Working Your Trigger Points

Working on muscle trigger points is not easy at first. But then, what is? Some of your initial attempts may seem to only make it worse. Or perhaps you have some elevated inflammation, due perhaps to a less than stellar diet, or perhaps to a recent surgical procedure - particularly one that temporarily immobilizes one or more muscles (causing the other muscles to be forced to compensate).
 So here's our "Advanced Trigger Point" section:

Working the Trigs

It might be well to read the "Massage Guidelines" presented in chapter 3 of the Trigger Point Therapy Handbook. In summary, the authors suggest the use of deep stroking massage, repeatedly and in one direction, several strokes per trigger point, doing this several times throughout the day.
 Note that this might not be what the professional masseuse does. He/she is likely to apply firm pressure without stroking, until the trigger point "releases" or they decide that more time would be detrimental. Trying to do this yourself - at least at first - may lead to frustration, as it did for me. Thus the takeaway from a professional trigger point massage is not necessarily the method of "servicing" the trigger points but rather learning where they are.
 In some cases you can "release" a trigger point the first time. But in general it will take several attempts over the course of a day or several days. So avoid the temptation to keep trying on the same area. Too much pressure or strokes will irritate the area and induce inflammation.
After applying the pressure or the firm strokes, massage out the area to help flush out the toxins.
 Speaking of toxins, always drink some water when you work on your trigs! You'll be sore and headache-y otherwise.
 There may be sensations, even "electrical", in other areas when you press on a trigger point. These are the endpoints of the affected muscle, the "insertion points". Thus application of pressure on a lower back muscle may cause a sensation in the upper back, the buttocks, or both.
 Remember, too, that the trigger point that is causing pain in one area may be located elsewhere. This is called "referred pain." So for example, pain in the lower back can at times be relieved by working triggers in the mid-back, or those under the shoulder blade, or just above the buttocks, or even on the side, just under the ribs. The trigger for the upper thigh (that causes discomfort when sitting) may be along the hamstring - on the back of the leg between the knee and the thigh. Trigger points in the pectoralis (the big muscle in front of the armpit) can cause pain in the arm when you are doing things like push ups. Trigger points in the subscapularis (the muscle in the back of the armpit) can cause pain in the shoulder blade!
 Note that if a trigger points hurts an unusual amount when you are treating it, this may be due the fact that the underlying muscle is being used (and under tension). If you are working on the glutes or the hamstrings, make sure that the leg is relaxed. If you are using the theracane to work an area near the right shoulder blade, let the right arm relax - don't use it to push or pull the tool. Related note: A common muscle to be irritated is the part of the trapezius that is under the shoulder blade - between the shoulder blade and the spine. You can expose some of this muscle (on the right side for example) by placing the right arm in front of you toward the left, as if trying to grasp the left elbow.
 Working trigger points before you go to bed can have various results. Some muscles will be soothed by the strokes/pressure/massage. But others will just be ticked off, and they'll make you pay. This is something that will have to be learned.

You will soon acquire a feel for the proper technique for each type of trigger point. A firm steady pressure may in fact work for some, whereas a stroking motion may be better for others. In many cases it might be well to leave the muscle alone and come back to it later in the day, or even the next day. Soon you will be very pleasantly surprised to find that after a few days (maybe a week or two in some cases), the affected area will suddenly not be sore and tender. You will have succeeded.

A note about percussion type massage tools:
It's tempting to try to massage out muscle pain with a percussion type massage tool. I tried one of these during the period after the shoulder operation (before I found out about trigger point treatment). In my experience, these tools just make the discomfort worse. My guess is that the tool is just spreading the inflammation around.



Where exactly are all these Trigger Points coming from?

Feel like saying "I'm nothing but an ambulating Trigger Point"? I asked myself that after my shoulder operation in 2006. I asked (at one time or another):

"Where are all these triggers coming from?" Or:

"Do I have some condition that causes "chronic" trigger points?" Or:

"I feel like I have "Cascading Trigger Points", if there is such a thing.

After the shoulder arthoscopy I went through a period of serious pain and discomfort in many areas -- indeed my shoulder was the least of my problems. There was a fire between the shoulder blades, pain in the lower back, and more in the gluteus muscles. The pain in that area was perhaps the worst of all, since it prevented me from sitting. So I could not sleep well and I could not even sit. That really doesn't leave much left except standing (and that became problematic after a few days at my "standing workstation" setup.)
 So if you find yourself experiencing a similiar period of pain popping up in more and more areas, of "cascading trigger points", or if you have just had an operation and are now sporting some new medical paraphenelia such as a sling or a leg brace, consider the following tidbits:
 First, you may have been favoring some muscles in the period before the operation, (in my case, not reaching up to high shelves with the bad arm). So, given the reduced motion before as well as the sudden immobility of the sling and tight bandages, the muscles are even more prone to be stiff. With the affected arm now immobilized, the other shoulder (and related muscles) are now suddenly doing more work. Further, the sling is probably causing neck pain due to the strap pulling on one side of your neck, as happened to me. Even your walking will be affected (one arm stationary, one swinging).
 In general, sudden or jerking motions are a prime cause for trigs. Well, your other muscles are now subject to just exactly that - quick jerking motions - in order to compensate for the affected muscles which are unable to do their work. Remember: limping is a jerking motion! Try to walk as "normally" as possible.
 The other prime cause for trigs is inflammation. An operation will preduce a surge in inflammation due to "operation induced trauma." My massage therapist (a former nurse), pointed out that an operative procedure is not really much different from any other trauma. She also said "you don't know what they did to you on that operating table, either!"
 So, rather than speaking of "cascading trigger points", the better term might be "cascading muscle compensation".

But apart from all this, if you're over 40 or so, you really are an "ambulating Trigger Point"! Trigger points usually don't dissipate on their own; they just go dormant. My massage therapist described some areas where the muscles and tendons had gotten tight and even had a little calcification. So you and your massage therapist are waking up these dormant areas as well.
 And while we are at it, we could look a little deeper. From an "understanding" point of view, it could be said that we're awakening old muscle memories. Who knows what old pains and tensions have been stored there, some perhaps from causes that are not entirely "physical." We are embodied beings, and everything's not just the "physical".

Also, you may experience seemingly unreleated trigger points appearing when you start working on your trigs for the first time, or start on a new area. For example, if you start to work on hamstring trigger points, others just might start popping up in the calves, and even in the soles of the feet. Why? When you release existing triggers, other muscles are suddenly used more - or at least differently. If there were latent trigs in them, these may suddenly be felt. Adjacent triggers in the same muscle may show up, or be irritated by the treatment of the other triggers.
 Also, most of us are rookies at this sort of thing. And, releasing triggers hurts! Between these two reasons, you may only succeed only in irritating the existing triggers initially. Even a trained neuromuscular masseuse may cause more discomfort at the start of the treatment sessions than he/she will relieve.
 Further, what would be the result of this new activity? That would be inflammation, which would be added to the inflammation due to the operational trauma.
 Then there might be the inevitable "'What is wrong' questions". Did I have fibromyalgia? What about a low grade infection? Wait, could this be incipient bone problems? So what would be the result of these questions? Stress. And what is stress? More inflammation.
 So be patient and be aware that in the words of T.S. Eliot, "in order to be cured, the sickness must grow worse." In other words, a week or perhaps two of heightened pain - or pain in new areas - is sometimes to be expected. But after a few months, you just might be in far better shape than you've been in years. You will have succeeded.



 

Copyright © 2018 J.A.