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.

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.  

Dealing with Tension/Anxiety

I could feel my tension increasing over the past few days.  I woke up with my teeth clenched (harder than usual), and I could feel my shoulders and neck getting tighter and tighter.  Because of my tension, I really didn't feel like doing much that I considered productive--I couldn't seem to focus--and so I "wasted" some time.  I responded by tensing up even more.  

When you feel tense and/or anxious, it is hard to motivate oneself to work trigger points.  (It's hard to motivate oneself to do anything.)  Even if you want to, you may not be thinking clearly, or you may feel overwhelmed and not know where to start.  You may think that it may not work anyway, etc. But, working them will help--sometimes a lot.

The number one thing to do is to start somewhere, anywhere.  There is a domino effect, and releasing the tension in one muscle will help release tension in other muscles.  Once you get the ball rolling, you will feel a noticeable lessening of tension.

I have found that if I try too hard to work my shoulder and neck muscles in the beginning, I am not always successful, maybe because I am using the muscles that I am trying to relax, and I am just too tense to make it work at that point.  However, if I work them after I have worked some other muscles, I have more success.

Today, I will give you an overview of what I might work if I am feeling tense.  Generally, I don't do this all in one go.  I might do two or three areas, take a break, and then continue later with the other areas.

First, I use the lacrosse ball against the wall to work my gluts (these are your backside muscles).  Remember not to press hard against the bone.  But, press as much as you want on the muscles.

Working the hamstrings with a lacrosse ball. 

Next, I sit on a hard chair and work my hamstrings (the muscles in back of the upper leg).  Using your body weight, move your leg over the ball, from side to side and from your knee to your sit bones.  As usual, work both legs.  If you have never done this before, you may be surprised by how many places hurt.  You may also be surprised at how loose and limber you feel after working your gluts, hamstrings and quads.   Your leg muscles are somewhat tender, so don't press too hard, but you will need to press fairly firmly in order for it to be effective.

Then, I usually work my quads (muscles in front and side of the upper leg).  The trigger points on the outer side of the leg are particularly painful.  Take it easy.  You may want to work around them at first, and gradually work up to working on them directly.  

Place lacrosse ball in the front of your thigh.  

Working the sides of your quads.  

Be sure to stay off the bones of your spine.  

I then move up to my back. Make sure to stay off of the spine.  You can work the muscles close to the spine.

If you are able to lean back far enough, you can move up to your shoulder area.

Working the serratus anterior (below the armpit).

I like to work the muscles under my armpit (the serratus anterior). Raise your arm and put the ball just below your armpit. These trigger points are extremely tender, so be careful. There are also some potent trigger points just below where the arm and back meet, on both the back and the arm.

Working the upper arm.

Work your upper arms--front, back and sides. 

Working the inside of the forearm. 

Put your hand behind your back to work the inside of the arm.  Be careful here.  These muscles can be tender.  

Working the outer forearm. 

Work the outside of the arms by leaning against the ball.

Then I use my theracane on my neck and shoulder area.

Today, I found a big trouble-maker in the back of my neck.  It is easier to work now that I have relaxed my shoulder and arm muscles enough to effectively use the theracane, and I have relaxed some of the surrounding muscles.

(Note:  Some of these first posts are adapted from emails that I sent out before I started the blog.  This was from October 12, 2011.  I am keeping track of the dates because I am always looking for patterns in my pain, including how often certain types of symptoms appear.)