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.

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


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. 


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.