Trigger Point Self-Care Manual

For Pain-Free Movement

Donna Finando

• Publisher: Healing Arts Press
• Year: 2005
• Print ISBN: 9781594770807
• eBook ISBN: 9781620550670
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

A guide to the treatment of pain from common sports injuries and other physical activities• Contains at-home techniques to promote healing and self-awareness of the body's musculature• Explains how to relieve pain using manual massage in conjunction with small physio balls• Includes an illustrated treatment reference section organized by region of the bodyThe vast majority of physical injuries incurred by active people begin with muscular injuries that are not addressed by the conventional medical approach to orthopedic care. Injuries of this type are generally too minor to warrant splinting, casting, or medication and often do not prevent participation in physical activities. They do, however, produce noticeable discomfort and, over time, frequently lead to more severe injuries.In Trigger Point Self-Care Manual Donna Finando presents methods for the healing and prevention of musculature injuries. She identifies the causes of and remedies for areas of muscular tightness and restriction and details many self-care techniques, including precise self-massage, stretching, and the use of wet heat and/or ice. In the fully illustrated reference section, organized by body part, she identifies the pain associated with trigger points in each muscle of the body and provides instructions for palpating, treating, and stretching the muscle in order to release it.

CHAPTER 1

What Are Trigger Points and How Do I Treat Them?

Taken as a whole, the musculature is considered to be the largest single organ in the body. The system is comprised of approximately two hundred paired muscles (most muscles are mirrored on the right and left sides of the body) constituting 40 to 50 percent of the body’s total weight. Muscles are utilized in all levels of body movement, from the gross to the miniscule, from the skeletal to the organic. They help to maintain our posture, they contain our internal organs, and through their movements they contribute to the maintenance of body heat.

When the muscles are impaired and cannot properly perform their role, the systems that they affect, contain, or control also become impaired. The implication is clear: When the muscles are dysfunctional there is ultimately an affect on the body as a whole. Yet the muscles are often the “neglected children” of conventional medical care. No medical specialty actually focuses on treatment of the muscles. They are frequently overlooked and may even be considered irrelevant in relationship to the overall healing of injuries.

When an injury occurs—a fracture, sprain, or dislocation—the concern for healing is rightly directed at the trauma, the break, the injured joint. As a result of this unilateral focus, innumerable people who have sustained an injury have healed, but they have healed only partially. They are returned to almost normal function but not complete function. Range of motion may be slightly limited, but it is limited. There may be a bit of stiffness, but there is stiffness.

That final bit of healing that has yet to occur is the healing of the musculature. The muscles are the agents of movement and joint stability. When a bone or joint is injured, the muscles that act on that joint must be given the attention that they require so that they may be returned to the length and strength that they owned prior to the injury.

Athletes know better than anyone that the little bit of muscular ache and stiffness not attended to may lead to chronic soreness and inflammation, which at the very least may reduce capability and force. Over time an even more severe injury may occur, when the proper practice of technique is sacrificed in an unconscious desire to avoid pain. Trainers and coaches know this pattern well. Their approach usually involves attending to the muscle through the use of rest and ice, parts one and two of the familiar RICE formula for care of musculoskeletal injuries, in order to avoid inflammation of the tissues. (The total RICE prescription is Rest, Ice, Compression, and Elevation.) Some trainers and coaches recommend massage and/or the use of moist heat or hot soaks in a tub to flush the tissues, in the hope of returning the muscles to their normal elastic state. Missing, however, is the awareness that muscles become injured in their own way.

Muscles are comprised of individual bands of muscle tissue lying parallel to one another. These bands work together when the muscle contracts. A muscular strain or trauma can lead to the restriction of one or more of these bands, resulting in what we call a “taut band.” A trigger point will be located within the taut band. If you think of a muscle spasm as the contraction of a whole muscle, it follows that a taut band is like a microspasm, a “spasm” of an individual band of the muscle. The muscular dysfunction caused by the taut band will remain until the taut band is released.

Muscles are wonderful structures. They are supple, elastic, resilient, and powerful. You know when they are healthy because your movement is fluid, easy, unrestricted. You bend with ease. Standing, reaching, and twisting take place without a second thought. Joints move freely without a hint of discomfort or limitation. When your muscles are healthy you don’t think about them, except for the joy and exhilaration that movement brings. When you touch them they’re soft. You can easily feel the underlying structures, the bones that lie beneath them. They aren’t tender to the touch; they don’t hurt.

When a muscle develops taut bands and trigger points it becomes constricted. It feels tight to the touch. It loses its elasticity and suppleness. If it remains constricted over time there might be a reduction of blood supply to the muscle, making it more fibrous and less elastic. You might well experience the steady, deep, dull, aching pain or tenderness associated with trigger points in the muscles, a condition that has been termed a myofascial pain syndrome. Each trigger point produces a predictable pain pattern that is reproducible when the trigger point is compressed.¹ Interestingly enough, the pain frequently is not located at the site of the muscular trigger point. Pain resulting from a trigger point, what is known as referred pain, is felt at a distance from the trigger point. This is important to remember because it means that a person can look at an image of a pain pattern to find out which muscle is involved in producing that pain.

So how does a muscle develop trigger points? It usually begins with some form of mechanical abuse or overload. Active people between the ages of thirty and fifty are most at risk for developing trigger points and suffering with the resulting myofascial pain. However, it doesn’t take an athletic endeavor to be on the receiving end of trigger point pain. Trigger points can develop from an unexpected missed step, landing the wrong way from a jump, sleeping in the wrong position, reaching too far to return a tennis serve, using a poorly positioned computer, playing too much softball after taking the winter off, gardening with abandon on the first warm day of spring, carrying a huge box filled with books up stairs, or sitting at your desk or on a plane for an extended period of time. The list of causes for trigger point activation is endless because the possibilities for movement are endless.

Mechanical abuse of the muscle can occur as a result of either overuse or overload.

Overuse of a muscle often takes place when the muscle is put to work over and over again, performing the same action in the same way. Going out to practice your backhand in tennis and hitting one hundred balls is a good example of overuse. The next day your elbow is sore and you believe you may have developed tennis elbow. What’s happened is that the forearm muscles have been taken through the same action, over and over again, far in excess of what they normally do. They have become shortened, developed taut bands and trigger points. The trigger points have referred pain to the elbow.

Something that I have taken to calling “trainer-induced injuries” is an example of muscle overload. A weight trainer has you doing quadriceps extensions. You’ve already done three sets of twelve repetitions. Your trainer encourages: “Just one more rep, one more.” Your body is crying out to stop because your muscles are fatigued and you simply cannot imagine being able to do one more rep. Yet you do it. The following day when you get out of bed you find that you can’t stand straight because your thighs are terribly sore, beyond the normal charley horse that you’ve experienced before. The pain lasts for days; it’s unrelenting and it markedly affects your ability to walk, climb stairs, and sit down. An overloaded muscle is one that is made to exert more force than the muscle is physically capable of.

Overloading a muscle can take place in one of three ways. In our example here, the injury was in response to a repetitive overload.

Acute overload is another way in which a muscle can be injured. In acute overload you suddenly and often unexpectedly place way too much force on the muscle. Imagine this scenario. A martial artist is demonstrating a throw with an inexperienced student. As he takes hold of the student and tries to bring him to the ground, the student holds on for dear life. This results in an acute overload to the back muscles of the martial artist, who unexpectedly has to deal with a 175-pound weight on his back.

A sustained overload might be experienced when you find that you have to carry the weight of a heavy box of books up not one flight of stairs, as expected, but up three or four flights. In addition to overuse and overload, direct trauma, trauma that occurs by impact, such as by getting tackled in a football game, can be the source of muscular trigger points, as can the trauma that might result from a fall or automobile accident. Chilling of the muscle can cause trigger points to develop as well.

There are different types of trigger points. Latent trigger points represent the vast majority of trigger points present in the musculature. Everyone has them. Latent trigger points develop as the result of postural habits, strains, overuse, chronic disease, and recurrent emotional and physical patterns of behavior. Latent trigger points produce stiffness and weakness in the affected muscles and restrict full range of motion of the joints that the affected muscles act on. Latent trigger points will not release without direct release techniques and they may easily persist for years.

The chronic tightness in the upper shoulders that just about everybody experiences is an example of latent trigger points in the upper trapezius muscle. You might feel muscle tightness or restriction when you try to stretch your upper shoulder by aiming your ear toward your shoulder. When you touch the center of the rounded part of your upper shoulder and press into it, in all likelihood you will feel a tender “knot” there. That’s your trigger point. It developed because of the way you hold your arms and shoulders or because of the way you use your shoulder to talk on the phone.

Through a bit of overuse or an unexpected overload, that latent trigger point can become an active trigger point. An active trigger point in a muscle produces a predictable referred pain pattern that is specific to that muscle. Each muscle has its own referred pain pattern. When that latent trigger point in your upper trapezius becomes active, in addition to the stiffness, weakness, and reduced range of motion you will begin to feel a deep, aching pain that might go right up to your skull behind your ear. The muscle might be so locked up and the trigger point so irritable that the pain might go around your ear into your temple. There may have been a specific incident that produced the active trigger point, or the onset may have taken place gradually, over a period of time. The muscles located within the pain pattern may be tender to the touch. This tenderness will dissipate after the trigger point has been reduced.

Pain from active trigger points varies in intensity during the course of the day. Pain will increase with use of the muscle, during stretching of the muscle, upon direct pressure to the trigger point, with prolonged shortening or repetitive contraction of the muscle, in cold or damp weather, and in the company of viral infections and stress. Conversely, symptoms will decrease after short periods of rest and with slow, passive stretching of the muscle, particularly during the application of moist heat to the muscle.

We’ve said that trigger points are directly activated through overuse, overload, direct trauma, and chilling. But trigger points can be indirectly activated as well. Disease of the internal organs, particularly the heart, gall bladder, kidneys, and stomach, can produce trigger points in their associated musculature. Joint disease or dysfunction, such as arthritis, puts an overload strain on the surrounding musculature, and can therefore be the source of trigger points in those muscles. Immobilizing the muscle or keeping the muscle in a shortened position for an extended period of time can produce trigger points. Emotional distress can lead to trigger points as well.

When a muscle lies within the pain pattern produced by other active trigger points, trigger points can develop in that muscle as well. We call these satellite trigger points.

Generally, the degree of conditioning of the muscle is the factor that most defines whether a latent trigger point will become active. Strongly conditioned muscles are less susceptible to trigger point activation than poorly conditioned muscles. Active trigger points will frequently return to latency with sufficient rest; however, trigger points will not be fully reduced without direct treatment. People frequently report that the pain keeps coming back, sometimes over periods of years, and this is the reason why.

How are trigger points treated? First, the trigger point must be located within the muscle. This is done by palpating, feeling the muscle with your fingers. Once the trigger point is located, the medical professional might use an analgesic or anesthetic injection; an acupuncturist may use acupuncture needles; a physical therapist might use modalities such as ultrasound or electrical stimulation, possibly combined with muscle-energy technique or a technique called postisometric relaxation.

The manual or massage therapist will use compression, applying direct pressure to the trigger point. This is a technique that we can all use for self-care. The key is in finding the trigger point. Many trigger points are located in predictable locations; however, owing to physical differences, trigger points can be located in any muscle and in any location within a muscle.

In their most healthy state your muscles are elastic and supple; touching them shouldn’t hurt at all. But if the inside of your knee was painful and your knee was buckling, the muscle on the inside of your thigh close to your knee wouldn’t feel so supple. Moving your hands and fingers over that muscle you would recognize that, rather than a ball of pliable dough the muscle might feel as though there were taut, stringy bands in it. It is within those taut bands that you will find the trigger points.

You will have to palpate your muscles to get a sense of the difference between soft, pliable muscles and muscles that contain taut bands. This likely sounds more difficult than it is. Just relax and bring your curiosity into your hands and try to “see” with your fingers. You will be delighted by what you will be able to feel.

When you palpate your muscle you will need to feel it throughout its length. Take a moment right now to feel your body—place your fingers and the palm of your hand on the middle of your thigh. Imagine that your thigh muscle, quadriceps femoris, is clay that you are molding or dough that you are kneading. Press into your thigh with your entire hand: your palm, fingers, and fingertips. Quadriceps femoris runs along the length of your thigh, from your hip to your knee. Try to feel for a taut band by moving your hand crosswise over the muscle. Feel across the length of the muscle, not along its length. As you feel across the length of the muscle you’ll be able to identify a taut band; it will feel tender to the touch. In a muscle as large as quadriceps femoris the taut band might feel as broad as a thin cable; in smaller muscles taut bands can feel as thin as guitar strings.

Once you’ve found a taut band, keep your fingers on it. Try to isolate it from the surrounding musculature. Follow it through its length and you will come to an area that is very tender, more tender than any other area in the band. You might even note that when you apply pressure directly to that spot there is an involuntary twitch of the muscle. This is what Travell calls a “twitch response.”² This most tender spot is the trigger point.

Once you’ve found the trigger point, press into it—use your finger, a pencil eraser, a tennis ball, a squash ball, or one of the many products currently on the market that are designed to apply pressure to trigger points. (See appendix 2 for information on such products.) Any of these will allow you to compress the trigger point. Hold the compression for twenty to thirty seconds. With a moderate amount of pressure, the point will hurt. Note that with trigger point release more is not necessarily better. Press just enough to feel the tightness of the band and the soreness of the trigger point and then keep your pressure at that level. Don’t press into it any harder.

While you are maintaining that pressure for a few moments you will feel two wonderful things—the tenderness underneath your fingers will start to reduce and the tightness under your fingers will begin to let go—you will feel the release of the muscle. As the muscle releases you can increase your pressure just a bit more to “follow” it with your fingers. Over the course of several sessions where you work on the muscle in this way you will begin to notice that the pain in your knee has been reduced, and at some point you will note that your knee hasn’t buckled for a while.

After working on the muscle it’s important to stretch and then apply moist heat. Stretching lengthens the muscle, helping it to return to its normal suppleness and resting length. With each muscle description in this book I’ve provided a stretch or stretches to specifically target that muscle. These stretches were designed to work individual muscles, not large muscle groups. When you stretch it’s very important to place your body correctly in order to lengthen the specific muscle that you’re targeting. You’ll know you’re in the right position as soon as you begin stretching—you won’t have to stretch very far to...

Table of contents

• Cover
• Title Page
• Contents
• Introduction
• Chapter 1: What Are Trigger Points and How Do I Treat Them?
• Chapter 2: Common Musculoskeletal Injuries and Trigger Points
• Head and Face Pain
• Neck and Upper Back Pain
• Shoulder Pain
• Elbow, Arm, and Hand Pain
• Torso Pain
• Low Back, Buttock, Hip, and Thigh Pain
• Groin and Inner Thigh Pain
• Thigh and Knee Pain
• Lower Leg, Ankle, and Foot Pain
• Conclusion: Guidelines for Injury Prevention
• Appendix 1: Associated Muscles
• Appendix 2: Helpful Treatment Aids
• Footnotes
• About the Author
• About Inner Traditions
• Copyright