Another Tool in the Headache Toolbox: Arms

  As you may remember, headaches are particularly problematic because of the cascading effect of trigger points referring pain to other trigger points, which refer pain to still other trigger points, which refer pain to the head.  It is really hard to track down the culprit at any given time. 

  Quite by accident, I found that when I worked some trigger points in my arms, the pain referred straight up to either the side of the neck or up the back of my neck to the back of my head.  Using this knowledge, I have sometimes been able to lessen my headache's intensity or make it go away altogether by working trigger points in my arms.

  There are so many trigger points in the arm, and they are so close together that it would probably not be practical to try to identify just a couple of trigger points to work.  Instead, systematically work your arms, front and back, from wrist to shoulder.  Proceed more cautiously on the inside of your arms as they are very sensitive. 

  I have found using a bouncy ball that is around 2 inches in diameter gets most trigger points.*  I like to use a smaller ball (around 1 inch) to get into deeper spots and tight places. 

  Using a ball against the wall is my favorite method, but if you prefer, you can use it on a table, or even a chair arm.  You may also be able to use the ball in the palm of the opposing hand. 

There will be quite a few trigger points on the side of the upper arm. 

Using a 2-inch ball on the upper arm.

Working on the lower arm. 

Don't forget the trigger points right above the tip of the elbow.

Some trigger points in my lower arm refer up to the side of my neck. 

Using the one-inch ball on the forearm.  I normally would have my body weight pressing against the arm. 

  After working the trigger points, heat rice or flaxseed packs if you have them, and place them on your arms and shoulders for a few minutes afterward.  Then move your arms through their full range of motion a couple of times. 

  Meanwhile, take care of those arms and hands of yours.  The fact that we can type very quickly and easily with our modern keyboards will end up a disadvantage if we do not give our muscles a break.  We often type for long periods:  45 minutes, 2 hours, perhaps more, without stopping.  We may not even necessarily notice it in our hands or arms, but we are majorly stressing those muscles. 

  I type on a MacBook Air and it is nice and light and I can take it about anywhere.  I can have it on my lap for long stretches because it is not too heavy.  In my case, my wrists and hands hardly move, but my fingers jump around the keyboard.  Although the entire arm will be affected by this, the front-line muscles are the muscles in the forearm: The flexors and extensors of the fingers.  If I don't stop from time to time, my forearm muscles become incredibly tight.  I was amazed at how tight they were the first time I worked those trigger points. 

  Here are some suggestions to help take care of your hands and hopefully reduce your headaches:
Take breaks about every 20 minutes or so.  Remove your hands from the keyboard, push away from your desk and take a break.  Do one of the following: 

1) Shake your arms out.  Drop your arms and shake them (like a rag doll) for a few seconds.  Alternatively, you can hold them straight up and shake them.  Then go back to your typing.  It doesn't take that much time. 

Another break activity is to 2) clasp your hands together and reach your arms forward, turning your hands outward to expose the palms, and then upward over your head.  Be careful in the beginning with this stretch.  If your muscles are overly tight, you may stretch too far and injure yourself.  You don't want to overdo it.  Any stretch you feel should feel good.  If it is feeling painful at all, back off and don't stretch that far until you have worked some trigger points. 

3) Drop your hands to your side, or rest them on the chair arms, and lean your head back in your chair and close your eyes.  (If you can't do this comfortably, you need a better chair.)  Rock back and forth a couple of times if you have a chair that will rock. 

4) Get up and walk across the room or into another room.  Get a drink of water, use the restroom, let the cat out, etc. 

5) Work a few trigger points. 

  Another note about headaches.  Some people, like me, are particularly susceptible to temperature.  The problem is, I don't always know that I am cold until I reach over with my hand and feel my arm or face.  Cold activates trigger points.  Check your arm temperature from time to time and cover your arms to get them warm.  Cold arms could be kickstarting or exacerbating your headache. 

  Recently, my husband and I went on a get-away where we spent many hours of many days traveling in the car.  I discovered that having cold air-conditioning blowing on me could cause an instant headache.  My husband would sometimes notice it before I did.  I would say, "Oh my head hurts," and he would say, "Is that air conditioner blowing cold air on you?  Are you getting too cold?" We would turn it down or off, and my headache would subside.  My ears and face were particularly vulnerable. Because it was hot outside, we needed the air conditioning on at least part of the time.  So, I resorted to wrapping a towel around my head and ears, and I used a jacket to cover my arms; that helped until we could turn the air conditioner down. 

  I also found out that sometimes when I have a headache, I can make it more tolerable if I wrap a medium towel snugly against my hairline.  I overlap the towel on itself and clip it with a claw-type hair clip. 






*I have been able to get this size out of Golden Corral's gumball-type machines--they cost four quarters each, and there is a chance that you will get a 2-for-one breakfast coupon instead, so be forewarned.  If you get a ball that looks like a soccer ball or other sport ball, try again.  They are too slippery.  You want one that feels a bit more rubbery.  If the ball is too slippery, you will have to push down harder and it won't be as effective.  

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 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...)