More Trigger Point Tools

Having the right tool can make all the difference. For example, it would not be very effective to use a screwdriver to hammer in a nail, and it would not make much sense to use a hammer on a screw. Sometimes, we can substitute another tool and it will be somewhat effective, like using a knife as a screwdriver, but it will be faster and more efficient to use the right tool. Sometimes, we have tools that are good enough, but a more specialized tool would make it so much easier.

I have introduced you to what I would consider the mainstays of a trigger point tool kit:  the lacrosse ball and the theracane (or backnobber). Today, I will introduce you to a few other tools that can be useful, especially for specific jobs.

Interestingly enough, bouncy balls are great tools for getting to some of the harder to reach muscles. They come in different sizes so you can usually find something that will fit your particular purpose. They are not as durable as lacrosse balls, but they are relatively inexpensive and they will last for quite a while.

Two sizes of bouncy balls and lacrosse ball.  

I have a favorite size that I have been using to massage the muscles in my arm while I am recovering from my elbow injury. There are many narrow muscles in several layers that I am working and this ball is perfect for this. The ball a size up is too big and the ball a size down is too small.  

Using bouncy ball on the outer elbow area.  

Using bouncy ball on inside area of elbow and down the arm.  

 Using the opposite hand, I press and roll the ball into my muscle. I use the heel of my palm to get particularly deep, but I also use the entire palm of my hand, and my four fingers held straight and close together to form one tool. Using this method, I roll the ball around my arm, and as I find trigger points, I work them for a few strokes before continuing on.

Getting in position to use the opposite hand on outer elbow.  The ball is placed between the palm and the opposite elbow. 

I have used a bigger size (the purple and orange ball in the photo above) for my triceps, and it is perfect for that. When I first got off the pain pills and I was starting to venture out into the world again, I went grocery shopping. I took that ball with me, and whenever my elbow started to really ache, I worked my triceps with the ball, and it relieved my pain.  

As part of my physical therapy, I have to wear a splint on my arm for 6 to 8 hours a day to help me stretch my muscles back to where they were before the accident. Often, my arm starts to ache when I wear this, but I can work some trigger points through the back side of it, which is open. I can also take the splint off temporarily, work some trigger points on the inside and put it back on. When I have worn it for several hours, my arm is usually pretty tender all over, and it hurts to move it. I use the ball to work all of the areas that are tender and stiff.  

The difference between the two arms.  I have gained quite a bit of range of motion, but I have some way to go still. My arm usually extends farther after I have had my arm in the hot whirlpool bath for 15 minutes at the physical therapist's office.   

My arm in the splint.  

Sometimes, I can just set the ball on the table, or another hard surface like a book, and roll the exposed part of my arm on the ball.  

Another tool that I have used recently is called the Palm Massager (made by a company called Pressure Positive, available online).  

Palm massager.

This handy tool is held in the palm of the hand. The fingers fit comfortably into grooves molded into the tops of the three "arms" of the tool. Each "arm" has a rounded end. Two of these ends are relatively small, while the remaining end is larger.  

The finger fits in the groove on top of the arm.

This design makes it easy to use quite a bit of pressure without totally trashing your fingers. I have used it for trigger points in the back of the neck, and, lately, I have used it to work my inner elbow. It is good for going deep.  

Using on the back of the neck.  It is even better if you can lean back into it, so that the muscles that you are working are relaxed.  

Late one night, I was using the palm massager on my inner elbow, and I was able to find some places that hurt that I had not been able to reach before. I worked them, and I could see that it was increasing my mobility. I was pretty excited. The next morning, I was dancing and singing: I've been dreaming of an arm that moves... to the tune of, "I've been dreaming of a true love's kiss," from the movie, Enchanted. It has become sort of a theme song for me.  

Another tool is the Knobble (also by Pressure Positive, available online).

The Knobble

This tool looks a lot like a round door knob. It has a rubber-like surface on its side, which helps in gripping the tool. I often like to hold the tool sideways and use the rubberized side for the trigger point therapy.

The Knobble, side view.

The Knobble is great for places that you want to get into deep with minimal effort. I have used it on my arms, my quads (but I decided later that I like the lacrosse ball against the wall better for the quads) and also on my pecs (using the side).

In position to use the Knobble on my arm.  My fingers are held up to show how the Knobble is placed.  They are wrapped around the Knobble when working the trigger points.  

Holding the Knobble sideways to work the pecs.  

I have even used it on the muscles of my head, staying on the gentler, rubber side.

Using the side of the Knobble on my temporalis muscle. 

Experimenting with different tools, you will probably find some that you prefer over others for particular tasks. The more comfortable you are using a tool, the more likely you will be to use it. You will also probably be more effective, giving the right amount of pressure, not too much, not too little.

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.  

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.)

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...)