Excerpts from The Trigger Point Therapy Workbook by Clair Davies, NCTMB
Exquisitely painful places are often found at or near where the muscle attaches to bone. Travell and Simons believe these attachment trigger points are created secondary to central trigger points in the muscle belly. Rather than being true trigger points, they may be only highly sensitized connective tissue that has been abused by the stress of continuous muscle tension. Attachment trigger points are always under the control of centrally located trigger points, which should be the primary target of treatment. Attachment trigger points generally cease to be tender when central trigger points have been deactivated. In chronic conditions where trigger points have been in place for months or years, stresses at the site of muscle attachment are thought to cause degenerative changes in the joint (1999, 72, 76; Fassbender and Wegner 1973, 355-374).
Mystery of Referred Pain & Trigger Point Symptoms
The easiest theory to accept regarding referred pain is that the signals simply get mixed in your neurological wiring. Sensory inputs from several sources are known to converge into single nerve cells at the spinal level, where they are integrated and modified before being transmitted to the brain. Under these circumstances, it may be possible for one electrical signal to influence another, resulting in mistaken impressions about where the signals are coming from (1999, 56). On the surface, this looks like bad design, but the displacement of pain seems too consistent to be accidental. Janet Travell's great discovery was that referred pain occurs in very predictable patterns in everyone, with only small variations. This predictability implies that there may be some evolutionary advantage to the referral of pain. It's notable that referred pain occurs very often in or near a joint, where pain is most likely to make you modify the activities or conditions that have created the problem (1999, 96).
The sensory symptoms created by myofascial trigger points take a variety of forms and they aren't limited to the sense of pain. Symptoms of dysfunction -- such as muscle stiffness, weakness, edema, nausea, dizziness, and postural distortions, to name a few -- are even more diverse and include a number of surprises.
The defining symptom of a trigger point is referred pain. Characteristically, referred pain is felt most often as an oppressive deep ache, although movement can sharpen the pain. Referred myofascial pain can be as intense and intolerable as pain from any other cause. It should be noted that the pain level depends more on the degree of trigger point irritability than on the size of the muscle. Trigger points in the tiniest muscle can cripple you with pain. Some common examples of referred pain are tension headaches, migraine, sinus pain, and the kind of pain in the neck that won't let you turn your head. Jaw pain, earache, and sore throat can be expressions of referred pain. Another is the incapacitating stitch in the side that comes from running too hard.
Sore legs, sore feet, and painful ankles are examples of referred pain. Stiffness and pain in a joint should always make you think first of possible trigger points in associated muscles. Pain in such joints as the knuckles, wrists, elbows, shoulders, knees, and hips are classic trigger point symptoms. If you don't count headaches and backaches, pain referred to the joints is the most usual manifestation of myofascial pain syndrome.
Other symptoms such as numbness, tingling, burning, hypersensitivity, cold feeling distant body parts, reddening of the eyes, excessive tearing, blurred vision, a droopy eyelid, excessive salivation, persistent nasal secretion, goose bumps, dizziness, and even irregular heartbeat are some other results of trigger points.
Self-Massage Techniques
It's important to realize that self-treatment won't all be smooth going. There will be some difficulties to surmount. You can make some kinds of pain go away very quickly but a long-established chronic problem can take a while to clear up. This is because trigger points that have been in place for a long time have made pathways in the nervous system that tend to reinforce and perpetuate them (Travell and Simons 1999, 56-57; Yaksh and Abram 1993, 116-121).
Another reality is that trigger point massage hurts, though if done correctly it will be a pleasant kind of pain, a level of pain you can still relax into. Trigger point massage may not be pleasant at first if you're a person who reactively avoids all pain. If you believe that all pain is bad that it's a dumb idea to make yourself hurt, you may not be willing to do enough massage on yourself to do any good. On the other hand, if you try too hard to make massage work and do too much of it, your body will react against it and make your pain worse for a day or two. Overenthusiastic use of hard tools for massage can result in bruising not only of the skin, but possibly also of deeper tissues, such as muscles and nerves. When you have a lot of very active trigger points and work too long on yourself, you can come out of it feeling woozy or nauseous. If you have widespread pain, don't try to take care of everything at once. Work on your worst problems first and try to be patient with the method and with yourself.
Massage Guidelines At A Glance
1) Use a tool if possible and save your hands.
2) Use deep stroking massage, not static pressure.
3) Massage with short, repeated strokes.
4) Do the massage stroke in one direction only.
5) Do the massage stroke slowly.
6) Aim at a pain level of seven on a scale of one to ten.
7) Limit massage to six to twelve strokes per trigger point.
8) Work a trigger point three to six times per day.
9) If you get no relief, you may be working the wrong spot.
Saving your fingers, hands, and wrist means using good technique when working on trigger points. You can Google such techniques and/or find them in the book referenced herein. Aside from your body, there are a variety of massage tools available to assist your efforts as well such as the Thera Cane, hard rubber ball, tennis ball, and even a foam roller. Remember to ice afterwards if you have particularly seized up muscles.
Note that if you do not change the work habits, posture issues, lack of exercise and/or stretching, overuse and/or muscle abuse etc., that caused your myofascial imbalance resulting in trigger point(s) in the first place then relief of your treated trigger point(s) will be short lived.
Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good! Clair Davies' story is amazing as is his entire book. I am very grateful to his dedication and revelation of this subject matter!!!
For Part 1 of this series: Trigger Points
Attachment Trigger PointsExquisitely painful places are often found at or near where the muscle attaches to bone. Travell and Simons believe these attachment trigger points are created secondary to central trigger points in the muscle belly. Rather than being true trigger points, they may be only highly sensitized connective tissue that has been abused by the stress of continuous muscle tension. Attachment trigger points are always under the control of centrally located trigger points, which should be the primary target of treatment. Attachment trigger points generally cease to be tender when central trigger points have been deactivated. In chronic conditions where trigger points have been in place for months or years, stresses at the site of muscle attachment are thought to cause degenerative changes in the joint (1999, 72, 76; Fassbender and Wegner 1973, 355-374).
Mystery of Referred Pain & Trigger Point Symptoms
The easiest theory to accept regarding referred pain is that the signals simply get mixed in your neurological wiring. Sensory inputs from several sources are known to converge into single nerve cells at the spinal level, where they are integrated and modified before being transmitted to the brain. Under these circumstances, it may be possible for one electrical signal to influence another, resulting in mistaken impressions about where the signals are coming from (1999, 56). On the surface, this looks like bad design, but the displacement of pain seems too consistent to be accidental. Janet Travell's great discovery was that referred pain occurs in very predictable patterns in everyone, with only small variations. This predictability implies that there may be some evolutionary advantage to the referral of pain. It's notable that referred pain occurs very often in or near a joint, where pain is most likely to make you modify the activities or conditions that have created the problem (1999, 96).
The sensory symptoms created by myofascial trigger points take a variety of forms and they aren't limited to the sense of pain. Symptoms of dysfunction -- such as muscle stiffness, weakness, edema, nausea, dizziness, and postural distortions, to name a few -- are even more diverse and include a number of surprises.
The defining symptom of a trigger point is referred pain. Characteristically, referred pain is felt most often as an oppressive deep ache, although movement can sharpen the pain. Referred myofascial pain can be as intense and intolerable as pain from any other cause. It should be noted that the pain level depends more on the degree of trigger point irritability than on the size of the muscle. Trigger points in the tiniest muscle can cripple you with pain. Some common examples of referred pain are tension headaches, migraine, sinus pain, and the kind of pain in the neck that won't let you turn your head. Jaw pain, earache, and sore throat can be expressions of referred pain. Another is the incapacitating stitch in the side that comes from running too hard.
Sore legs, sore feet, and painful ankles are examples of referred pain. Stiffness and pain in a joint should always make you think first of possible trigger points in associated muscles. Pain in such joints as the knuckles, wrists, elbows, shoulders, knees, and hips are classic trigger point symptoms. If you don't count headaches and backaches, pain referred to the joints is the most usual manifestation of myofascial pain syndrome.
Other symptoms such as numbness, tingling, burning, hypersensitivity, cold feeling distant body parts, reddening of the eyes, excessive tearing, blurred vision, a droopy eyelid, excessive salivation, persistent nasal secretion, goose bumps, dizziness, and even irregular heartbeat are some other results of trigger points.
Self-Massage Techniques
It's important to realize that self-treatment won't all be smooth going. There will be some difficulties to surmount. You can make some kinds of pain go away very quickly but a long-established chronic problem can take a while to clear up. This is because trigger points that have been in place for a long time have made pathways in the nervous system that tend to reinforce and perpetuate them (Travell and Simons 1999, 56-57; Yaksh and Abram 1993, 116-121).
Another reality is that trigger point massage hurts, though if done correctly it will be a pleasant kind of pain, a level of pain you can still relax into. Trigger point massage may not be pleasant at first if you're a person who reactively avoids all pain. If you believe that all pain is bad that it's a dumb idea to make yourself hurt, you may not be willing to do enough massage on yourself to do any good. On the other hand, if you try too hard to make massage work and do too much of it, your body will react against it and make your pain worse for a day or two. Overenthusiastic use of hard tools for massage can result in bruising not only of the skin, but possibly also of deeper tissues, such as muscles and nerves. When you have a lot of very active trigger points and work too long on yourself, you can come out of it feeling woozy or nauseous. If you have widespread pain, don't try to take care of everything at once. Work on your worst problems first and try to be patient with the method and with yourself.
Massage Guidelines At A Glance
1) Use a tool if possible and save your hands.
2) Use deep stroking massage, not static pressure.
3) Massage with short, repeated strokes.
4) Do the massage stroke in one direction only.
5) Do the massage stroke slowly.
6) Aim at a pain level of seven on a scale of one to ten.
7) Limit massage to six to twelve strokes per trigger point.
8) Work a trigger point three to six times per day.
9) If you get no relief, you may be working the wrong spot.
Saving your fingers, hands, and wrist means using good technique when working on trigger points. You can Google such techniques and/or find them in the book referenced herein. Aside from your body, there are a variety of massage tools available to assist your efforts as well such as the Thera Cane, hard rubber ball, tennis ball, and even a foam roller. Remember to ice afterwards if you have particularly seized up muscles.
Note that if you do not change the work habits, posture issues, lack of exercise and/or stretching, overuse and/or muscle abuse etc., that caused your myofascial imbalance resulting in trigger point(s) in the first place then relief of your treated trigger point(s) will be short lived.
Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good! Clair Davies' story is amazing as is his entire book. I am very grateful to his dedication and revelation of this subject matter!!!
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