A “Complex” Case

Another Complex Case

By William Huhn


Since there is a severe global dearth of dedicated TP therapists, many people must travel (sometime considerable distances) to receive comprehensive trigger point treatments.


Last year I completed 30 (thirty) daily sessions to a client who traveled 4,000 km for treatment.

She came to me here on the Canadian West Coast, as she could not find anyone in her region who practiced comprehensive Trigger Point Therapy methods, nor anyone who felt comfortable taking-on her complex case.


Her chief complaint was chronic back pain near the spine.

However, the many therapists she talked with considered her case “complex” due to multiple other symptoms that she presented throughout her body/limbs, and consequently they declined accepting her as a client – this can be very worrisome to someone suffering multiple pain issues.


After her initial email to me that described her case, and a lengthy initial phone interview that included an extensive history, I recognized that virtually all her described symptoms could have trigger point sources, and decided to accept her as a client.

As usual, I made it very clear, I could offer no promise of symptom remediation.


During the office intake interview, we discussed all her symptoms, that included occasional headaches, breast pain, restricted ROM to both shoulders, occasional numbness in hands feet. She also reported lower back pain across the sacrum, hip pain that included buttocks and groin, dysmenorrhea, frequent urination, pelvic floor pain, and knee pain. One could argue her case was indeed “complex”.


She agreed to follow TP protocols to minimize possible perpetuating factors. Her treatments were carried out daily for approximately 1 month and little by little, all her symptoms began to disappear. By the end of her stay, she was virtually pain-free. Except for some minor back discomfort that could easily be remedied by her massage therapist back home.


So, what was deemed a “complex” case, was simply multiple TrPs throughout her body. There was nothing too complicated about this… it simply took time, effort and commitment, to facilitate a remedy.

To date, she is still pain-free and living an active life.


Interestingly, most of her symptoms were due to what we describe as a cascade (or domino) effect. I.e. as one muscle fails to function normally, a similar functioning muscle is called upon to assist, or in some cases, fully take over the required task. This “extra duty” can eventually cause the called-upon muscle to over-work, and likely develop TrPs, and over time lead to its failure/dysfunction. And as this failure pattern continues throughout the body, more and more symptoms can appear, thus presenting as a complex case.


Here’s an example – let’s say your primary hip flexors (the iliopsoas) have developed significant TrPs – let’s say enough TrPs to weaken them and produce related symptoms. This weakness will cause other muscles that can also provide hip flexion, to assist with, or take over the hip flexion task.

In this scenario the involved muscles include the rectus femoris (part of the quadriceps) that typically prefers doing knee extension, and the anterior fibres of the thigh adductors – their primary function, of course, being thigh adduction.

So now, due to a domino effect, we could end up with trigger points (and their possible referral effects) in the iliopsoas, rectus femoris, adductor magnus/longus/brevis and pectineus. Over time, these TrPs could become active, and possibly produce satellite TrPs in other muscles, causing even more symptoms such as knee pain and pelvic floor symptoms.


I see this domino effect quite regularly with clients. The symptoms are quite similar and seem to follow a predictable pattern… and I don’t consider it complex.

It simply takes more thought, effort, and an understanding of TP therapy, to remedy.


If you are suffering from multiple or global pain issues, please contact us.

Perhaps we can help.


Thanks for your time.