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.

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.

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.  

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, Part 2

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

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

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

Theracane is working muscles on opposite side of back.

Front position of theracane to work other side of back.

To work your shoulder muscles, hold the cane with the curved part up and extending to the back. Place one hand on the curved part of the theracane and the other on the lower end of the cane. Place the large knob at the end of the curve on your shoulder. Push down with the top hand, and out with the bottom hand. Experiment with the leverage until you get the desired pressure.  

Using the opposite hand to exert the pressure.

Using the large knob is quite effective for the muscles in back of the neck and is especially useful when trying to get to some of the deeper muscles in your upper back and neck area. When working the muscles in the back of your neck, it is a good idea to lean back into the cane, relaxing the muscles that you are working.

Working the side of the neck.  

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

There is a deep trigger point here.

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

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

Using arm or wrist to give a break to the hand.

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

To work this area, place the theracane curve around your waist, with the knob in back and the stick in front. Place your hands outside of each of the handles. Push forward with the hand that is closest to the straight end.

Working the back and sides near the bottom of the rib cage.

You can also use the large knob to work your chest muscles. Again, use caution because some of the chest muscles are also very tender. Go easy at first, and you will get an idea of how much pressure is just right.  (See my post on working pecs for more information on working your chest muscles.)  

 The theracane is a pretty handy tool.

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

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.