How Extracorporeal Pulse Activation Therapy (EPAT) Can Help in
Cases of Myogelosis
Tension in the neck, shoulders or lower back – hardly anyone can avoid it. These problems are,
however, not nearly as hopeless as they often seem to be. The new extracorporeal pulse activation
therapy can even help ease the most stubborn pain. Alternative practitioner Kathrin Raegener, an
expert in this novel treatment method, reports amazing possibilities.
Severe back pain afflicts approximately two-thirds of all German citizens over the age of 14, according to an official survey by the German Federal Association of Company Health Insurance Funds.Your shoulder keeps getting stiffer, getting dressed or undressed means overcoming the pain, and tying your shoes has become an acrobatic routine. It started out as nothing at all. Over time, an almost imperceptible tug or a brief twinge turned into a lasting ache. And finally, the pain took on agonizing proportions. Usually, this is when an odyssey through the world of medicine begins: orthopedist, neurologist,radiologist,physical therapists – often none of them can really help. Then, one day, the advice that most patients with chronic, inexplicable pain get: Go see a psychologist!Because despite huge technical efforts and countless examinations, the true cause still can’t be found! But many of these phenomena have a simple explanation: triggers (see box). They are the most common cause of chronic musculoskeletal pain and the most diverse pain syndromes. Precisely because these triggers cannot be detected by ultrasound, X-ray or other imaging procedures, they are often ignored by conventional medicine. Limited mobility and pain when moving are simply dismissed as manifestations of deterioration due to old age and treated with pain relievers.
What Triggers are and the Havoc They can Wreak
Triggers set off something else. Set off, because touching a trigger point can sometimes set off acute pain. Sometimes so acute that the patient cries out. Triggers are permanently contracted muscle fibers that manifest as painful spots in the muscle. The metabolism of these muscle fibers is disrupted. Conventional medicine also calls triggers mygeloses (muscle knots) or myofascial pain syndrome (pain syndrome involving muscles and fascia, or connective tissue). If one or more triggers are located in a muscle, the entire muscle tenses. This results in the tension almost all of us know, maybe in the neck, perhaps in the back. Skilled therapists can feel these triggers as tiny knots, hard cords, or swollen tissue. In advanced cases, more and more of these trigger knots form. The consequence: Entire muscle groups become tense and moving becomes increasingly more bothersome. Beyond that, the surrounding connective tissue becomes hard and sensitive as more and more waste products are deposited in them. Because muscles with triggers lose their strength, other muscles are automatically overloaded so you can continue to move. This eventually leads to improper weight bearing and abnormal posture. Which in turn lead to wear and tear on cartilage, osteoarthritis and problems with spinal disks. – A truly vicious circle! In addition to local tension, distal pain can be set off by remote triggers. Such pain doesn’t follow a logical pattern and is therefore harder to diagnose. – Moreover, triggers can cause irritation related to the senses such as cold hands and feet or prickling in the extremities.
Trigger maps like Bauermeister’s catalog widely triggered muscle areas, here on the buttocks and thighs.
From: “The Fit Back Program,” Südwest Publisher
Triggers can be felt as myogeloses or muscle knots. This is where pain collects.
Photo: Viktoria Health Insurance
The causes of pain in the musculoskeletal system can generally be found in tense muscles.
Extracorporeal pulse activation therapy treats the trigger points that set off pain with targeted
Over-exertion, abnormal posture and daily stress: a dangerous trio
Some Germans have suffered from massive triggers since they were young. Others – especially indigenous peoples – live to be 80 years old or more and never experience such pain. The explanation is simple: Too little movement, unilateral, standing or sitting activities and poor nutrition lead to the formation of triggers. If these triggers can be released in time, before articular cartilage is destroyed, a pain-free life can be possible again. Triggers form when muscles are overexerted or overstretched. Sustained stress is also an important trigger. Some people “save” their daily experiences, and their emotions manifest themselves in their musculature. In these people, the neck and shoulder areas are often affected, which can also lead to headaches in many patients. Moreover, bad technique in sports – for instance in strength training, tennis or golf – can trigger pain. Patients more and more frequently complain of trigger problems resulting from their static position while working at their PCs day in and day out. Tension most often occurs in the shoulder and neck areas, particularly in people who constantly sit at a desk or drive. In addition to headaches and migraines, vision problems and tinnitus can also be triggered. If the triggers can be eliminated, even headaches and migraine attacks that are resistant to pain medications will disappear. Triggers can be the cause of functional organ pain, especially appendicitis-like pain and underbelly pain. Slipped disks are also frequently the consequence of triggers. Many muscles that are responsible for our upright posture run along the spine.
If a muscle contracts on one side, for example as a result of an awkward movement, a strong pull is exerted on this side of the spine and there you stand, lopsided. The body attempts to compensate and contracts the musculature on the other side.
Constant, static strain causes tension in the shoulders and neck. And triggers can be at the root of headaches and migraines. Photo right: Migraine Clinic
Suffering due to Spinal Disk Damage and Osteoarthritis can be Avoided
If this continues for a while, the muscles running parallel to the spine become shorter and shorter. This in turn increases the pressure on the disks, which function as buffers between the individual vertebrae. At the weakest point, generally L4/L5 (the disk between the bottom two lumbar vertebrae) or L5/S1 (the transition between the lumbar spine and sacrum) the disk often can no longer bear the pressure and bulges outward – and we have the well-known slipped disk. This contracted musculature is also the reason why many people experience pain after a successful disk operation. The intervention may have repaired or replaced the disk or relieved the pressure on the nerve, but the musculature, the actual cause of this dilemma, remains contracted and painful. A further consequence of triggers can be osteoarthritis.
Osteoarthritis can often be avoided if you free your musculature of triggers in time and return it to its original length. The contracted muscles, namely, lead to the joint bearing weight improperly. In this way, cartilage wears out and arthritis sets in. A good example of this is osteoarthritis of the knee: More and more people complain about knee pain, are unable to remain active, experience stairs as torture. The standard treatment in this case is injections, cortisone, and pain medication. But it needn’t be that way! During a manual examination, the trigger points responsible for the knee pain can be found quickly. If they are released, the pain disappears too. Blockages appear as a consequence of contracted musculature: Joints are pulled into an incorrect position by unequal tension, and blocked. If the contracted musculature can be relaxed, most of the blockages will correct themselves. Stubborn cases can be helped by soft- touch chiropractic. Here is the decisive difference to conventional chiropractic treatments: If the joints are brought back into position with force, essentially against the muscle tension, it is no wonder that the blockage returns after a short time. The musculature, which is still contracted, forces the joint back into the improper position.
Tensed back muscles along the spine press on the disks. The consequence: a slipped disk at the
weakest point between the last lumbar vertebrae and the sacrum.
Treating Trigger Pain with Extracorporeal Pulse Activation Therapy (EPAT)
Treatment with extracorporeal pulse activation therapy (EPAT), also known as trigger pulse activation therapy, has proven to be an amazingly successful method of releasing triggers in the musculature. Extracorporeal pulses are high-frequency sound waves that are directed into the body using a handpiece (see illustration). Extracorporeal means that the shock waves are created outside the body in the handpiece of the device. This therapy originated in the field of urology, where kidney stones have long been disintegrated using high-frequency extracorporeal sound waves without invading the body. – In orthopedics EPAT is being used successfully to treat tennis elbow, heel spurs and frozen shoulder. The attempt was therefore undertaken to alleviate triggers with EPAT as well. The results were astonishing: Using EPAT, even previously barely accessible, deep-seated triggers were released quickly and easily. Because treatment with EPAT is not painful, the treatment can now be significantly more effective. Triggers had previously mostly been released by hand. The therapist exerted a pressure of several kilograms on the trigger, which is quite time consuming and, moreover, relatively painful for the patient. Furthermore, EPAT does more than release triggers. It stimulates the metabolism, thus activating the body’s own repair mechanisms. This allows the body to heal pain that has become chronic itself. Connective tissues that have become over-acidified as a result of waste products being stored in them are also stimulated. The waste products are flushed out and oxygen and nutrients can again reach the musculature. As with cupping, knots in the tissues are released.
Many people complain of knee pain – often already in their youth. Over time, contracted muscles lead to the joint bearing weight improperly. Trigger points can be treated with EPAT.
Alternative practitioner Kathrin Raegener uses centered EPAT to release triggers on the back. Mobility often improves astonishingly after only a few treatments.
Many trigger points correspond to acupuncture points. In EPAT these points are stimulated as in classical traditional Chinese medicine – energy can then flow freely again.
Photo: Meridian Chi Hotel
Pain free at last, even moderate fitness training is fun again.
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Indications for Extracorporeal Pulse Activation Therapy:
• headaches, migraines
• chronic tension
• chronic pain syndromes
• back pain from the throat/neck to the tail bone
• pain in shoulders/arms
• pain in knees/hips
• pain in the soles of the feet, heel spurs
• osteoarthritis pain
• sports injuries, rehab
• muscle and tendon injuries
• tennis elbow, golfer’s elbow
• improved sports/fitness performance
• dizziness, tinnitus
• pain in the cervical spine resulting from whiplash
Another positive effect is the effect on acupuncture points. Many trigger points correspond to acupuncture points. The energy flow of the meridians is often disrupted at these points. EPAT stimulates the acupuncture points in the same way as classical acupuncture, and energy can flow again. The radius of motion increases significantly. The arm, for instance, can again be lifted above the head without difficulty; it is possible to walk or run without pain. Many patients with shoulder/neck pain experience significant loosening and feeling of freedom after treatment, as if a load had been taken from their shoulders. The longer the patient has been in pain, the greater the number of required treatments will be, normally. As a rule, it is three to eight sessions. The time between appointments should be one to two weeks. In extreme cases, two treatment sessions in one week may make sense. An EPAT session lasts from 30 to 60 minutes. After treatment, the area that was treated may exhibit minor swelling or redness; minor bruising may occur in rare cases. Bruising disappears after three to four days. As this therapy does not employ medication, no further side effects need be feared. Comprehensive EPAT does not focus only on triggers . To effect a long-term increase in quality of life, it is important to consider the entire person. Certain habits, which may lead to new triggers, may need to be changed. This may mean getting rid of abnormal posture or improper technique in sports, or creating a more ergonomic workplace. Nutrition should also be improved or supplemented. It is important for people who suffer from stress to do regular relaxation exercises to relieve stress and relax their muscles. Patients often come into the office having been told that their weak muscles are the cause of their pain. They have regularly tortured themselves at the gym and finally determined that their pain was getting worse instead of better. Generally they have been told, “That can’t possibly be. I’ve never seen that before.” It is, however, absolutely logical: a contracted muscle cannot function properly. If it is then exercised, the muscles and joints bear weight improperly and the pain continues to increase. Important: Special fitness training makes sense only after the trigger has been released. In most cases, after successful trigger therapy, patients can again move completely without pain, go for walks, work in the garden, play tennis, etc. so that the muscles naturally retrain themselves.
From Veterinary Medicine to Professional Sports: A Variety of Areas of Application
EPAT has already been used successfully in professional sports for several years. Particularly in the area of performance improvement and quicker healing after an injury, the use of EPAT is indispensable. This treatment is not only being used on humans. If race horses display problems with their gait or toss their heads, triggers in the musculature are often the cause. In this area, EPAT can help solve problems quickly and, above all, permanently. – In closing, three more examples from daily experience that demonstrate how effective even a few treatment sessions can be.
Case 1: Help for Chronic Back Pain
Felix Müller*, 55, has suffered from pain for years. “All over,” as he reported. Further inquiries revealed chronic back pain, but recently his knees and shoulders have hurt too. Three years ago, he had a slipped disk that was not operated on. His pain in the lower back had begun approximately 10 years previously. At the end of his first EPAT treatment, the patient was already to walk without knee pain for the first time in months. Putting on his shoes was also much easier. After a total of 10 treatment sessions, he feels reborn. Today he enjoys pottering in the garden again and takes his dog for frequent walks.
Case 2: Acute Shoulder Pain Alleviated
Anna Wild*, an older lady of 80, had suffered from severe shoulder pain for two weeks. While giving her history, the patient mentioned that she had fallen on the shoulder two weeks previously. She had already had an X-ray taken in the hospital. Her bones were fine, so she was given pain relievers and sent home again. The pain did not improve – quite the contrary. As a result of Anna Wild’s fall and subsequent favoring of the shoulder, triggers had formed in the shoulder/arm area. After only three treatments with EPAT, the patient was again pain free.
Case 3: Freed from Constant Migraine Attacks
Andrea Hagen*, 32, a hair dresser, had suffered for years with constant migraine attacks and tension headaches. Until recently she had gone to the gym regularly, but recently her pain after her workouts had become worse and worse. An examination revealed that her shoulder/neck musculature was severely tense. Cause of her triggers: the stark posture required by her job. After only a few treatment sessions,
her headaches were significantly better. During this period, only one single, mild migraine attack occurred. After a total of eight sessions, the headaches and migraine attacks had disappeared. Today she has returned to the gym. And to prevent the formation of new triggers, she regularly stretches and loosens her musculature.
* Not their real names.
Holistic trigger therapy also takes life circumstances into consideration: This may mean creating a more ergonomic workplace or getting rid of poor technique in sports. Relaxation exercises help to reduce stress.
Don’t jump the gun: Strength training makes sense only after the tension problems have been resolved.
Further Case Studies
Alternative practitioner Heinz-Jürgen Prinz insists on a thorough, manual examination. In this way he can localize blockages and triggers. EPAT has proven to be especially helpful in treating tension in the back and shoulder/neck areas.
Alternative practitioner Heinz-Jürgen Prinz has had good experience with EPAT. A holistic approach is particularly important to him. If patients come to his office with pain in their backs, shoulder/neck area, cervical spine or knees, a thorough manual examination is called for. The first thing he checks is the lengths of the legs and levels them as necessary. If a difference in the lengths of the legs has caused the pelvis to become lopsided, there will without a doubt be blockages in the spinal column causing pain.
Mobile and enjoying life again
Rudolph Köstler*, 69, had had severe pain in the lumbar spine for years. Despite many doctor’s visits, no improvement. Injections, massage, acupuncture and electrical stimulation, his problems had not been alleviated. He was planning to marry and therefore wanted to be more mobile as soon as possible. In May, a difference in the lengths of his legs of 2.0 cm was first compensated. Then EPAT to remove clearly palpable triggers in the lumbar-spine region. The patient left the doctor’s office pain free. After his further treatment, Rudolf Köstler returned only to say that he no longer had any pain whatsoever and he was looking forward to his wedding.
Frozen shoulder: Operation became needless
Ernst Hartmut Hinggsen*, 68, had complained for more than a year about restrictions in movement with pain in his right arm. According to the diagnosis he had calcium deposits in the shoulder. He was therefore to have an operation as soon as possible. Before the operation, however, the patient wanted to try EPAT as an alternative method. Ernst Hartmut Hinggsen had three treatments. Following the therapy he had no pain and was able to move his arm with no problem. The operation was canceled.
Help with painful fibromyalgia
Stephanie Kroll*, 28, suffered from fibromyalgia. The patient had unbearable pain all over her body, from her pelvis to her shoulders. The typical trigger points could be clearly palpated. After four EPAT treatments of 10,000 shocks each, targeted at the triggers, she now has no pain. From one treatment to the next, the patient was able to feel significant improvement.
* Not their real names.