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.  

Assuming a Neutral Position

Today, I would like to discuss assuming a neutral position.  You might think that I am going to get political here, but I'm not.

Think of an automobile in neutral.  When the gear shift is in neutral, no gears are engaged.  As I understand it, the gears are totally detached from the operation of the vehicle.  In a neutral position, the gears are not doing any work to move the car forward or backward.  You might say that the gears are "resting."

Our muscles also benefit from time in a "neutral" position.

When you rest, are you really resting?

There is a relationship between the "neutral" position and achieving actual rest.  If muscles are partially engaged, they will not be resting.  The continual fatigue of these muscles will lead to trigger points that are very hard to get rid of.

Try an experiment, when you lie down to go to sleep, focus on each area of your body.  Note if it feels rested or if it still feels tense.  What happens if you consciously encourage that part of your body to rest?  Does it feel comfortable?  Or does it feel like it cannot disengage?

You may need to arrange pillows to help support areas that seem unable to release.  For example, if you are a side sleeper, a pillow between your legs can be just the ticket for your hips and legs.  Make sure that it is long enough to support knees and ankles.  Experiment with pillow height until you find one that can hold your legs in "neutral."

You can put a pillow behind your back and in front of your body to help support those muscles.  A pillow to hug is also a good option to help your arm and shoulder muscles to assume a more neutral position.

It is also important to make sure that your neck is parallel to the bed.

Side sleeper.  Both neck and head are parallel to bed.  This is a good neutral position. 

Proper support for the head can be tricky to achieve and it is a very individual thing.  In my case, my neck area, where I need higher support, is fairly short, and my head area, where I need lower support is longer.  If the pillow is too big, the poofiness sometimes lifts my head too high and takes my neck out of the neutral position.

Side sleeper.  The pillow is too big.  The head is being forced up by the top of the pillow.  This is not a neutral position.

The same thing can happen if the pillow is too low.

Side sleeper.  Started out with good support for neck, but the pillow is too low and the weight of the head takes it out of neutral.

I find that I need to use two different pillows to achieve the correct balance for me.

When you consider that headaches are often caused by trigger points in the neck muscles, you can understand the importance of getting the right balance here.  It is definitely worth the investment if you can find a pillow or pillows that enable your body to rest in a neutral position.

If you sleep on your back, try a fairly low pillow between your legs to slightly elevate the insides of the knees, and a low, comfortable pillow under your neck for support.  Make sure the pillow is not under your shoulders.  They need to rest, too.  If your shoulders are lifted up all night, this is hard on the pectoral (chest) muscles because it keeps them shortened all night, and on the various shoulder and back muscles because it keeps them stretched all night.  You want them to be in neutral. (Sometimes a lightweight, rolled-up towel is just right for under the neck.)

If you sleep on your stomach, I understand this is the hardest on your neck muscles.  It is impossible to put the neck in a truly neutral position because your neck will be turned to one side or the other, stretching one side of the neck and shortening the other side.  If you must sleep on your stomach, use as low a pillow as possible.  You might also try sleeping on your side with a couple of pillows arranged to support your stomach.  That way you can get the feel of sleeping on your stomach without actually being on your stomach. 

As you experiment with each position, notice the difference.  I am often surprised at how much tension is in my body when I am supposedly resting.  No wonder I have awakened many times feeling like I have not rested at all!

When it is time for bed, taking the time to arrange things so your body will be properly supported and in a genuine "neutral" position is a wonderful gift to give yourself.    Be sure to be awake enough when you are going to bed to do this.  If you just crash into bed exhausted (and I know many of you do), you may end up stuck with whatever position you landed in, and it may not be a good one.

A Word about the Weather

Have you ever heard someone say that they can tell when a front is coming in?  Perhaps you are one of those people.  I am.  For many years now, I have had various symptoms that can range from something as "mild" as an antsy feeling, to feeling like I have a stomach flu, with nausea, muscle aches and headache. I noticed that certain symptoms predict certain types of weather.  For example, if my knees started to ache really bad, that usually happened before a snow storm.

The common factor, though, was that once the front finally arrived, I felt better.  The tension would cease, or the pain would subside, and I would feel tons better.

One theory that I have heard about the joint pain, is that as the pressure changes, the pressure changes in our joints, and that is why there is pain.  This made sense to me, but I found out something interesting.  After I learned about trigger points and started to work them on a fairly regular basis, instead of feeling the pain in the joints when a front came in, I felt pain in the muscles that referred to those joints.  For example, instead of feeling pain in my knees, I felt pain in my thigh muscles.  Instead of feeling pain in my bones of my lower back, I felt pain in the muscles of my buttocks.

This piqued my interest.  I did a lot of research on the Internet, trying to learn about what happens when the weather pressure changes.

I wondered if the changes in the electromagnetic field might have something to do with it.  Years ago, when my husband worked for a large software company, I noticed that I could not visit him at his office for very long because of all of the computers (with CRT monitors).  That environment seemed to suck the energy out of me and I could hardly function by the time I had been there for 15 minutes or so.

I also remembered that once, when a salesperson demonstrated a whole-house air cleaner that when he turned on a particular feature--I think it was an ionizer or de-ionizer, but I honestly can't remember--I got a headache, almost immediately, and that headache went away after he turned it off.

But, I could not find much on electrical fields.  I learned that night and day, and summer and winter have different configurations.  But I could not find a way to measure these differences at home to see if they were having an effect.  And I could not find a website that kept track of this kind of information.

For now, I have had to be satisfied with knowing that changes in my body are associated with changes in the barometric pressure.

To learn more about how this affected me, I first charted a week's worth of symptoms.  Then I went to a website that has information for the past two weeks of weather.  This is Time and Date.com. Here is the link, if you are interested:  http://www.timeanddate.com/ (Go to Weather.  Then click on Past Week.  You can put in your specific location, or a location that is near to you.  The barometric pressure information will show up when you click on the Detailed List link.) I compared my symptoms to the weather and noticed a very strong correlation, which was, of course, no surprise.

Next, I kept a record for a few days of how I was feeling at various times and I recorded the barometric pressure at that time.  (We have a portable weather station...)  At this stage, I was interested in noting specifics.  Was I feeling worse at the time that the pressure started to drop after it had been steady?  Was it the absolute value of the pressure, or was it how far and how fast the pressure was dropping that was affecting me?  Were there different symptoms associated with each phase?   I kept a chart by the weather station and marked the information down whenever I was feeling symptomatic.

I am still fine-tuning this understanding, and it may be that there are other factors that determine what type of symptom I have.

Next, I found a really great app for my iPad (It is also available for iPhone, Windows Phone, Android, Blackberry, and WebOS HP Touchpad).  It is called WeatherPro by MeteoGroup. Here is the link if you are interested:   WeatherPro  It costs about $5.00.  It says it has information for over two million locations in the world.  It has four general areas:  Weather, Radar, Satellite, and Maps.  In the weather section, it has an eight-day forecast, with several categories, including barometric pressure.  It is charted in a graph form, and you can see the whole week at a glance.  It is fairly easy to pinpoint about what time during the day the barometric pressure will dip, bottom out, go up, etc.

I have compared it with the actual readings that happen here, and it is very reliable.

The next thing that I have done is to use the forecast as a tool to help me plan what I will do and to give me perspective when I am in a symptomatic period.

For example, if I know that there is going to be a huge drop in the barometric pressure, I will realize that I may not be able to do much of anything, and so perhaps I need to plan some down time, something I can do while lying down with my feet up, if need be.  I can also plan to work trigger points before hand, and, if needed, take ibuprofen to lessen the severity of the symptoms (kind of like taking ibuprofen before going to the dentist).

If I see that the barometric pressure is going to change in the afternoon on a particular day, I might try to get important chores taken care of at the beginning of the day, so that I will not be agonizing over how much I did not get done later.  My rest period will occur at a natural time and will coincide with the time I would not be able to do much anyway.

If it is a moderate drop, I often feel antsy, so I might plan something active to do during that time.  It is not a good time to sit and read.  If I do that, I will find myself constantly going into the kitchen and opening the cupboard, looking for that item that has the perfect combination of chewy and crunchy without being too sweet or too savory.  So, I might plan on vacuuming, exercising, yard work, or anything else that will help to get that restless energy channeled.  (Last time, I made homemade bread and cinnamon rolls... the family liked that.:)

I have noticed that if it is a steeper drop in pressure, I usually have more pain.  I may have to just muddle my way through, taking pain medication and trying to distract myself.  But, for me, it also helps to see that the pressure is going to head back up in an hour or so.  Or, if I know that it going to last longer, I can tell myself that this is the perfect time to watch those shows that I have wanted to watch.

I think it is better to avoid the computer because of the tension that typically builds up when we are on the computer.  If we are typing, our head, neck, shoulders, arms and hands, are continually tense, along with any part of the body that is positioning itself just right for us to balance the laptop (knees) or to reach the floor (feet in tiptoed position).  I find that it is better to do something that is pleasant and distracting, in a position where your entire body is supported comfortably.  You don't want to add any more tension.  But, it might be different for you, so do what relaxes you.

I have noticed that sometimes when the pressure goes quite high, I get migraines.  I am still monitoring that aspect.  My migraines are also very affected by my hormones.  (One thing that I am very happy about, since learning about and using trigger point therapy, when I do get headaches, if I cannot relieve them by using trigger point therapy, I can at least treat most of them now with ibuprofen.  Nothing worked before.)

One thing about these pains is that they eventually go away.  I love having the chart that tells me about when they are heading out. I suppose it makes me feel more in control of my situation.

I am also interested to see how things will change as I continue to work my trigger points.  Right now, I can feel pretty good, and a front will come in and I will feel like I have been attacked.  But, as I mentioned above, the nature of the attack has changed.  It is now in the muscles that refer pain to the bones that I feel it.  I wonder if this pain will lessen over time as I get those trigger points more under control or if it will stay the same.  My hope is that the pain will lessen.  Time will tell.

In the meantime, I am very grateful for the techniques, devices, and medicines that help me over these rough spots and help me to be able to enjoy my journey.

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

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.  

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.)

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.

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.