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Clinical Trigger Point Massage
More Information about Trigger Points
Written by: C. M. Shifflett
Round Earth Publishing
http://round-earth.com
Claims made for the healing effects of massage and bodywork may seem phenomenal. But the effects are real because bodywork really affects at least two very important body structures: muscle (which may make up 50%-60% or more of your body weight) and fascia (the connective tissue) which ties it all together. Massage improves circulation; speeding removal of waste products such as lactic acid. It reduces muscle tension in ways that drugs and pills cannot, improving blood pressure and nerve transmission. This in turn improves reflexes and the associated problems of hypertensive disease. Muscles are designed to twist and stretch. Tight, shortened muscles are weaker than supple healthy ones and can inhibit movement in ways that threaten daily activities, safety, and function. For example, if you can't turn your head to check for other cars, you are in a life-threatening situation. Older people who lose the ability to walk due to painful or weak leg muscles (losing the ability to care for themselves) are all too likely to end in nursing homes.
Traditionally, pain attributed to muscles hasn't been taken very seriously ("it's just tension!") but muscles and fascia can cause severe pain. People who have had "serious" diseases (such as heart attack, kidney stones, or broken bones) affirm that myofascial pain can be every bit as bad - or even worse. Meanwhile, people who are otherwise healthy and fit suffer unnecessary pain and dysfunction. This is still a relatively new idea. How can so much pain be due to "mere" muscles? It depends on the problem of course, but consider that over 30 major nerves, veins and arteries are commonly found to be compressed or "pinched" ("strangled") by tight muscles and fascia. Tingling, numbness, pain, slowed reflexes, swelling, and blood clot formation is just a few of the possible side effects. Relax the constricting tissue and you may restore proper function - without the use of potentially dangerous medications. For example, headaches of all types are now known to be triggered by muscles. This was made clear when Botox injections had an unexpected side effect: patients reported that their chronic life-long migraines had vanished. Their pain was coming from muscles and the muscles had trigger points.
What are Trigger Points?
"Trigger Points" (TrPs) are areas of shortened, tangled fibers within muscle or fascia. They are named for their remarkable ability to "trigger" pain to areas far distant from the origin. Some 80%-85% of the time, where you hurt is not the source of the pain.
Common Pain Patterns
In the following diagrams, solid areas indicate the most common "essential" areas of pain. Stippling indicates less common or "spillover" pain patterns. Black circles indicate trigger points. Notice how rarely these points appear in the actual area of pain. For example, a circle of intense pain at the base of the skull is a very common pattern caused by the trapezius muscle of the back. The muscle
attaches here, but notice that the actual source is in the mid-back portion of the muscle. This is
why the steroid shot to the painful elbow so often fails to provide lasting relief; the pain is coming not from the elbow but from somewhere else entirely. Pain patterns may vary from person to person, but in general, patterns of muscular pain are predictable and reproducible. But why are they there at all?
Precipitating vs. Perpetuating Factors
Trigger points form for many reasons, commonly divided into "Precipitating" and "Perpetuating" factors. The "precipitating" factor that starts the pain may be a onetime injury to the muscle, for example, muscle-shortening by holding a telephone between neck and shoulder. Chilling makes it worse. Injuries may be "perpetuated" (continued) by infections or by habits such as sleeping curled around many pillows. The reverse is also true: infections, days in bed or poor nutrition ("starve a cold!) can set off aches and pains that continue later because of poor posture and body mechanics. The boundary between the two categories is extremely slithery, but watches for all possibilities that will help you heal. And watch the actual patterns of pain. Do the following pain patterns look familiar? Despite different names and interpretations, they all come from muscles.
Sternocleidomastoid
This big ropey muscle (SCM for short) runs from behind the ear down to the collarbones and breast bone of the chest. No other muscle causes as many bizarre and frightening symptoms. SCM is commonly strained by:
· Sleeping with neck flexed, head propped forward,
· Overhead work (such as painting or hanging curtains),
· Breathing with chest (rather than diaphragm),
· Chronic coughing,
· Hauling or weight lifting,
· Tight collars and ties,
· Word processing / keyboarding,
· Infections (i.e., sinusitis, abscesses, or herpes simplex).
Symptoms range from dizziness and car-sickness to problems with swallowing, mysteriously teary eyes ("but I'm not crying!"), visual disturbances, chronic sore throat, earaches and (reversible) hearing loss. It also causes brutal forehead pain (which is usually interpreted as "sinus headache"). This typically appears when working with the head turned to one side, as when typing from materials placed to one side of desk or keyboard.
  
Trapezius
The trapezius muscle runs from base of skull to mid-back and out to the bony points of the shoulders (see diagram above left). It pulls back neck and head, shrugs the shoulders, and helps raise the arms upward. It's a big muscle with a big job and of all the muscles in the body, in both adults and children, it is the most likely to have trigger points. Despite its size and strength (or possibly because of it) the trapezius is easily damaged by:
· Holding arms up for long periods, or hunching shoulders forward,
· Tight bra straps, heavy purses,
· Too-low or missing arm-rests in vehicles / furniture.
· Typing / keyboarding (overstretching trapezius).
Trapezius produces a "fish-hook" headache often with nausea (commonly diagnosed as "migraine"). It also causes grinding pain at the base of the skull and pain between the shoulder blades. Trapezius pain is common in people who spend long hours at a keyboard, computer or piano; in barbers, beauticians, and others who spend hours working with arms held upwards.
Pectoralis major is the "major muscle of the chest." The shoulder, arm, and chest pain of this muscle suggest serious disease. In women, breast pain is feared to be due to breast cancer and patients may be sent for repeated mammograms (ironically, exposing them to additional radiation). Tight pectorals can also cause shoulder and chest pain extending down the arm to below the elbow. In both men and women, this pattern (especially when on the left side) can be terrifyingly similar to the pain of angina and heart attack. Conversely, pectoralis major can develop painful TrPs following a heart attack. Pain reflexes can shrink blood vessels, further starving the heart of blood. There is even a pectoralis TrP that causes irregular heartbeat. Pectoralis major is strained or shortened by:
· Hunching shoulders forward,
· Sitting or sleeping with arms crossed on chest,
· Typing / keyboarding (shortening pectorals).
Always check chest pain with your physician! This is important because of the seriousness of heart disease and cancer. It is also critical because angina pain (a warning sign of heart attack) can be relieved by treating this muscle. In other words, it is possible to turn off the fire alarm without putting out the fire. Be sure that there are no heart problems. See your doctor. If there are no signs of heart disease? Check muscles!
 
Subscapularis is one of the rotator cuff muscles. It pulls the arm toward the body and also rotates it inwardly. TrPs in subscapularis cause pain behind the shoulder possibly as far down the arm as the elbow. There may also be an odd bracelet-like band of pain around the wrist. Tenderness at back of wrist and hand may be so severe that the wristwatch must be moved to the other wrist.
Subscapularis is commonly strained by:
· Ball pitching, swimming, or forceful overhead lifting,
· Stopping a fall by reaching backward.
· Immobilizing the arm close to the body when sleeping, injured, or pressing a purse or child close to the chest.
When tight, subscapularis can prevent the arm from rising. If you find it difficult or painful to reach up and behind your head to comb your hair or throw a ball, this muscle is likely to be involved. If left untreated other shoulder muscles (including the pectoralis major) will tighten and shorten causing even more pain. The result is commonly known as "frozen shoulder."
Scalenes
These powerful neck muscles entrap nerves which supply the upper back, arms, and hands. The numbness and tingling of Carpal Tunnel Syndrome is far more likely to be due to scalenes (or a separate muscle in the chest) than the carpal tunnel itself. They are strained by:
· Lifting and tugging, especially with hands held below waist.
· Severe coughing or straining for breath as commonly occursin pneumonia, bronchitis, asthma, or extreme athletics,
· Lifting or carrying large or heavy packages with arms extended in front of the body.
As for other neck muscles, problems can begin with a habit of holding phones with neck and shoulder. But scalenes don't merely cause pain. They can pinch nerves so severely that the arm weakens to the point of withering. Scalenes raise the upper ribs allowing room for lungs have room to expand; they are very active during hard breathing. When tight and not working properly, they may be responsible for the feeling of being "short of breath." "First, Do No Harm"
One of the beauties of bodywork work is that it does no harm yet often resolves the actual source of pain and dysfunction without drugs or their potentially dangerous side effects. Our therapists will work with you to eliminate the sources of your pain and teach you to treat and relieve pain at home.
Do you think that massage and body work are self-indulgent? Absolutely they are! They are also a wise and sensible investment in your health and well being for many years to come.
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