and patients’ symptoms still improve or go away, that part has not changed. However the theory of how the adjustments help the joint is different. So here when a chiropractor refers to a “subluxation” of a joint, he or she is describing the lack of motion not a change in position.

As you can see, it is easy to understand why people can become confused, even those within health care. There are three different meanings for one word. One meaning refers to “excessive motion”, one is “out of place” and one means “not enough motion”. In light of this, there are a few things you might find helpful:

• If you tell your doctor that your chiropractor said you have a subluxation in your back, realize that your medical doctor and your doctor of chiropractic may use this word with opposite meanings.
• Some chiropractors may not use the term at all because of the confusion it causes.
• Whatever the definition of the word “subluxation” the chiropractor uses; keep in mind it is a benign state. No one will ever die from a subluxation.
• X-rays are not required in the treatment of every patient. An x-ray is just a picture in time and does not show motion or the ability to move.
• If you change chiropractors, you may notice that they work and explain things differently. One may just focus on treating joint subluxations of the spine, one may treat both muscles and joints together.

Whatever the case may be, if you are unsure of what your chiropractor means, just ask, I am sure he or she would be happy to explain. As for my treatment style, I treat joint restrictions and muscles problems and give exercise prescriptions so that patients do not come in week after week for ongoing care.

By John-David Kato
Chiropractor and Clinical Exercise Physiologist

I am often surprised at how often people have never heard of trigger points in muscles. This concept is not new [1]. These trigger points are well accepted by chiropractors, physiotherapists, registered massage therapist, sports medicine doctors, physiatrists and other medical specialists as a common cause of pain. In speaking to patients I will often hear them say “Oh, I think it is a muscle pain…” This is not necessarily always correct or the complete picture, however many people are right that the symptoms they are feeling are coming from muscles. But when I begin to explain that the pain is caused by trigger points, it is a new concept to them. I hope that this article provides some understanding of this common cause of pain people experience.

Myofascial trigger points, or trigger points, have been described as “a hyper irritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia, that is painful on compression and that can give rise to referred pain, tenderness and autonomic phenomena.” [1]. Simply said, this describes a sensitive, often extremely painful spot, in a tight muscle or in the connective tissue that surrounds the muscle (the “fascia”). The muscle will feel “tight” and as fingertip pressure is moved along the muscle belly there is a specific point which is often so tender it can actually make the person suddenly jump. The above definition of trigger points describes interesting physiologic responses including referred symptoms, such as pain felt in an area distant to the trigger point. For example, pressure on trigger points in the muscles on the neck may reproduce a pain around the ear or eye which is a common complaint of headache sufferers. Or another example is pressure on the trigger points in the muscles in the shoulder can reproduce a sensation of pain or numbness in the fingers of that arm. In both cases the area being pressed can be very painful, but there are also symptoms in areas that are not being touched. The concept of “autonomic phenomena” refers to the discovery that often there may be changes in the activity of the autonomic nervous system (causing such things as sweating, tearing, goosebumps, etc).

Other interesting characteristics found with trigger points:

• Trigger points can sometimes be “latent” (as opposed to “active”), which means that they are present in the muscles but do not cause any symptoms unless pressure is applied to them.
• Trigger points are also said to be “electrically silent”. Normally, an electrical signal is sent through a nerve to excite a muscle. This excitation causes the muscle to contract. With a trigger point the band of taut muscle is contracted at rest even though there is no electrical signal.
• When a trigger point is pressed, a brief twitch response is often seen. This twitching is involuntary. Sometimes patients tell me they can feel it, sometimes they cannot, but they are often fascinated when I can show them.
• Trigger points cause the muscle to be weaker and to fatigue quickly.

Patients with trigger points are often misdiagnosed due to the fact that there is no clinically relevant test for trigger points, and the symptoms are often distant from the point of origin. For example a patient may be suspected to have heart disease because of chest pain when in fact the pain was referred from a trigger point in the neck or chest. Or some people have been diagnosed with a disc herniation because of pain referred into their fingers. Examples such as these and many other situations occur all the time as trigger points can form in pretty much any muscle.

So how do you prevent and treat these trigger points? You can help prevent them by following a few different steps. The best way is to engage in a stretching and strengthening program to ensure that your muscles are strong and limber. It is especially important to target stretching in those muscles which tend to get tight and strengthen those muscles which are prone to becoming weak. If done on a regular basis, this will go a long way in preventing trigger points and their symptoms. Furthermore by increasing muscle fitness (strength, endurance and flexibility) muscles are just less prone to injury. This exercise program should emphasize proper posture, proper balance of strength between opposing muscles and postural awareness as problems in any of these areas are common contributors to trigger point development. You should also be aware of activities that have contributed to the development of previous trigger points, and either try avoiding those activities or modifying them. For example spending hours looking down at a laptop computer screen (as seen with students) can cause trigger points resulting in neck pain and headaches. A suggestion would be for the student to try using a separate keyboard and prop the laptop up higher when working at a desk. This simple ergonomic change promotes better neck posture and along with further precautions including periodic mini-breaks and strengthening the core muscles of the neck will prevent symptoms without reducing productivity.

If you do suspect you have muscle pain or headaches due to trigger points, there are a number of treatments available. And the good news is that trigger points are often very responsive to care. First though you will need someone experienced to be able to find them. Usually when they are present, they occur in more than one muscle. Examination of muscles takes practice of palpation skills as well as knowledge of the common referral patterns of pain. So the examination would not only include the area you feel pain but other related areas. Furthermore it is my experience that the joints associated with the area of complaint and the areas of the trigger points need to be addressed. Treatment could then include a combination of techniques which may consist of stretching of the taut bands, massage to the muscles, mobilization or adjustment of the joints, physical therapies and instructions for self care, exercise and most importantly prevention.

Prior to beginning my Chiropractic practice in Toronto, I was the director of the Therapeutic Exercise course at the New York Chiropractic College. My master’s degree is in Exercise and Sports Science and I hold the highest level certifications in both the American College of Sports Medicine and the Canadian Society of Exercise Physiology.

1. Travell J and Simmons D, “Myofascial Pain and Dysfunction: The Trigger Point Manual,” Williams & Wilkins, Baltimore, 1983.

By Linda Jung RMT, BComm
Registered Massage Therapist

The majority of the population has experienced a headache in their lifetime, with tension headaches being the most prevalent. Tension-headaches are often associated with poor posture, immobility and stress.

When held in a certain position for a prolonged period of time, muscles contract and become tight. Within these muscles, trigger points, irritable nodules or “knots”, can develop. Together, they can produce local or referred pain (non-localized pain) and generate a tension headache (if the muscles of the head, neck, and shoulders are involved).

In my practice, I see many patients who have tension-headaches from tight muscles or trigger points. These patients are treated effectively with massage therapy. I work on the affected muscle(s) to enhance circulation, to reduce tension and to release the trigger point(s). By reducing muscle tension and releasing trigger points, patients report that their headaches are diminished in intensity and frequency. They also report improved sleep and a reduction in stress.

To prolong treatment effects, patients are given muscle stretches and strengthening exercises and tips on postural awareness to reduce the occurrence of their headaches. As muscles become “re-educated”, follow-up visits can significantly reduce the chances of a return tension-headache by working on those affected muscles. I also encourage patients to practice and foster good breathing habits everyday to relieve stress and muscle tension.

In addition to massage therapy for the treatment of tension headaches, I find that my patients also benefit from the integration of naturopathic and chiropractic therapies.

Keeping the body agile along with good spinal health, a healthy diet and exercise all play an integral role in improving posture, health and reducing stress. Actively addressing these can make a world of difference in overall well-being, including tension headaches.

I have been working as a registered massage therapist in Toronto for the past 4 years. I treat a multitude of conditions including tension headaches, trigger points, pre and post natal massage, and trauma and complex care (motor vehicle accidents and workplace injuries).

For more information on tension headaches, registered massage therapy, and how our team can help, please give the clinic a call at 416-926-0084.

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