To my cab driver– I meant it, that doctor did not tell you the truth:

Dear sir,  

I appreciated your kindness in making sure I had my seatbelt on.  And the humor about directions (you were right, it was the Northeast corner).  Your conversation about weight loss and getting shorter as we age was fun (keep moving and Pilates is a fine choice if you like it).  

But that thing just as you stopped at my place – we need to pull that apart, and I hope you do come to read this.  For the rest of you, it went like this:

Cabbie:  You’re a PT? Do you know anything about stiff muscles and trigger points?  Because I’ve been told that I have this thing wrong in my neck that is Myofascial trigger point something or other and that it will take a lot of treatment to get better.

Me: I know a bit about that, what else did the person say?

Cabbie:  Do you know ____________ ? She told me I need Saline solution injected into the trigger points and maybe cold laser.  But it’s expensive and she said it would take a long time to help and I’m not sure.

Me: No.  Don’t do that. There’s not good evidence for it, and there are better (more effective) ways to get you feeling normal – and most importantly, things you can do for your self so that you don’t need multiple visits for lots of money.

<I wrote the clinic information on the back of my receipt – I hope you do call!>

Cabbie:  Can it really get better without injections?  She said the trigger points are making it so the muscle is touching some nerves and that is bad.

Me:  Please call me!  I HOPE the muscle is touching those nerves, since they run through the muscles and are hardy things.  I can help you, without injections and teach you how to take care of yourself.

He drove off, and I am sitting watching the sun set thinking how wrong and indefensible it is for health care practitioners to be selling such unfounded stories to people who should instead be helped honestly and kindly.  Saline injections have no evidence to support their use.  There’s compelling evidence that we should all toss the term Trigger Point (Travell and Simons did NOT do proper study and there’s a recent chapter about pelvic trigger points where the author clearly states that Simmons and her “extrapolated” the pelvic trigger points… ) See this and this and this.

I promised him that I could help him learn to take care of himself and that if he didn’t see positive change in 6 visits or LESS, that we would not keep going. It’s Easter.  Let’s hope for a miracle and a shift in health care away from celebrating passive treatment and words designed to create passive (and fearful) patients – let’s aim for active change and self-empowerment.  I’m all for gentle, kind manual therapy to unstick the stuck spots – and for teaching people how to do that for themselves. For cabbies (and everyone else).

Sandy