Dec 012017When using trigger point therapy to stop your gout attack, hopefully at stage-1, you should keep a few “hints” in mind. It isn't easy getting into trigger point therapy or finding trigger points, so here are a few helpful hints:
Helpful Hint-1:
When you definitely find a trigger point, mark that spot with a sharpie; you will be revisiting and massaging that spot many, many times before the gout attack is over. You will probably have a half-dozen trigger points marked that you need to continuously work (in stage-1), many more in stage-3. It is not easy to find a trigger point, so marking it allows you to get right to it instead of wasting time trying to find it every time (and probably losing it, which will increase your pain). It helps to have a sharpie in the bathroom to remark the spots faded by a shower.
Helpful Hint-2:
When massaging extremely painful trigger points (and some will be) I have found it helpful to just put enough pressure on it that is tolerable (5 out of 10 pain level) and massage with small circular motions for about 20-30 seconds. Then wait for about 20-30 seconds and massage it again. Each time you do this the massaging pain will become less and less. Keep doing this until the massaging pain is gone (or dull); you are then done with that session. If the initial massaging pain is close to a 10, you will need to do many sessions that day until the massaging pain is gone, hopefully along with that gouty joint pain.
Helpful Hint-3:
Don't think that after you eliminate a joint pain through trigger point massage that you are done with it. Trigger points come back because of the inflammation and your unnatural walking/sitting/etc., while in pain. By massaging it you have removed that 1-2 pain level trigger point in stage-1, but it will progress to a stage-2 or stage-3 if not continuously attended to until your entire attack is over. By massaging ALL of your trigger points every day, as many times as you can, you can avoid re-triggering them. Also, the more you massage them the faster you will get over the attack. Fortunately, there is an end to the pain and swelling, but only if you are diligent and quell the attack as soon as possible. Why be in pain for many, many weeks when you can eliminate it in minutes or hours (stage-1) or eliminate it in days (stage-2) before it gets to an intolerable stage-3.
Helpful Hint-4:
Gout attacks go from a stage-1 to stage-2 to stage-3 to stage-2 to stage-1 before the attack is over. It is best to continue with stage-1 treatment (massaging known trigger points) for a few days or a week after ALL of the pain and swelling is gone. This will assure you that you don't automatically transition into another gout attack because the present one isn't fully eliminated.
Helpful Hint-5:
Some of the nastiest trigger points occur on the bottom of your foot, especially if you are in stage-3. There is though a simple way to deal with of them. Roll a golf ball under your foot, all over, and when you reach a spot that gives you much pain, you have discovered a trigger point. Put pressure on that trigger point by pressing your foot down for 20-30 seconds and then let up for another 20-30 seconds. Repeat until that trigger point is painless or dull. Then roll the golf ball around until you find another trigger point and massage it the same way. Do this until all of the trigger points on the bottom of your foot are eliminated. When in stage-3, it is very difficult to get a decent night’s sleep if you don’t eliminate the trigger points on the bottom of your foot. Of course, it also helps to eliminate your other trigger points (the ones you marked with a sharpie) before going to bed. And a good night’s sleep helps you to recover more quickly. To help AVOID gout attacks, use the golf ball under the foot massage monthly, it really does make a difference.
Helpful Hint-6 (drugs):
It is difficult to determine the NSAIDS (ibuprofen, etc.) drug dosage to take to reduce your inflammation. I tried the following: 1) taking the suggested 1-2 tablets—didn't work; 2) taking 4-6 tablets sporadically—worked, but I had severe musty smelling night sweats; 3) took three tablets every 5-6 hours—worked, with no night sweats. After the inflammation went down significantly, the night sweats returned so I reduced to two tablets, which worked fine. I'm not saying that you should overdose, quite the opposite, this is just what works for me, a person who has a high tolerance to drugs. The hint here is to realize that if you take too much of a drug that your body will probably excrete it in night sweats and that you probably need to reduce your dosage.
Jan 012021Synopsis of this article:
There is both helpful and misleading information about gout attacks in the media and support blogs, which confuses gout sufferers, making it difficult to resolve their gout. Over the past 9 years I have done extensive research on my gout attacks. I have stopped my severe gout attacks, which now allows me to now walk smoothly without pain or dysfunction. Here is what I have found:
1. If you get gout attacks year after year you have “gout”—that’s what it’s called so get use to it.
2. A person with gout will get gout attacks—sometimes yearly, sometimes monthly.
3. Gout probably develops over many years with increasing pain from pain level 1 to 10.
4. The accumulation of uric acid crystals and “tophus” in your joints cause your gout pain—tophus is a hard chalky white deposit of sodium urate in your joints causing “foreign body inflammation”. Gout tophi (plural) can be removed from the joints by taking ½ teaspoon of baking soda daily for many months, although other remedies may also help.
5. If you do not remove your joint tophi and UA crystals you will suffer severe gout attacks more than necessary.
6. “Trigger points” in your leg and foot muscles trigger your gout attacks. Trigger points shorten the muscle and pull the joint attached to that muscle’s tendon out of position—this allows more tophi to accumulate in the joint causing severe pain and swelling.
7. Trigger points can be resolved by massaging them, thereby allowing the joint to go back into its healthy position—the timing of these massages is critical to resolving your gout attack.
8. Gout attacks occur in three stages—if you don’t resolve it in stage-1, it will progress to stage-2 and if not resolved in stage-2 it will go to stage-3 with severe pain and swelling.
Getting Started
You need to know what NOT to waste your time on to cure your gout—diet and medication. Once aware of your gout you look for ways to get rid of it and most of what you read is that uric acid (UA) crystals cause by purines in foods exacerbates your gout attacks. You also hear that lowering your blood UA level with diet or medication will lessen or eliminate your gout attacks. Normal blood UA levels are 2.4 - 6.0 for females and 3.4 - 7.0 for males—gouty people have similar blood UA levels. The fact is, 70% of your blood UA is due to your overnight anabolism (rebuilding your cells)—only 30% of blood UA accumulates from the foods you eat. To test this I did an intensive 450-day study measuring UA blood levels (3.5 to 11.0) and gout pain levels (1 to 10) for daily purine intakes of 25 to 1,000. I measured my uric acid (UA) level each morning (after fasting) three times and averaged the three readings for accuracy. Like myself, most people eat about 400 to 800 purines a day, so to eliminate the effect of purines on blood UA I did a study eating only 25 purines/day (3 corn muffins and two liters of water) for 10 days, and tested my blood UA levels every 6 hours at 6:00 am, 12:00 noon, 6:00 pm, and 12:00 midnight. The 10-day average ended up with 6-hour blood UA levels of: 6.25, 5.50, 5.00 and 4.65 (averaging 5.35 per day). I also did a 7-day study of UA readings with a typical daily intake of 525 purines/day with 6-hour blood UA levels of: 7.70, 7.00, 6.95 and 6.70 (averaging 7.10 per day). Thus at a typical 525 purines a day there is a 1.75 (7.10 – 5.35), 30% increase in blood UA level over daily metabolism. But, maybe a 1.75 increase in blood UA due to diet is significant enough to cause gout—I doubt it.
About Drugs
Bad News: You will hear a lot about reducing blood UA using drugs like Allopurinol. To see if Allopurinol had any effect on blood UA I did a 13-month study monitored by my MD using a medical lab to draw and test my fasting blood during each stage of the study. After one month of Allopurinol (at 100 mg/day) my blood UA went from 8.2 to 6.8 and after two more months (at 200 mg/day) it went from 6.8 to 5.9—sounds great. Unfortunately, after another two months (at 200 mg/day) it went up to 7.7 so I increased the dosage to 300 mg/day for three more months and it went up to 8.7. I then stopped using it and after five more months it settled at 8.6. Yes, it does work at first, but in the long run it doesn't.
GOOD NEWS: Years later I found a new blood UA reducer, "Febuxostat 40 MG Oral Tablets". After 3 months I noticed a drop in attacks and tophus. After 6 months my blood test showed a UA of 4.4. I also noticed a reduction of swelling in my joints caused by tophus. Febuxostat is the only way to go as far as I am concerned. My gout attacks are now few and far between.
Other GOOD NEWS: The topical ointment "Voltaren", which was only available by a doctor's prescription, is now available over-the-counter. Applying it in the am and before going to bed reduces or eliminates the gout pain...it's great! If severe swelling, it works best with a compression wrap applying it 3-4 times a day.
Other than the Febuxostat and Voltaren, I still seemed to get gout attacks back then, so I looked elsewhere. I had been massaging my trigger points to remove lower back pain and decided to use it to reduce my gout pain—best thing ever. I used the “Trigger Point Therapy Workbook…third edition” to find the trigger points in my legs and feet triggering the gout pain. There were many trigger points, but once I found them all and massaged them, my gout subsided from severe pain (10) many times a year to little to no pain (0-2). But, when the pain was evident I had to immediately massage the trigger points causing that pain or else the pain would progress to 3 or 4 and eventually 8-10 with severe swelling.
Limiting the "Three Stages of a Gout Attack"
Immediacy is important! There are three stages of a gout attack. Stage-1 is slight trigger point pain (1-3) in a joint that needs to be resolved immediately! If not resolved for a couple of days you will slip into stage-2 with 4-6 pain and noticeable swelling. At this point you must vigorously resolve the trigger points and take Ibuprofen for the swelling and possibly Aleve for the pain. If not resolved for 2-3 more days you are in for a full blown gout attack with 8-10 pain levels and severe swelling that may last for weeks, sometimes months. In stage-3, nothing works to resolve the painful swelling except time (painful!) or a Prednisone steroid regimen. I have had many stage-1 and a few stage-2 gout attacks in the past couple of years, but it doesn't progressed to a stage-3. But there was still some dysfunction in my feet, making me trip and walk stiltedly. I heard from a fellow gouty that if I took ½ teaspoon of sodium bicarbonate (baking soda; in a glass of water) every day that it would remove the tophi that had collected in my joints over the years. I took it for six months and my swollen tophi joints disappeared and my walking became smooth, painless and effortless. I took baking soda every day for two years to eliminate tophi collection in my joints and it stops my gout attacks at stage-1. I then decided to stop taking baking soda for 100 days and it was the first time in over two years that I progressed to a stag-3 attack. I started taking it again and it helped clean out the joints after two weeks. I guess I should take a teaspoon once or twice a week forever as a precaution.
Another problem with muscle fatigue and trigger points is that it has a domino effect. Once you get past stage-1, inflammation sets in and affects your gate (walking) since the affected joint is now painful and your body will compensate for it. This weakens other foot and leg muscles and creates trigger points in them. You then have to chase down and eliminate those trigger points too. This is why it is imperative to stop your gout attack at stage-1.
Resolving Trigger Points
In order to get a painful joint back to its normal no-pain state the trigger point needs to be erased. This is accomplished by applying pressure on the trigger point. This pressure crushes the trigger point allowing the muscle to return back to its natural length, but it can be as painful as the gout itself. Fortunately, if you can get make it through that pain for about 20-30 seconds of trigger point pain, the gout pain will disappear. It may though at first, take numerous 20-30 seconds sessions each day over many days. Thankfully, once you start massaging the trigger point, each session becomes less and less painful until the trigger point has been erased. If you continue to maintain your unhealthy daily routine (which is likely) the muscle will fatigue and the trigger point will come back, but erasing it will be much less painful and the relief will occur in minutes, if not seconds. For most, gout is a never-ending condition, but with periodic trigger point maintenance it can be kept at bay. It does though require that you be aware when a trigger point is re-developing, by being aware of the pain/numbness developing in the joint that muscle is attached to. If you wait too long, the more painful it will be to erase it.
Trigger points under the foot were extremely painful making walking impossible. To resolve this, I roll a golf ball under my foot to crush the trigger points—it hurt as much as the gout, but after a few minutes it removes the trigger points and the pain. After my trigger points were under control I unfortunately continued with daily habits (sitting, standing, lifting, etc.) that caused muscles to fatigue and trigger points to appear—it’s a fact of life, especially as you get older and muscles get weaker. As the trigger points appear I massage them immediately and relieve the pain in minutes if not seconds—it’s wonderful!
Bottom line, if you have gout you have already accumulated UA crystals and tophi deposits in your joints over the decades. Use baking soda for at least six months to remove them from your joints to allow them to work smoothly again. When a gout attack is starting, massage your muscle trigger points that pull your joints out of position, thus keeping additional UA crystals and tophi from being collected in those joints. The sooner you remove the trigger points the sooner your bones will go back in place and keep UA crystals and tophi from collecting in that joint, stopping the gout attack in stage-1 and avoiding its elevation to a painful, debilitating stage-3 attack.
Also see the article on the left: "Helpful Hints for using Trigger Point Therapy"
I hope that this helps you to manage your gout attacks—good luck!
