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.

It's in the Details: Using Moist Heat

  I am the type of person who really likes to learn, so after I read Claire Davies' book (The Trigger Point Therapy Workbook), I wanted to read the book where he got his information.  This two-volume set is called, Myofascial Pain and Dysfunction:  The Trigger Point Manual, and is written by Janet G. Travell and David G. Simons, et al.   (Hereafter called the Red books...) It has more detailed information in it and if you have a bit of anatomy background as I have, it is readable.  It also has great illustrations by Barbara D. Cummings. 
  One of the things that was emphasized in the Red books was to apply moist heat to the area after performing trigger point therapy.
  I thought this was a good idea, but I hadn't used it much, mainly because it seemed difficult to do.  I was picturing a fairly complicated scenario, in which I would take a hot bath, or at the very least, get a bucket of very hot water, dip a towel into it, squeeze out the excess water, and then apply to the affected site.  
  I wondered how to apply moist heat without all of the hassle.  Then I remembered:  Rice-filled, microwave-powered heat pads.  They give off moist heat.  I have some of those.  (If you don't have these, they are very easy to make.  Do a search on the Internet, and I'll bet you find some instructions.  If you can't find any, leave a comment here, and I will get some for you.)
  Several days ago, my back "went out,"  I used trigger point therapy on the most likely culprits:  the psoas, my gluts, the muscles surrounding my spine, especially up by the bottom of my ribs.  I would get temporary relief, but everything seemed to seize up again, pretty much immediately.  I decided that I probably had pinched a nerve.  I could not get my abdominal muscles to relax.  The pain would start in my sacrum area (center back around and below the waistline), and I could feel it reach up the sides of my neck and down my thighs.  It is really hard to maintain your cool when you can't get these muscles to relax.
  I called to see if I could get in to the chiropractor, but knew it was not likely.  They put me on the cancellation list, but I never got in.
  Knowing that the long holiday weekend was ahead of me, I knew that I was going to have to tough it out.  It was then that I remembered my rice-filled heating pads.  I took my ibuprofen.  Then I heated up three of my rice heating pads and sat in a comfy easy chair.   I put one heating pad on my back behind my waist, another around one of my hips to help one of the trigger points in the gluts, and the other I put around my shoulders.
  I was amazed at how fast my pain subsided.  I could actually think!  After a while, I was able to get up and do a few things, very carefully and slowly.  Of course, after an hour or so, I began to feel pain again, but I was encouraged; at least I could manage the pain through the Thanksgiving holiday!
  I decided to do an experiment (I am taking a statistics class right now, so I think like this...).  In a few hours, I tried just the ibuprofen after using trigger point therapy, but I used no warm, moist heat.  It lessened my pain somewhat, but it seemed hardly noticeable.  A few hours later, I used just the moist heat after trigger point therapy, with no ibuprofen.  Again, I felt that instant, soothing relief!  Yay!  I found that taking the ibuprofen every four to six hours, and doing the trigger point therapy and moist heat every hour was an ideal prescription for my pain. 
  Over several sessions, I was able to get my back to the point where it did not feel like a pinched nerve anymore, but it still had the residual soreness from the whole traumatic experience.
  My upper back started to feel like it might go out though.  This happens sometimes when one area of the body has been so tight that other areas are tightening to keep the balance.  When the overly tight area finally releases, sometimes the second area seizes.  (Think of the energy involved in a tug-of-war.  Both sides are pulling very hard on the rope.  If one side suddenly lets go, the other side will be exerting too much energy and fall down.  It is a similar idea.) 
  I have been continuing to use trigger point therapy on all of these areas, and I am careful to not overdo my activities.  At least I can walk somewhat smoothly today.  And I can get up and down out of the chair without trouble.
  I was able to get up this morning and roll out my "twisty" rolls for Thanksgiving dinner.  I am so thankful that I was not doing the turkey this year.  I don't think my back is strong enough for that yet.     I will bring my therapy ball (lacrosse ball) and my heating pads to Thanksgiving dinner.  Meanwhile, I am feeling very thankful that my pain has lessened significantly

 
 

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.

Dealing with Back Pain: Psoas

Back pain can come from a variety of places.  Did you know that back pain can come from muscles in your abdomen?  One of these muscles is called the psoas (pronounced "SO-az").  It actually connects up with another muscle called the iliacus and together they are called the iliopsoas ("Ill-ee-oh-SO-az'").

The psoas can refer pain to the back, anywhere from the shoulder blades to the buttocks area.  Back pain from the psoas is usually on one side of the spine or the other, unless both the psoas muscles have trigger points, in which case, the pain will not feel like it is confined to one side or the other.  Here are some other places that the psoas can refer to:

• groin 
• upper thigh 
• contributes to scoliosis 
• abdomen 
• genitals 
• stiffness in hips or groin in morning when you get up 
• rotates legs outward 
• can't stand up straight
• stooped posture
• leaning to one side

(Information is from, The Trigger Point Therapy Workbook, by Clair Davies, pp. 151-155.)

The psoas attaches to the bones of the spine, starting at about the height of the last rib. It comes down and forward to attach to the top of the thigh bone.  The iliacus portion of the muscle starts at the front of the hip bones and joins the psoas to attach at the same place on the top of the thigh bone.

Primitive drawing, but it should give you an idea.  The psoas is shown in red, the iliacus in green.  

While the iliacus is a little more accessible, the psoas is buried deep in the abdomen.  But it is possible to work it.

You must use caution.  It is important to stay away from major veins and arteries, so if you feel a pulse when working your psoas, just move over a bit until you do not feel it anymore.

The psoas is actually located under your intestines.  To work it, you need to come in at an angle.  There are a couple of ways to work the psoas.

One is to lie down on your back with your knees bent.  Then let your knees drop to one side.  This will bring the hip opposite your knees up and move your intestines over a little. (Move your knees to the other side to work the other psoas.)

The main trigger points are a couple of inches away from the belly button on either side.  You can start there and look for trigger points about halfway between your belly button and your hip bone.  Bring your hands together with the fingers of each hand on the backs of the fingers of the opposite hand.  Using this tool, push down into your abdomen, searching for trigger points.

Tool for working abdominal trigger points, including the psoas.

You will probably find trigger points in other abdominal muscles, and you can just go ahead and work those while you are at it.  If you want to know for sure if you have located the psoas, you can move your leg up and down.  You should be able to feel the muscle under your fingers as you move it.  Do not work the muscle while moving, however.  Trigger points are much easier to work out when the muscle is relaxed.

A second way to work the psoas, and this is where I am saying use caution, is to use the theracane.  I personally like to do it this way, at least sometimes, because my arms seem to wear out pretty fast when I work my abdomen.  I would advise that you learn how to find the psoas first, using your hands and when you feel like you have a good handle on where it is located, then you can move up to using the theracane.

To work the right psoas, hold the theracane in front of you with the curve on the right, curve facing upward.  Grasp the top of the curve in your right hand and the outermost handle in your left hand.

Holding the theracane.

Let your knees fall to your left side.  Then push the remaining handle into the trigger point.  It is very important to proceed gently and carefully.

Using remaining handle, press into trigger point.  I am standing in this picture to provide a better view how to push in with the theracane, but you would be lying down.  

You can also work the iliacus with a lacrosse ball against the wall or a countertop.  Place the ball just below your hip bone in the front.  You can also work your quadratus lumborum, another contributor to back pain, by placing the ball just above the hip bone.  Working both of these areas will make it easier to work the psoas.

When you work the psoas muscles, be sure to work both of them every time.  And it is a good idea to work your glutes, quads and hamstrings, since they work with the psoas.  If all of the muscles are tight, and you loosen one of them, the others may reflexively tighten even more.  Picture a tug-of-war happening.  As long as both sides are pulling hard on the rope, it stays pretty much in the same place.  But, if one side lets go, the other side will end up falling down because they have still been exerting the same amount of force needed to keep that rope in the same place when the other side is pulling with all of their might.

So, if two muscles (for example) are plagued with trigger points, both muscles will be extremely tight, but that tightness will be tempered by the pull of the other muscle.  When one muscle suddenly has its trigger points released, there is no longer a pull on the other muscle and it is likely to tighten even more, resulting in more pain.  Because of this, it is a good idea to work any muscles that are antagonists (the muscles perform opposite functions) or synergists (the muscles perform a function together) at the same time that you work the original muscle.

Addendum added Oct. 23, 2012: 
I have found another way to work the psoas which I think is easier IF you are able to get down on the floor.  I have been able to get down on the floor lately, and it is easier to access the psoas using this method.

Part 1:
1) I lie face down on the floor with a lacrosse ball placed between me and the floor, about two inches out from my waist.  I take slow, deep, full (abdomen fills also) breaths and let myself fall further into the ball each time I exhale.  After two or three times, I go to step 2. 

2) I lift my head and rest on my elbows and forearms.  At the same time, I pull slightly forward.  I do the same breathing routine.  Then I go to step 3.

3) As I exhale my first deep breath, I lift my leg on the same side the ball is on and I let myself fall into the ball.  I hold my leg in that position until I have done about 3 repetitions.  The leg is lifted from the hip.

Then I repeat on the other side.

Part 2:
Then I turn over onto my back and work two or three trigger points at my bottom rib area and at the top of my pelvis (about waist level).  Using the breathing technique is helpful here also.  I do this on both sides.  Then I roll over gently and get up.

I found this excellent youtube video by tptherapy that shows how to do Part 1:  Trigger Point Weekly Workout #1   There is more on the video, but the part I am referring to is the first few minutes when he shows how to work the psoas with a therapy ball. 

For the second part of what I am describing, check here:  Remove Muscle Knots Yourself (Tennis Ball Release).  This youtube video by Paula Moore is excellent.  She also gives good advice about getting up from working your trigger points.  Don't just sit up.  She will show you how to roll over correctly when getting up.

One more thing:  This video, uploaded by posturedoc, describes a good sleeping position to help prevent back pain. I found it very helpful.  The Best Sleeping Position and How to Get Out of Bed

Hopefully, something here will help you. 

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.

How "cruel" are your shoes?

I read a story written by comedian Steve Martin some years ago entitled, "Cruel Shoes." In this story, a woman goes to a shoe store to purchase shoes, and is not satisfied with any that are brought out to her by the salesperson until she finds a pair that are so uncomfortable that they contort her feet and make them bleed. When she tries these on, she is finally pleased, and decides to get them.

When I was younger, there were times when I walked all over BYU campus in heels, sometimes spiked, not all of the time, but at least once a week for a school year when we had church services in a building on the opposite side of campus from where we lived. I knew it wasn't good for my feet; however, I have short legs, and I thought wearing high heels made my legs look longer. Besides, I did not want to make myself look weird. So, I kept wearing them and put my feet up to rest when I got home.

In my late thirties to early forties, I noticed that whenever I wore high heels (as opposed to lower heels), my knees started to hurt a lot within 15 minutes. It was so bad that I could not stand, but had to sit down. They kept hurting for a while after I took the heels off. I stuck to low-heeled pumps for several years, until a few years ago, I could not even wear those. The bottom of my foot had started to hurt in addition to the knee pain. It felt like I was walking on the bones, with no cushioning at all. I had to stop wearing dress shoes completely. Also, there was only one style of athletic shoe that did not make my knees hurt, and the last time I went to get another pair, they were discontinued.

Thankfully, it was about that time that I found out about trigger point therapy. I worked the trigger points in my legs to help get rid of the pain. The pain in the knees came from my thighs, and the pain in the foot came from my calves. But the pain was quick to return when I walked for any length of time.

I learned that I have something called Morton's foot (not to be confused with Morton's neuroma), that is, I have a longer second metatarsal (bone behind the second toe) than the first metatarsal. This predisposes me to problems with my feet and indirectly causes pain in the rest of my body. This difference in metatarsal length made it so I was walking on two points of my foot, instead of three--kind of like walking around on an ice skate, but without the high top boot. The muscles farther up my body were working very hard just to keep me standing.

Fortunately, The Trigger Point Therapy Workbook had a fairly simple and inexpensive way to compensate for my foot structure (See p. 243). I cut out an oval or circle of moleskin about an inch-and-a-half in diameter for each foot. I stuck it (it is a peel-and-stick product) on the bottom side of a foam insert that had been cut to fit my shoe, in the area under the first metatarsal.

Foam insert, cut to size. 

Example of piece of moleskin attached to bottom of foam insert. 

I was amazed at the difference this made. I could actually stand tiptoe, something I had not been able to do for a long time. It eliminated my knee and foot pain (as long as I stick with low shoes). Putting the pad under the first metatarsal gives it a little more "length" so that it can hit the ground before the second metatarsal.  The first and fifth metatarsals, and the heel, act as a tripod to bear the weight of the body.

So, if you have ongoing foot pain, knee pain, or back pain, it might be a good idea to take a look at the bones that protrude when you bend your toes. (There is more information on p. 243-245).

To fit yourself with one of these "custom orthotics," flex your big toe upward and feel for the bony part in the center of the fleshy pad below the big toe.

Feel the bone in the fleshy pad below the big toe.  

Trim the circle or oval of moleskin to fit comfortably under that bone, without going under the bone that is further into the foot (the second metatarsal). Check where to place the pad* first (before you peel off the backing), then peel the backing off and stick it to the bottom of the foam insert. Then place the insert in your shoe. Mine usually last a month or two before the insert starts to wear out.

Also, consider the type of shoe that you wear. Clair Davies writes, "Wearing high heels keeps the soleus [this is a large flat muscle that wraps around the back of your calf] muscles shortened, which is a sure way to create and perpetuate trigger points. The ankle instability typically caused by high heels also strains the soleus muscles with each step." (p. 239).  Trigger points in the soleus can cause "deep pain in the sacroiliac area and maintain spasms in the muscles of the low back" (p. 238). It also sends pain to the back of the calf, heel of the foot, and inside ankle.

So, how cruel are your shoes?

_________________________

*I have noticed that some people have a very large difference in length of the first and second metatarsal.  They may need to have a thicker pad to compensate.  Experiment a little bit to see what helps you.

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