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.  

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...)

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...) 

Sharing

You were probably taught to share at some point in your life. You may have heard phrases like, "Many hands make light work." Our muscles share, too. They often work together in teams. There might be several muscles from different areas of the body, working together to perform one function. When they all work together, the job is not too hard for any one muscle. But when one muscle stops doing its part for some reason, the other muscles take up the slack. If it is a temporary situation, these other muscles might recover quickly once the emergency is over; however, if it is a long-term situation, the other muscles may also become disabled.

Understanding which muscles perform which functions, gives us helpful information when treating our trigger points. It is a good idea to check the other muscles in a group to see what shape they are in. Muscles that work together often get trigger points together.

Have you ever used window blinds that use two cords to open and close the slats? One string pulls the slats closed one way; the other cord pulls them closed the other way. Many places in our body work on the same principle. For example, in our forearms we have the flexor muscles on the under side, which "pull" our hands and fingers down, and the extensor muscles on the top side, which "pull" our hands and fingers up. With window blinds, sometimes it is necessary to put tension on both cords to set the slats to the proper angle.

The same thing occurs with the extensor and flexor muscles of the forearm. Both sets of muscles are required for many tasks. For example, gripping requires both sets of muscles. Computer work calls on both the flexors and extensors. Many of us (including me) spend long periods of time at the computer, overworking not only our arms, but our shoulder and neck muscles, too.

The relationship between other muscles may not be as obvious. When we have back trouble, it may not occur to us to check our stomach or buttocks muscles for trigger points, but when you understand that stomach muscles work with back muscles to lift us up and carry us around, and that the buttocks muscles help us maintain our balance, it makes perfect sense to check them as well.

Sometimes, a whole set of muscles becomes disabled and we use another set of muscles to accomplish the task that the disabled muscles used to do. Often, these other muscles are not able to handle the extra job, and they, too, become disabled. This can set up a scenario of one problem after another.

A few years ago, I discovered that I could use a grabber tool to pick things up off the floor without having to bend down. At that time, my back was so disabled that I had maybe one or two bends a day before I simply could not do any more. I could not sit on the floor to pick things up because it would make my back worse. I purchased my grabber tool and I went to town. I picked up everything. I got fast at it. I was so happy that I had found a way around my disability. However, it was not long until I started to have problems with my shoulders, arms, and hands. I could hardly do anything with my hands. I distinctly remember one time trying to cut out biscuits with a biscuit cutter and being in so much pain that I took a break after each biscuit. It was excruciating. I had overworked my hands, using the grabber tool to compensate for my disabled back, and in the process, I disabled another large portion of my body.

I can now bend over and pick things up again, and I save the grabber tool for getting things in hard to reach places and for picking up garbage out in the yard. I work my trigger points before and after bending activities. I work muscles in my back, gluts, legs and stomach, since they all participate in the bending. As for my shoulders, arms, and hands, I am still working on recovering them.

So, it is a good idea to know which muscles share tasks together. The Trigger Point Therapy Workbook describes the function of muscles, and has them grouped together in a logical way. The trigger point map has some drawings that help to understand the placement of muscles. You can also analyze your own movements. Place your fingers on your forearm, for example, while you flex up and down. You will get an idea of which muscles are doing what.

Knowing more about your muscles will help you to treat your pain more effectively.

But I wasn't doing anything!

How often have you had a pain come on suddenly, when you were not doing anything at all to cause it? This has happened to me many times. I would often lament, "But I wasn't even doing anything!" I could understand it if I had been in the middle of lifting something, but for the pain to come out of nowhere seemed like adding insult to injury. After studying trigger point therapy, I realized that when a pain comes out of nowhere, it is almost certainly caused by trigger points.

I have found that to use trigger point therapy to its full potential, you need to be a detective. This won't happen overnight for most of us, but over time, you will start to learn what type of activities or "inactivities" lead to trigger points in various muscles. In other words, you will learn what has been happening to cause your pain.  

Picture this real-from-my-life scenario: I have been getting ready for church on a Sunday morning. I have stepped out of the shower, grabbed a towel and brought it up to my face. Suddenly, I freeze. There is a sharp pain in my upper back on the inner side of my shoulder blade. It feels like my shoulder blade is "out." It hurts to move and I wonder how I am going to finish drying myself off, let alone get dressed, fix my hair, apply makeup, and get to church. Further, I am panicked because at this time, I have responsibilities that I need to be church for, and I just don't have time for pain right now. (Who ever has time for pain, anyway?) In addition, I am feeling like a victim. I have no control over this arbitrary pain that seems to appear out of nowhere. Not only am I in pain, I feel helpless and hopeless.

This experience has happened to me more than once and even after I had started learning about trigger point therapy, I wondered what I could possibly have been doing to set this or that pain off.

It took a while, but I think I figured my "shower" pain out. For one thing, I was not doing "nothing." Here are what I consider to be major contributing factors:

• I had just had my arms lifted over my head for quite some time while I washed my hair, rinsed it, put conditioner in and rinsed it out.  (Arms raised without a break.)
• In order to rinse the hair thoroughly, I had tilted my head back and I turned it from side to side, while still in the tilted-back position. (Head tilted back without a break.)
• I was doing all of this arm-raising and head-tilting while my legs and trunk worked to hold me steady in the shower, so I would not slip and fall.  (Tension in trunk and legs.)
• As I was showering, I was thinking about what I needed to get done in the next few hours, perhaps wondering if I would be able to make it through the meetings without any pain.  I became very tense, although I was not consciously aware of that fact.  (Increased tension over entire body, especially shoulders and stomach area.)
• I stepped out from a hot shower into a cold bathroom.  My muscles all tensed up in response to the cold.  (Sudden temperature change.  My muscles seize.)  

It took me quite a while to eke out this information. I did figure out enough immediately to know that I did not want to shower right before church on a day when my bathroom was cold and drafty. 

The first time this happened was before I learned about trigger point therapy. But it also happened after I had learned about trigger point therapy, and I still hadn't made the connection. One day, months after I had started learning about trigger point therapy, it just dawned on me. First of all, I was doing these activities which stressed my shoulder, neck, and upper back muscles. I have always had problems with my shoulders. (Even as a teenager, my arms would start to hurt and burn when I held my blow dryer up to dry my hair.) Stepping from the hot shower out into the cold air was the proverbial "straw that broke the camel's back."  

Okay, well, I figured it out, but what do I do with this information? In my case, I decided not to shower during the winter. (Just kidding! Wondered if you were paying attention.) Actually, in my case, I decided to shower the night before when the room would be warmer. I would not have the stress of having to be ready at a certain time and I could dry off by wrapping myself in a terry cloth robe with no time limit to be dry. This can work sometimes. I am also looking into having a portable shower head installed on my bathtub (yes, my shower and tub are separate--came with the house) so that I can have the benefits of shower-rinsed hair, but keep my core body temperature much warmer. There are some other ideas, but you get the idea.  And, I am also working on my trigger points, of course.  

You have two ways to help yourself. One is to find and work the trigger points. The other is to examine your activities and perhaps modify what you are doing, at least until more trigger points are deactivated. In other words, you may need to back off on some activities until your trigger points are more under control. For the trigger points that are caused by inactivity, you may also need to move those muscles more to help them fully recover.  

So, be aware. Periodically, stop what you are doing and analyze each part of your body. Is it relaxed? Is it tense? Can I make a connection between what I am currently doing and the tension level in my body? Have I been overworking or underworking some muscles? Are some muscles cold? 

You may find that you are a pretty great detective!    

Working Your Pecs

I got up early this morning and I was stiff, but I was so tired still and didn't really want to get up and work trigger points. I decided to work my chest muscles. I could work them without too much effort, without getting out of bed, and I was pleasantly surprised at how much it helped to release the tension in other muscles as well.  

Your "pecs," or pectoralis major are your large chest muscles. They are three large bands of muscles that fan from each side just below your shoulder to the middle of your chest (p. 136, if you have the Trigger Point Therapy Workbook).  Among other things, your pectorals work with your upper back muscles to keep your posture upright. If your pecs are tight, they are putting constant pressure on those upper back muscles. They tend to pull your shoulder toward the front.  

There is a domino effect to this, which can end up sending trigger points to the sternocleidomastoids and the scalenes, muscles in your neck which can be responsible for pain and stiffness in a lot of areas. There are other chest muscles as well, and it is not necessary to differentiate them at this point. Working any of them will do some good.  

The chest muscles are more tender than the back muscles (in my experience, anyway) and it does not take much to work them. Remember that you want to "hurt good." Don't try to rub them out; you will make things worse. Just work them. You can come back every couple of hours or so if you want to.  

I use one hand with four fingers held together as the precision tool, and place my other hand on the back of the "precision tool" and push. 

Place opposite hand on back of "precision tool." 

Lying in bed is actually a great place to work these because I can place the elbow of my working hand (the hand that is pushing) on the bed, so it takes very little effort to work these.  

Top hand is the "power."  Bottom hand is the "tool."

To be more specific, lying on my right side, I use my right arm (which I am lying on), bent at the elbow, to support my left arm, which is also bent at the elbow.  The left hand has fingers held together.  Using my right hand, I press the left finger tips into the trigger points.
Sw

itch sides to use the other hand.  

Search all around your chest area.  For women, you are searching in the muscles, so you are working around and under the breast.  (The breast itself is not muscle.)  

Working the pecs and other chest muscles.

If you have never done this before, you may be shocked, alarmed, or even frightened at how many places hurt.  These are trigger points.  They hurt a lot, but working them a little bit does a lot of good.  

If you are already up and about, another way to work at least some of your chest muscles is with a lacrosse ball against a wall that is close to a corner, so that you can lean in further without being blocked by the wall. 

This was written October 1, 2011.  Extra information added October 22, 2011.

Note:  Please be patient with me as I learn how to use these publishing tools.  I have tried several times, for example, to fix the word "switch" above, but it keeps publishing the split word.  Eventually, I will figure out why it is happening and come back and fix it.