The deactivation of TPs is difficult, but preventing them from reactivating can be even more difficult. I remember when I first began to make progress with deactivating the TPs, I thought I had finally cracked the problem. Unfortunately, I quickly found out that they would always reactivate again. I was in a never ending cycle of hard work (cool & stretch, acupressure, massage, etc) to deactivate them, then, when a bit better, would do something to inadvertently reactivate them again.

I found several rules for TPs.

1. The longer TPs have been active (ie months / years) the more difficult they are to deactivate, and the more readily they will start up again.
2. The longer they have been deactivated, the less sensitive they will be to reactivation.
3. Activities that cause reactivation to occur are difficult to judge, and do not necessarily cause pain ie. pain is not a good judge of whether an activity is appropriate.
4. After deactivation, a comprehensive exercise, fitness, stretching and strengthening programme is very important to building up resistance to reactivation.

TPs are complicated by the fact that they can become chronically irritable, and by increasing weakness and loss of fitness through inactivity. This means that, after a time, almost any activity can be enough to cause reactivation.

I believe it has taken me several years for the sensitivity of my TPs to reduce.

In dealing with rehabilitation and TPs there are several guidelines I found useful.

1. If you don't feel up to something say NO. This can be very difficult, as you begin to feel you cannot be depended upon, and cannot carry out any responsibilities reliably. I was lucky staying with my parents for a year. If I didn't feel up to doing the dishes, or putting some washing out I would just say no and my parents accepted it.
2. If something begins to feel uncomfortable, or hurts, stop IMMEDIATELY.
3. Increase work rate very slowly. If TP has just been deactivated try to avoid stressing it for at least month, to let its sensitivity reduce a bit.
4. Test an activity several times before increasing it.
5. If a TP feels like it is starting to get sore again, or does reactivate, stop all new activities immediately and start work on deactivation as soon as possible (in the next few hours if possible). Remember if it has been reactivated again, even for a short time, its sensitivity has been increased again.

Unfortunately it can be very difficult to know whether an activity is going to cause problems. I found it extremely frustrating that I could, for example, go for a swim do a few lengths using my hands with no problems. I would go home feeling great, and pleased that I had done something new without problems, then several hours later my TPs in my hands would begin to reactivate. In the end it was a combination of experience (it caused a problem last time, so avoid this time), and trial and error.

It is easy, (I found) to become somewhat paranoid. At one stage I never seemed to know what activity might cause a problem, and was constantly aware of my hands / arms / etc, studying them for the slightest hint that something might be going wrong. This is not particularly healthy, and can apparently create further problems by causing a heightened awareness of the problem areas. I almost deliberately became a hypochondriac.