Friday, December 30, 2011

Senses and Sensitivity

Have you ever picked up what you thought was a pitcher full of water (or other drink) and found out that it was actually almost empty? Instead of lifting the pitcher in a well-controlled manner, you may have catapulted it high into the air. You expected it to be heavier, and you automatically made adjustments in the force you used to lift the pitcher. Because you had incorrect information, you used too much force for the weight of the pitcher.

We get information from our basic five senses, but it is not as simple as: I smell, or I don't smell; I hear, or I don't hear; I feel things, or I don't feel things. In reality, there are many nuances to our senses that we might not even be aware of--unless we have a problem, for example, if certain smells give us a headache, particular sounds irritate us, or certain textures feel unpleasant. In addition, there are other less-talked-about "senses" that give us information about our world. For example, our vestibular sense helps us know where we are in space, and among other things helps us keep our balance. Our proprioceptive sense helps us perceive our muscle movement and body position.

So, what if we rarely had the correct information about the weight of an object or how much force we were exerting? We would be experiencing proprioceptive difficulties. This sense helps us to judge how much force to exert and how far to move our muscles. When we put a glass down on a table, we see visually how close we are to the table, but we also sense when we are close to and have touched the table. If our nervous system does not let us know that we have touched the table, we will continue to press down until we feel the table. If we have already reached the table, but our proprioceptive sense does not register that, we will continue to push down until we sense that we have reached the table.

Our proprioceptive sense helps us to know how much force to use, where to place our body, and gives us the ability to put our body where we want it, as fast or as slowly, and with as much control as we need for a given situation. If we have proprioceptive difficulties, these abilities can be greatly reduced.

If we are not receiving enough proprioceptive information, we might exert a lot of force in our movements:  we might stomp when we walk, press very hard down on the paper when we write, or bump and crash into things. Instead of sitting gently into a chair, we might drop into it. On the other hand, if we are receiving too much proprioceptive information, we might be extra cautious in our activities. We might not exert enough force to accomplish the task at hand. In either case our ability to grade our movement might also be affected. Instead of moving smoothly, we might move from low to medium to high with no speeds in between.

Applying this information to trigger point therapy...

1) If you are working your trigger points and you are one who has proprioceptive difficulties, it may be difficult to gauge how much force to use.

As you may have learned by now, when we work our trigger points, it is supposed to "hurt good." If we press too hard, our efforts might backfire and make things worse for a while. If we do not press hard enough, there will be no benefit.  Clair Davies suggested that it should be at about a 7 on a pain scale of 1-10.

When I first started trigger point therapy, I worked my trigger points so that they hurt at a 7. But over time, I found out that it was too hard. I was getting bruises and then I would have to wait until things healed up a bit before I could work those trigger points again. After much trial and error, I decided that I needed to be at about a 5 on a pain scale of 1-10. (As you might have guessed by now, I have proprioceptive difficulties.) I am probably exerting as much pressure as Clair Davies would to get a 7, but I am only registering a 5.

2) Taking this idea a step further, it is possible that many people with proprioceptive difficulties (at least those who are not receiving enough input) have a higher tolerance for pain.

Because they are not reacting as if they have a higher level of pain, they may not be taken seriously when they actually have intense pain.

I am one of those people. I would go to the doctor for some type of pain. Inevitably, the doctor would press here or there and ask if it hurt. Well, it hurt a little, but I hurt everywhere a little. Was it supposed to hurt more than the other places? In fact, sometimes, it actually felt better when they pressed on the spot. Or the doctor might ask me if the pain was like such-and-such, and I would hesitate and have to think about it. Because my reaction was not what they expected, they did not think I had much of a problem. I would leave no better off than I was when I came in. In fact, I was worse off because what I thought was my best possibility for help had just been nullified. I would not come in to the doctor unless I really thought I needed to come in, but I had just been treated as if I had overreacted. Now, I would wait even longer before I would go in again for something.

I have often heard people say, "Oh, you would know it if you were experiencing such-and-such type of pain." Well, I had migraines for many years before I knew they were migraines. While other women were staying home from church or school and offering each other cokes and pain relievers, I kept going, unwittingly making things worse. I did not have enough information.

Pain is exhausting. What if you are in pain, but you really aren't even aware of it? It may have become such a part of your existence that you have become resigned to it.

If we are aware of our proprioceptive difficulties, there are adjustments that we can make to the way we do things and to how much we expect of ourselves. (See the link below for more information.)

Add to that a regular routine of working our trigger points (with the appropriate pressure), and we can lessen our overall pain, be more physically active and hopefully get fewer trigger points. In other words, hopefully, we can reverse the vicious cycle of pain, immobility, trigger points, more pain....

3) If our movements are not smooth and gentle, but are more choppy and abrasive, chances are that we might injure our muscles as we bump into things, stomp our feet and even clench our jaw.

Clenching my jaw is a big one. I know that as soon as I get to sleep, my jaw will clench. This overworks several muscles, including the masseters, which contribute to headaches. I have noticed that if I work some trigger points before I go to bed, all of my muscles seem to be more relaxed, including my jaw.

I have noticed that when I work my trigger points that I feel like I have been oiled. My movements are more fluid and I feel like I have more control over my movement. I am more relaxed, and, I am actually a little more coordinated. (It's pretty motivating, actually.)

4) If we are not receiving enough input, we may overuse our muscles because we do not quit when they get tired.  

This is a big one for me. I also have a personality that likes closure, so between those two characteristics, I can really overdo it. Again, working the trigger points seems to give me more awareness. Instead of beating a dead dog to do things, which is how it usually felt for me--I already felt like my muscles had given all that they could give, even before I started an activity--I was starting out with, well, maybe not a peppy puppy, but at least I felt like I had energy and when I started to get tired, I could tell a difference.

Janet Travell, the doctor who pioneered the research on trigger point therapy, suggested that we mix up our activities during the day. It may be helpful to set a timer for 20 or 30 minutes at a time. It might also be good to post this statement somewhere that you will see it:


Pushing through to finish an activity is not worth being in pain for several hours or days.

It is hard to remember when we are deep in a project what happened the last time we decided to push through. In fact, we might just remember that we finished and may not have made the connection between the pushing through and the symptoms that followed perhaps a few hours later.

So, take a break. Your future self will thank you.

If you think that you or someone you know may have some proprioceptive issues, check out the link below.


If you are interested in learning more about sensory processing difficulties, this site has a good overview.  This link goes directly to a checklist, but there is a lot to explore on the site itself.  http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

Wednesday, December 14, 2011

Dealing with Headaches: The Sternocleidomastoids

You might be intimidated by the name, but you needn’t be. The sternocleidomastoids (pronounced STERNO-CLYDE-OH-MAST-OYDS), or SCMs, are muscles that contribute to headaches, especially migraines. Located on the sides of the neck, they are the fleshy muscles that extend from the ear down to the sternum (breastbone) and clavicle (collarbone). 

There are two branches of the SCMs. Both branches attach just below the ear at the top, but the clavicular branch descends and attaches to the clavicle, while the sternal branch attaches to the sternum. 
Side View



Front View
There are better (and more to scale) drawings in The Trigger Point Therapy Workbook.  See pages 51-55 for more information.  

The sternal branch refers pain to 
  • the top of the head 
  • above the eye  
  • front of the ear 
  • the side of the head 
  • the chin 
  • upper neck 
  • lower neck.  
  • deep eye 
  • tongue (when swallowing) 
  • jaw (can mimic TMJ) 
(Note:  You don't have to have pain in all of these places in order for the SCM to be the problem...)

Trigger points in the sternal branch can also cause 
  • dimmed, blurred, or double vision 
  • red eyes
  • excessive tears
  • runny nose
  • drooping eyelid
  • twitching eye
  • the print to appear as if it is jumping all over the page
And it can mimic trigeminal neuralgia (face pain).


The clavicular branch causes 
  • frontal headache
  • pain in the ear 
  • pain behind the ear. 
It also can refer pain to the opposite side of the forehead, which is kind of unusual; most pain referral is to the same side of the body.


In addition, trigger points in the clavicular branch can cause 
  • deep earache 
  • toothache 
  • dizziness
  • nausea 
  • fainting 
  • unilateral deafness or hearing loss. 


The range of symptoms of the SCMs is really quite incredible. Besides headaches, they can cause: 
  • disturbed weight perception 
  • cold sweat on forehead 
  • excess mucus in sinuses, nose, and throat
  • chronic cough 

The SCMs are fairly easy to work. And you can work them practically anywhere.  


Massage these trigger points between your fingers and your thumb. This is one area where using a tool will not work. If you grab the flesh just below your ear, and begin to squeeze, you may be able to discern the two different branches of SCMs. Trigger points can be found anywhere up and down the two branches of the muscle.  Work your way down both branches.  Be sure to work both sides of your neck.  



Massaging the sternocleidomastoids near the top of the muscle.  
Moving further down.  

Working with the opposite hand.  




Following the sternal branch down.  

Thursday, December 8, 2011

Trigger Points in the Lower Legs-Working Your Calves

This is from a post that I drafted on October 21st, but I am finally getting it posted.

I've been focusing on working my calves for the past few days, and it is amazing what a ripple effect it has.  I feel more flexible and lighter on my feet.

Trigger points in the lower leg can send pain to the foot, the lower leg and up to the lower back.  If you have had back pain that has not responded to other trigger points, you may want to check your soleus muscle in the back of your lower leg (See p. 239 in the Trigger Point Therapy Workbook.  You can also click on the trigger point map link in the right column of this blog.)

The soleus is a very broad muscle that covers the upper two thirds of the back of the leg.  Much of the soleus is covered by the gastrocnemius which is a very thick muscle that has two branches.  The gastrocs (that is what I will call them--I have no idea if this is a typical term) form the part of the calf that bulges out in the back.  The Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus are narrower muscles that are located under the soleus and gastrocs.  (See pp. 234-243 in The Trigger Point Therapy Workbook for diagrams and details.)

It takes a lot of strength to work these muscles because of the thickness of the outer muscles and their location on the back of the leg.

There are several ways to work the lower leg muscles.  It is tempting to use your fingers, but you can soon end up with sore fingers, arms, and shoulders.  Another way is to lie on your back, or sit up, and rest one calf on the knee of the opposite leg.  By sliding the top leg back and forth, you locate the trigger points.  When you find a trigger point, massage it by pressing your leg in a little deeper.  This is effective, but can get quite exhausting, particularly for your quads .

If you are lucky enough to have an older armchair that has solid wood in the arm instead of cardboard, you can sit in the chair, place a lacrosse ball on the chair arm, lift up your leg and move your calf around on top of the ball.  This can also be quite effective.

I have recently come upon an idea that is working well for me, so I will share it with you.

Lie down on the floor next to a bare coffee table or side table.  Place a lacrosse ball on the table and place your calf on top of the ball.  Move your leg around the ball and work trigger points as you find them.

If you need to push a little harder for some of the trigger points, bring your opposite ankle over and rest it on top of the ankle of the leg you are working.   This takes the least effort and is the most effective of the ways I have tried to massage my calves.

Some of you may not be able to get down on the floor to do this.  I know that I would not have been able to get on the floor when I first started doing trigger point therapy.  One idea is to get a lightweight table (like the LACK side tables that IKEA sells for around $10). If your bed has enough room, place the table on one end of the bed and you can do the same procedure while lying on your bed.  You can also place the table in front of a chair and do the procedure that way, but you may not have quite as much leverage.

You may have something else that works for you around your house already.  The idea is to make working your calves as easy as possible.

One note.  The ball may roll off the table from time to time, especially when you are first learning.  It is mildly annoying, but easy enough to put back up.  It is easier to control the ball if you have bare legs, or fairly snug pant legs, since there is a tendency for it to get entangled in your pant leg.

I won't go into detail for each muscle in this post, but just to get an idea of what types of symptoms are caused by or contributed to by your calf muscles:  calf cramps; pain in ankles and calves, on the bottom of the foot, Achilles tendon, back of ankle, in long arch of foot, back of thigh, knee, inner ankle, outer side of heel, heel; hard to straighten knee; deep pain in sacroiliac area; spasms in lower back; hypersensitivity to touch in lower back; pain in jaw, knob of inner ankle; plantar fasciitis pain; low blood pressure; unexpected fainting; posterior compartment syndrome; circulatory problems; pain in metatarsal arch, undersides of toes, under the big toe, head of first metatarsal; numbness underside of big toe; cramps in the bottom of the foot; contribute to hammertoe and claw toe.  (Take a breath here!)

In later posts, we will address some of these more specifically.

Wednesday, December 7, 2011

Triceps

The triceps have become a special focus for me lately. A week ago, the doctor removed the splint and I have been working on regaining mobility in my left arm. At that time, I could not twist my wrist back and forth. My elbow was at at about a 90° angle, and I could not bend it closer to my body or extend it farther away from my body.

The surgeon told me that I might have my movement back in 3 to 4 weeks. [Update:  Nelson told me that the doctor said 8 to 12 weeks.  I was on meds and did not remember...] I needed to be prepared for the possibility that I won't get my full range of motion back. It has been about one week, and I am pleased with what I have gained so far. Today, I am able to twist my wrist to make my palm face down, and I can twist about halfway in the other direction (palm up). But I have gained only a little bit of movement in my elbow.

I have been occasionally working my trigger points in my arm and it has helped me, especially in gaining the twisting movement toward palm facing up. I found a particularly effective trigger point in the muscles on the outside of the lower half of my forearm that I worked to decrease my pain and increase my flexibility in that area. I have also been careful to not work too much or too hard. My elbow is still fairly swollen, and I need to give it time to heal a little bit before I can do extensive trigger point therapy. I am also still dealing with a fair amount of pain, and it does not take much to overdo it.  

I have wanted to do more research on arms for quite some time. So I guess this is the perfect opportunity for me. I decided to research the muscles that control extending the elbow. This led me to the triceps. 

Triceps

To me, the triceps are somewhat like a spare bedroom or spare closet in the house. They are useful but they don't seem to get much attention. Because they're located on the back of the upper arm, they are not that noticeable. But there are some very important trigger points in this muscle. 

The triceps is actually one muscle that is divided into three bands. The one on the bottom is wider and the two on the top are narrower. Together, they cover the back of the upper arm. 

There are five main trigger points in the triceps.  (For some good diagrams, see pp. 101-102 in The Trigger Point Therapy Workbook.)


Keep in mind that all of these trigger points are located on the back of the upper arm.  

(1) Triceps number one trigger point is a couple of inches down from the armpit on the inside edge of the arm. It refers pain to the back of the shoulder and the outer elbow. But it can also refer pain to the upper trapezius and the base of the neck, making this a potentially important trigger point when dealing with headaches.

(2) Triceps number two trigger point is located just above the elbow a little to the outside. The muscle is quite thin here, so it does not necessarily feel intuitive to search here for trigger points. Its pain pattern is on the back of the forearm and it sometimes reaches down the entire forearm. It is also a source of pain in the outer elbow, or "tennis elbow."

(3) Triceps number three trigger point is centered about halfway up the back of the upper arm. It causes pain in the back of the upper arm. But it can also cause numbness in the thumb side of the forearm and hand if it presses on the radial nerve. This one was so bad I could hardly touch it when I massaged it today.  So, I am massaging close to it until it settles down enough that I can massage directly on it.  

(4) Triceps number four trigger point is also just above the elbow, but it is located about in the middle.  It sends pain to the elbow, and makes your elbow "hypersensitive" to touch.  

(5) Triceps number five trigger point is an inch or two above the elbow on the inside of the upper arm.  It refers pain to the inner elbow.  It can also refer pain to the inner forearm.  This is sometimes called "golfer's elbow."  

All of the triceps trigger points have the potential to do the following:  

  • cause pain in the fourth and fifth fingers 
  • cause oppressive sense of achiness in back of forearm and in the triceps 
  • weaken the elbow 
  • limit bending and straightening of elbow 


Fortunately, the triceps trigger points are pretty easy to massage.  The hardest part is knowing where to find them.  Massage them with a lacrosse ball against the wall or on a table top.  






Thursday, November 17, 2011

What I've been doing - Part 2

(continued from the last post...) 

I was so glad that I had taken the time to work my shoulder, upper arm, upper back, and pec muscles before going to the Emergency Room (ER). At the ER, they decided to do a CT scan. The technician had me lie down on the bed (trolley?) and asked me if I could bring my arm over my head and rest it on a pillow above me on the bed. I hardly thought that was possible, but he assured me that he would help me and convinced me to try. The ER doctor had confirmed that my shoulder did not appear to be injured. The technician said he would brace my arm as we inched it up and over to where it needed to go.  He carefully placed a hand over each side of my elbow joint. His hands overlapped my lower and upper arms, and kept the angle locked. Each movement was not of separate parts of the arm, but the arm moved as if it were one piece. We moved an inch or so at a time and soon, my arm was lying above me on the bed, and I had experienced no pain.  In fact, for the first little bit, it felt good because my arm was getting a change of position. I couldn't believe that it worked!

I thought about it, and if I had not worked my pecs and my shoulder and upper back muscles, it might not have gone so smoothly. I probably would have succeeded in getting my arm in position for the CT scan, but I suspect it would have been somewhat painful, judging by how much those areas needed to be worked.

Fast forward.

They gave me my diagnosis, informed me that I would have to have surgery, and sent me home with some meds and an estimated surgery date. While I waited, I tried to keep myself relatively pain free.

One night, I was trying to get to sleep, and suddenly my left thumb started to hurt.  It was throbbing.  I was exhausted and not thinking very clearly, but my first thought was that the brachialis (p. 113) refers to the thumb.  I reached over and started to work the brachialis trigger points, which are located in the lower part of the front upper arm (by the biceps). They were sore. Within a few seconds, the pain was subsiding in my thumb, but I continued to work the brachialis until it was substantially softer. The next day, when I went to look things up in my trigger point manual, I saw that brachialis was the most likely muscle to cause pain in the thumb  It made sense. The brachialis had been held in the same position for several days. It was stressed because the bent elbow limited its movement in either direction.

On the first day of the correctly prescribed meds, I felt so much better, but then I got a weak, but very unpleasant headache. I thought, "Oh no!  I'm already taking all of this pain medication.  If that isn't taking care of it, I don't know what I'm going to do!" Then my inner trigger point detective kicked in.

My neck had been through quite a bit lately. Where do most headaches come from? The neck. I had been wearing a sling, and my neck was bearing the weight that my shoulder and arm usually bore. Not only that, it was dead weight, and it had been necessary for me to assume awkward positions to keep from bumping and hurting my arm.

Also, because it hurt my arm so much to sleep lying down, I had been sleeping sitting up in an arm chair with my feet up on a footstool. My neck had been in all kinds of positions. I was often sleeping in a "C" position, with my neck tucked into my chest. This made it harder to breathe, too. The muscles in the back of my neck were being held in an extended position too long, and the muscles in the front of my neck were being held in a shortened position too long. Both conditions create trigger points.

First, I worked my sternocleidomastoids (SCMs) since several of my symptoms appeared to be caused by the SCMs. Then I worked my scalenes and any of the muscles in the back of the neck that I could reach. I was not using very good ergonomics because I was limited to one hand. I tried to make up for this a little bit by taking frequent breaks. I focused on relaxing my working arm and hand each time I took a break. I also worked my right arm's flexor and extensor muscles after each session of neck massage. The headache pretty much disappeared halfway through massaging the SCMs, but I continued until I had got every trigger point that I could reach.

Later, I ended up with a similar headache and I was able to get it under control very quickly, but I realized that I need to do more in the way of prevention. I located a few pillows, including a neck pillow to help support my neck. I arranged things so that I was not sitting with my head thrust forward, or some other awkward angle. This helped a lot.

My sling was causing its own set of problems because of the extra strain it put on my neck. Also, the way that the sling fit my arm actually caused me pain. The straps of the sling attached at the elbow and wrist and I could feel a significant pull in both areas. Ordinarily, that might not be a problem, but my elbow was injured and the extra pull on my elbow made it hurt worse.  I decided to make my own sling and design it with these issues in mind.

I sewed up a 4-5 inch wide, padded strap, with one end folded back on itself about 11 inches and sewn to form a loose loop. I placed the loop over my splint and found that somewhere near the middle was the ideal place for the sling to pull up. I pulled the strap straight up and over my left shoulder, pulled it around my right waist to the front of my body. I was trying to decide what kind of fastener to use, when I noticed that the weight of my injured arm would hold the end of the sling in place, so I left it at that (I probably really shouldn't have been making a sling in my condition, anyway...). Sometimes, I use my arm as the weight and sometimes I tie the end of the sling to the loop part, depending on what I am going to do. The point is that I got a sling that was not hurting my neck or elbow. I was trying to prevent more problems than I already had.

The new sling is much more comfortable and my neck is not being pulled forward.  

The sling goes straight up to my neck, around my back, and to the front.
(Note:  For some unknown reason, my camera takes pictures in mirror mode, so even though it looks like the right arm is in a splint, it is actually my left arm.)

Sunday, November 13, 2011

What I've been doing - Part I

Note:  Refer to the "What Happened..." post for background information.  

One of the first things that I did once we got my arm stabilized in a sling and once we had given me some ibuprofen, was to work any trigger points that I thought would have been affected by my fall.

I visualized what might have happened in the fall. I pictured my elbow hitting the ground. I could imagine that muscles and bones in my upper arms and my forearms would be jarred quite hard. I could see that all of my shoulder muscles were probably affected. They would have to work hard to keep my shoulder in place.

I steered clear of working trigger points in my arm in the beginning because I did not want to inadvertently put pressure on the broken bone, wherever it might be.

I started out working my infraspinatus, supraspinatus, and my pecs.

The infraspinatus and supraspinatus are the muscles that lie on top of the shoulder blade, or scapula. There is a raised part of the shoulder blade that goes across the upper half of the shoulder blade. It is sometimes referred to as the scapular spine. The infraspinatus is the muscle that lies below the scapular spine. (Infraspinatus means "below or under the spine.") The supraspinatus is a muscle that lies above the scapular spine.

I worked the infra- and supra- spinatus with a lacrosse ball against the wall. I was very careful to keep my injured arm from moving.  It felt good, not only because it felt good to work the trigger points, which did need work, but also because working the trigger points released endorphins; my pain was partially relieved.

Since I was already up, I decide to work my gluts, lower back, and quads, too. A fall like I had probably involved most of my body, now that I thought about it.

I also worked my pecs. I could feel that they were very tight.

During our first visit to the doctor, the practitioner suggested that I unwrap my arm from time-to-time and work on trying to extend my range of motion.  Later, when I was getting zero pain relief from the meds, I wondered if I had a pinched nerve somewhere.  It felt very much like pinched nerves I've had in the past.  I knew that working my trigger points would help to release something if it were pinched, so I began to work on the upper arm and lower arm muscles.  I had also been working on my scalenes and sternocleidomastoids.

The only measurable pain relief that I got during this time period (between the first doctor's visit and the ER visit), was when I worked my trigger points in my arms.  I worked from the top of the upper arm down toward my elbow, and from the wrist area up toward the elbow.  I used supported thumb or supported fingers, and sometimes used a pinching technique, which I know is not very ergonomic, but I was trying to be careful to avoid the bones as much as possible.  I could feel each muscle relax and the pain subside as I released its trigger points.  It became more difficult, however, as I got closer to the elbow. I was so exhausted but so happy that my pain had subsided enough for me to get to sleep. I would get to sleep, but I'd wake up an hour or two later with screaming pain again. The muscles that had just been loose and relaxed were now tight as a spring.

I knew there must be something else going on. At this point, I wondered if anyone would be able to help me with my pain at all. Here I was taking Lortab (I did not realize that I had been prescribed a half dose), and it was not helping at all. The only thing that had helped me up to that point was trigger point therapy, and that was only temporary. Plus, I was exhausted from no sleep, and from tensing up against the pain. I could feel the tightness going further up my arm, into my shoulder and neck muscles. I could also feel that my abdomen was as hard as a rock, and my hips and upper legs were tensing up, too. I felt like a giant corkscrew.

In the middle of the night on Wednesday/Thursday, my husband and I decided to try the ER. I really didn't know if they would be able to help. I anticipated them trying to take an x-ray of my elbow again. I hadn't been able to extend my elbow enough at the on-call doctor and the technician there was not very sympathetic. She said, "I warned you that it would not be fun."

Before we left for the ER, I worked my upper arm, shoulder, and pec muscles. I wanted to have as much flexibility coming into that experience as possible.

(To be continued...)

What Happened By the Light of the Silvery Moon

I injured myself last week, and I have been using trigger point therapy a lot.  To explain what happened, I am including an excerpt of an email I sent our son, who lives in another part of the country. It will save me having to do so much one-handed typing, which is slow. Plus, it makes me dizzy following my finger all over the board.  The pain meds are helping my pain (thank you!), but they make me a little dizzy.  :) 


This post will establish what happened. I will then write in a following post about how I am using trigger point therapy to help me through this.  

Last Tuesday, I was walking to Young Women in Excellence at the church. Emily and Dad had gone earlier, and I was by myself. I was looking at the beautiful full moon and a bright star. I guess I was not watching where I was going very well because I stepped on the left edge of the sidewalk and half of my foot fell to the grass below, taking the rest of me with it. I was suddenly sitting on the sidewalk, and at first, I was just embarrassed and I looked around, hoping that nobody saw me. The pain soon made itself known, however, and I didn't care if anybody saw me. I waited a minute, trying to get my pain under control, and then tried to get up. I couldn't pick myself up. My left elbow hurt and felt kind of loose, like the joint wouldn't hold if it were to have any weight on it at all. At this point, I hoped that someone would see me because I needed help to get up.


Daniel Lyon was the first to spot me, and he came out to investigate. (I was about 25 feet from the east entrance, and Daniel was in the lobby with some other boys.) When he came out, I said something like, "It's me. I can't get up. Can you go get my husband?" Daniel walked a little closer and appeared to be squinting. He couldn't tell who it was. So, I said something like, "It's Sister Miles. I've fallen and I can't get up. Can you go get my husband for me? He's at Young Women in Excellence." Daniel was about to go in and get help when Brother Erik Dunne walked up, and he said that he would take care of it. He was going to give me a hand up, but when I told him that I couldn't use my left arm, he lifted me up by my armpits from behind. He had me sit on the couch in the lobby and he went to get Dad.


We went to the on-call doctor that evening and they took x-rays and said that nothing was broken. They did say that there was a shadow there though; so to be cautious, they put a splint on me and told me to go to my regular doctor in a week to have them x-ray it again, just in case. I could not extend my left forearm all the way--too much pain--so they had not been able to get a complete picture. 


They also gave me a prescription for Lortab to take if I needed it for pain. I tried to just take ibuprofen at first, but after that first night, I asked Dad  to fill the Lortab prescription. After 3 doses and absolutely no pain relief from the Lortab, I was getting pretty discouraged. The pain was excruciating. I was at a 9 on a 1-10 scale. Finally, at about 2:30 in the morning Wednesday night (Thursday morning), I asked Dad to take me to the emergency room. When I was explaining everything to the dr there, he asked me what effect the Lortab had on me. I told him that it did absolutely nothing. He said something like, "Whoa! What do you mean it did absolutely nothing? Didn't it make you loopy or anything?" I told him that I had felt mildly tired and a little dizzy for about 20 minutes after the second one, but then it went away. He said, "Wait a minute! Do you mean second dose, or second pill?"  I told him that my prescription said to take one pill up to four times daily as needed for pain. He then informed me that 2 pills per dose is the proper prescription for an adult. So, no wonder the Lortab wasn't doing anything. He said, "We've got to get that pain under control!"  (I was certainly okay with that.)


Then he told me that he thought that my arm was almost certainly broken. He said that the "pinched nerve" pain that I described would make sense if the bone was broken at the elbow in the funny bone area. 


He had the nurse bring me 2 percocet (pain meds) and an 800 mg Motrin (equal to four regular ibuprofen). She also gave me some anti-nausea medicine because percocet can make people nauseous. Then they came and got me and did a ct scan on my elbow.


A while later, I started to feel some pain relief. And, believe me, it was relief. I had been tensing my muscles everywhere, bracing against the pain. 


The doctor came in and said, "Yep. Broken. Broken and angulated." 


So, I have to have surgery to fix it. I will go in on Monday (I'll probably be in surgery when you read this). I could use your prayers. 


My pain is much better under control now, more between 1 and 3 mostly--sometimes up to a 5, but that is much better than a 9. 


Here is a picture the ct scan of my elbow. The half-moon piece needs to be reconnected to the end of my humerus (the bone on the right).  They are going screw it back on and hope for the best. They told me that I probably won't have my full range of motion back. 



Mari's elbow.  Just a note to clarify.  The lower bone is not broken.  This is a CT scan and it takes pictures in slices(?).  What we see is parts of two different bones, but they are not injured. The humerus (upper arm bone) is the bone that is injured.  It has the half-moon shaped piece broken off. Click to enlarge.

Tuesday, November 8, 2011

Working with the Theracane, Part 2

In this post, I will share more ways to use the theracane.

The theracane is great to use on your upper back, neck and shoulder muscles. Experiment with the larger knob and with the smaller knob (described in the last post) and see what you like best.

Whenever you can, let the theracane do the work for you. If you can, use the hand that is opposite the area to be worked to exert the pressure. It is easier to work trigger points if the muscle containing the trigger point is relaxed.

Theracane is working muscles on opposite side of back.
Front position of theracane to work other side of back.

To work your shoulder muscles, hold the cane with the curved part up and extending to the back. Place one hand on the curved part of the theracane and the other on the lower end of the cane. Place the large knob at the end of the curve on your shoulder. Push down with the top hand, and out with the bottom hand. Experiment with the leverage until you get the desired pressure.  
Using the opposite hand to exert the pressure.
Using the large knob is quite effective for the muscles in back of the neck and is especially useful when trying to get to some of the deeper muscles in your upper back and neck area. When working the muscles in the back of your neck, it is a good idea to lean back into the cane, relaxing the muscles that you are working.

Working the side of the neck.  
Your upper back and shoulders have several muscles that are layered on top of each other. Sometimes, it is necessary to push quite hard to get to a trigger point in the deeper muscles. Remember to let the leverage of the theracane do the work for you.   

There is a deep trigger point here.
Whenever you can, brace the theracane on something else in order to give you more leverage with less effort. If you are sitting, you can brace the bottom of the cane on your lap. You may also be able to brace the cane against your chair or couch. I have found a lot of places to brace my theracane when sitting in the front passenger seat of a car.  

Theracane is braced on lap, so that only one hand is working.

Using arm or wrist to give a break to the hand.
The large knob of the theracane is also good to use on the trigger points at and just below the rib cage in the back and side. Use caution here. These trigger points are very, very tender, and it does not take much to work them. I work mine perhaps two or three strokes and then come back to them later.  Also, stay on the muscles.  Don't start digging deep into the area below the ribs.  You have kidneys in there.  

To work this area, place the theracane curve around your waist, with the knob in back and the stick in front. Place your hands outside of each of the handles. Push forward with the hand that is closest to the straight end.
Working the back and sides near the bottom of the rib cage.
You can also use the large knob to work your chest muscles. Again, use caution because some of the chest muscles are also very tender. Go easy at first, and you will get an idea of how much pressure is just right.  (See my post on working pecs for more information on working your chest muscles.)  


 The theracane is a pretty handy tool.

Here is another theracane tip:  Take it in the car with you when you are driving. When you are stopped at a light, instead of getting upset at how long it is taking, work a couple of trigger points. (But don't relax so much that you are not ready to go the second the light turns green...) 

Tuesday, November 1, 2011

Working with the Theracane

The theracane is an incredible tool. It allows you to deep-massage places that you would not be able to do by yourself.

In this post, I will demonstrate some ways to use the theracane on four areas: the scalenes, the muscles in the back of the neck and head, the muscles under the arm, and the spinal muscles.

Before we get started, a word of caution... It is easy to get really carried away with the theracane. You might start really digging in, and later end up very sore. You might even end up with bruises. (Ask me how I know.) So, it is a good idea to go easy in the beginning. You will learn how much pressure to use on each area as you continue to practice.

Also, it is a good idea to have a layer of clothing of some kind between you and the theracane, especially when you are working more sensitive areas.

Scalenes

In a previous post, I demonstrated how to work your scalenes (muscles deep in the side of the neck) with supported fingers as the tool. It is also possible to work many of the scalenes with the theracane. It is a good idea to have worked them with your fingers first, so that you have an idea of where they are located, how the trigger points feel, and how much pressure to apply.

Start out with the theracane upside down. Place one hand on the ball at the end of the curved area. This will be your "anchor hand." Place the other hand up on the straight area, somewhere between the two handles. This will be your "guiding hand."


One hand on end of cane.
Alternatively, you can place the guiding hand on the lower handle. You may find that this gives you even better leverage.  
Guiding hand on lower handle.

Experiment with positioning your guiding hand until you can easily push the small knob into your scalenes. The idea is to use as little effort as possible and to let the leverage of the theracane do the work.  

Working scalene with theracane.

Change position for the fourth scalene.

In position to work fourth scalene.
Bring one hand up and place the other on the ball at the end of the theracane (not shown in picture). Press up on the bottom of the theracane to put pressure on the working knob. You may want to put your upper hand on top of the closest handle for more leverage.

Working fourth scalene.

Muscles in back of neck and head

As usual, do not press directly onto the bones of the spine. You are fine to gently press on your skull, however.

There are several layers of muscles in the back of the neck and head, some of them very small. Using one of the small knobs of the theracane can be an effective way to work these trigger points.

To work these muscles, bring the theracane to the back of the neck with the curve of the theracane extending forward. Bring the higher small knob to the back of the neck, holding the theracane in the middle of the curve on one side and just in front of the ball at the end of the stick on the other.

You can work the points by pressing the theracane forward, or you can hold the theracane stationary and lean your head back into the theracane.

Working the back of the neck.
You can use even less effort by bracing the theracane handles into the back of a chair, and leaning into the knob. I sometimes do this lying down in bed also, but you must be extremely slow and gentle when you lean back. I have had times when I had a headache, that I put the straight part of the cane (between the knobs, or right in the curve) right where the back of the head starts to curve (in the suboccipital area) and leaned back into it. It made it possible for me to get to sleep when nothing else worked.  

Brace the theracane "handles" against the back of the chair.

Muscles under the arm 

The muscles under the arm can be hard to get to and they are very important. Many of them are also quite tender, so go very, very easy.  

First, place the theracane in front of you with the curve extending back. Place the knob at the end of the curve, under your arm.  

In position for working under the arm.
Holding the end of the theracane with one hand, grab the top handle with the other hand.  

Ready to work the trigger points under the arm.
Use the leverage of the theracane to work the trigger points under your arm.  

Working trigger points under the arm with the theracane.
Side view.

Spinal muscles 

The theracane is particularly useful for getting the muscles right next to your spine.  

Get in position by bringing the theracane behind you with the curve extending forward.  

Getting in position to work the spinal muscles.
Place your arm behind the theracane on the straight end, in a place that is comfortable for your size body. In my case, it is between the lower handle and the end knob.  

Place your hand behind the theracane.
Place the top small knob of the theracane onto either side of the spine. (Never use the theracane directly on the spine.)  Slide the theracane up and down searching for trigger points. Then work them as you find them. Most of these will be quite small, so your stroke will be shorter and more focused.   




These are just some of the ways that you can use the theracane.

Sunday, October 30, 2011

Sharing

You were probably taught to share at some point in your life. You may have heard phrases like, "Many hands make light work." Our muscles share, too. They often work together in teams. There might be several muscles from different areas of the body, working together to perform one function. When they all work together, the job is not too hard for any one muscle. But when one muscle stops doing its part for some reason, the other muscles take up the slack. If it is a temporary situation, these other muscles might recover quickly once the emergency is over; however, if it is a long-term situation, the other muscles may also become disabled.

Understanding which muscles perform which functions, gives us helpful information when treating our trigger points. It is a good idea to check the other muscles in a group to see what shape they are in. Muscles that work together often get trigger points together.

Have you ever used window blinds that use two cords to open and close the slats? One string pulls the slats closed one way; the other cord pulls them closed the other way. Many places in our body work on the same principle. For example, in our forearms we have the flexor muscles on the under side, which "pull" our hands and fingers down, and the extensor muscles on the top side, which "pull" our hands and fingers up. With window blinds, sometimes it is necessary to put tension on both cords to set the slats to the proper angle.

The same thing occurs with the extensor and flexor muscles of the forearm. Both sets of muscles are required for many tasks. For example, gripping requires both sets of muscles. Computer work calls on both the flexors and extensors. Many of us (including me) spend long periods of time at the computer, overworking not only our arms, but our shoulder and neck muscles, too.

The relationship between other muscles may not be as obvious. When we have back trouble, it may not occur to us to check our stomach or buttocks muscles for trigger points, but when you understand that stomach muscles work with back muscles to lift us up and carry us around, and that the buttocks muscles help us maintain our balance, it makes perfect sense to check them as well.

Sometimes, a whole set of muscles becomes disabled and we use another set of muscles to accomplish the task that the disabled muscles used to do. Often, these other muscles are not able to handle the extra job, and they, too, become disabled. This can set up a scenario of one problem after another.

A few years ago, I discovered that I could use a grabber tool to pick things up off the floor without having to bend down. At that time, my back was so disabled that I had maybe one or two bends a day before I simply could not do any more. I could not sit on the floor to pick things up because it would make my back worse. I purchased my grabber tool and I went to town. I picked up everything. I got fast at it. I was so happy that I had found a way around my disability. However, it was not long until I started to have problems with my shoulders, arms, and hands. I could hardly do anything with my hands. I distinctly remember one time trying to cut out biscuits with a biscuit cutter and being in so much pain that I took a break after each biscuit. It was excruciating. I had overworked my hands, using the grabber tool to compensate for my disabled back, and in the process, I disabled another large portion of my body.

I can now bend over and pick things up again, and I save the grabber tool for getting things in hard to reach places and for picking up garbage out in the yard. I work my trigger points before and after bending activities. I work muscles in my back, gluts, legs and stomach, since they all participate in the bending. As for my shoulders, arms, and hands, I am still working on recovering them.

So, it is a good idea to know which muscles share tasks together. The Trigger Point Therapy Workbook describes the function of muscles, and has them grouped together in a logical way. The trigger point map has some drawings that help to understand the placement of muscles. You can also analyze your own movements. Place your fingers on your forearm, for example, while you flex up and down. You will get an idea of which muscles are doing what.

Knowing more about your muscles will help you to treat your pain more effectively.

Thursday, October 27, 2011

But I wasn't doing anything!

How often have you had a pain come on suddenly, when you were not doing anything at all to cause it? This has happened to me many times. I would often lament, "But I wasn't even doing anything!" I could understand it if I had been in the middle of lifting something, but for the pain to come out of nowhere seemed like adding insult to injury. After studying trigger point therapy, I realized that when a pain comes out of nowhere, it is almost certainly caused by trigger points.

I have found that to use trigger point therapy to its full potential, you need to be a detective. This won't happen overnight for most of us, but over time, you will start to learn what type of activities or "inactivities" lead to trigger points in various muscles. In other words, you will learn what has been happening to cause your pain.  

Picture this real-from-my-life scenario: I have been getting ready for church on a Sunday morning. I have stepped out of the shower, grabbed a towel and brought it up to my face. Suddenly, I freeze. There is a sharp pain in my upper back on the inner side of my shoulder blade. It feels like my shoulder blade is "out." It hurts to move and I wonder how I am going to finish drying myself off, let alone get dressed, fix my hair, apply makeup, and get to church. Further, I am panicked because at this time, I have responsibilities that I need to be church for, and I just don't have time for pain right now. (Who ever has time for pain, anyway?) In addition, I am feeling like a victim. I have no control over this arbitrary pain that seems to appear out of nowhere. Not only am I in pain, I feel helpless and hopeless.

This experience has happened to me more than once and even after I had started learning about trigger point therapy, I wondered what I could possibly have been doing to set this or that pain off.

It took a while, but I think I figured my "shower" pain out. For one thing, I was not doing "nothing." Here are what I consider to be major contributing factors:

  • I had just had my arms lifted over my head for quite some time while I washed my hair, rinsed it, put conditioner in and rinsed it out.  (Arms raised without a break.)
  • In order to rinse the hair thoroughly, I had tilted my head back and I turned it from side to side, while still in the tilted-back position. (Head tilted back without a break.)
  • I was doing all of this arm-raising and head-tilting while my legs and trunk worked to hold me steady in the shower, so I would not slip and fall.  (Tension in trunk and legs.)
  • As I was showering, I was thinking about what I needed to get done in the next few hours, perhaps wondering if I would be able to make it through the meetings without any pain.  I became very tense, although I was not consciously aware of that fact.  (Increased tension over entire body, especially shoulders and stomach area.)
  • I stepped out from a hot shower into a cold bathroom.  My muscles all tensed up in response to the cold.  (Sudden temperature change.  My muscles seize.)  
It took me quite a while to eke out this information. I did figure out enough immediately to know that I did not want to shower right before church on a day when my bathroom was cold and drafty. 

The first time this happened was before I learned about trigger point therapy. But it also happened after I had learned about trigger point therapy, and I still hadn't made the connection. One day, months after I had started learning about trigger point therapy, it just dawned on me. First of all, I was doing these activities which stressed my shoulder, neck, and upper back muscles. I have always had problems with my shoulders. (Even as a teenager, my arms would start to hurt and burn when I held my blow dryer up to dry my hair.) Stepping from the hot shower out into the cold air was the proverbial "straw that broke the camel's back."  

Okay, well, I figured it out, but what do I do with this information? In my case, I decided not to shower during the winter. (Just kidding! Wondered if you were paying attention.) Actually, in my case, I decided to shower the night before when the room would be warmer. I would not have the stress of having to be ready at a certain time and I could dry off by wrapping myself in a terry cloth robe with no time limit to be dry. This can work sometimes. I am also looking into having a portable shower head installed on my bathtub (yes, my shower and tub are separate--came with the house) so that I can have the benefits of shower-rinsed hair, but keep my core body temperature much warmer. There are some other ideas, but you get the idea.  And, I am also working on my trigger points, of course.  

You have two ways to help yourself. One is to find and work the trigger points. The other is to examine your activities and perhaps modify what you are doing, at least until more trigger points are deactivated. In other words, you may need to back off on some activities until your trigger points are more under control. For the trigger points that are caused by inactivity, you may also need to move those muscles more to help them fully recover.  

So, be aware. Periodically, stop what you are doing and analyze each part of your body. Is it relaxed? Is it tense? Can I make a connection between what I am currently doing and the tension level in my body? Have I been overworking or underworking some muscles? Are some muscles cold? 

You may find that you are a pretty great detective!    




Saturday, October 22, 2011

Scalenes

So, I woke up early this morning and my right hand felt stiff and swollen.  It was very painful when I tried to close my fingers into a fist.  In fact, I couldn't bend my fingers very much at all.  I was still mostly asleep and my mind was trying to remember which muscles I should be checking for swollen fingers.

In the meantime, I remembered something helpful.  When swollen hands or feet are caused by trigger points (as they often are), it is because some place further upstream, the vessel is being partially blocked or squeezed, preventing the returning fluids from passing through.  So, although I could not remember exactly which muscles to work, I knew that raising my hand higher than the rest of my body would help.  So, I stuck my arm straight up in the air for several minutes until the swelling went down a little.

Later, when I was conscious, I went to my handy-dandy Trigger Point Therapy Workbook.  There was not a category for swollen hands and fingers, so I checked under "hand and finger numbness."  Scalenes, subclavius, and pectoralis minor looked like possible candidates, but on p. 140, in the write-up about the pectoralis minor, it said that swelling in the hand and fingers is not a symptom of this muscle, but is caused by "tight scalenes compressing the axillary vein, which runs under the scalenes but not under the pectoralis minor."  I decided that the scalenes would be a good place to work.  (You can find all the info you want about scalenes on p. 78 of the book if you have it.)

Scalenes (pronounced "SKAY-leens)

To give you an idea of how influential your scalenes are, on p. 82, it says, "The scalenes are likely to be involved in any myofascial pain problem in the upper body."  Here are some examples of possible scalene-related symptoms:  Chest pain; upper back pain; restlessness in neck and shoulder; bursitis and tendonitis symptoms; pain, swelling, numbness, tingling, and burning in arm and hand; and, because of the satellite trigger points it creates, headaches.

If you grab a hunk of flesh on the side of your neck, you will grab some fairly pliable muscles. If you press into the side of your neck with your fingertips (still holding onto those fleshy muscles), you will press right into the scalenes.

The scalenes are much tighter than the outer muscles.  Scalene trigger points can be very painful, sometimes feeling like you have hit a nerve.  Trigger points can be found anywhere on the scalenes.  Work each about six times per session.

There are three, sometimes four, bands of scalene muscles.  They basically attach your neck bones to your collar bone.  Some of the muscles are under the softer, outer muscles, so you need to move them out of the way while you work them.  The scalenes extend from under your ear to your collar bone, and from about 1-2 inches behind your ear down to the collar bone. There is also a horizontal band that is in the triangular depression between your collarbone and the big thick muscle of your upper back (the trapezius).  I am thinking that this is probably the one that was causing my swelling.

I have found that using supported fingers works well for scalenes.  It works better if you have fairly short finger nails.

I show just one side of the neck here, but it is a good idea to always work both sides of the body when you are working trigger points.

Start just below the ear.  The hand underneath (from the opposite side of the body) grabs the outer muscles and pulls them forward.  The hand on top pushes on the "tool hand."  The tool hand does not push down.  The top hand is exerting the force.  About six small strokes about one or two seconds each (not too fast) on each trigger point.

Note:  Any time you do massage, if you feel a pulse, just move over a bit.  You should never massage a place where you feel a pulse.  (You would have to go really high up under your chin to get a pulse, and if you are there, you are in the wrong place.)

The opposite hand pulls the outer muscles forward.

Continue down, moving the outer muscles out of the way.

The outer hand exerts the pressure.  
As you proceed lower, there will be fewer muscles to pull out of the way.   Proceed all the way down to the collarbone.  There can be some pretty hot trigger points right by the collar bone so don't quit early.

Continue with the back scalene, which is located in back of the first.

The last scalene actually runs more horizontally, and is located between the bulgy part of your trapezius and your collar bone.  
The stroke goes from under the trapezius (the big, bulgy muscle in back), parallel to the collar bone, and toward the neck.

Written October 5, 2011.