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!    

Scalenes

So, I woke up early this morning and my right hand felt stiff and swollen.  It was very painful when I tried to close my fingers into a fist.  In fact, I couldn't bend my fingers very much at all.  I was still mostly asleep and my mind was trying to remember which muscles I should be checking for swollen fingers.

In the meantime, I remembered something helpful.  When swollen hands or feet are caused by trigger points (as they often are), it is because some place further upstream, the vessel is being partially blocked or squeezed, preventing the returning fluids from passing through.  So, although I could not remember exactly which muscles to work, I knew that raising my hand higher than the rest of my body would help.  So, I stuck my arm straight up in the air for several minutes until the swelling went down a little.

Later, when I was conscious, I went to my handy-dandy Trigger Point Therapy Workbook.  There was not a category for swollen hands and fingers, so I checked under "hand and finger numbness."  Scalenes, subclavius, and pectoralis minor looked like possible candidates, but on p. 140, in the write-up about the pectoralis minor, it said that swelling in the hand and fingers is not a symptom of this muscle, but is caused by "tight scalenes compressing the axillary vein, which runs under the scalenes but not under the pectoralis minor."  I decided that the scalenes would be a good place to work.  (You can find all the info you want about scalenes on p. 78 of the book if you have it.)

Scalenes (pronounced "SKAY-leens)

To give you an idea of how influential your scalenes are, on p. 82, it says, "The scalenes are likely to be involved in any myofascial pain problem in the upper body."  Here are some examples of possible scalene-related symptoms:  Chest pain; upper back pain; restlessness in neck and shoulder; bursitis and tendonitis symptoms; pain, swelling, numbness, tingling, and burning in arm and hand; and, because of the satellite trigger points it creates, headaches.

If you grab a hunk of flesh on the side of your neck, you will grab some fairly pliable muscles. If you press into the side of your neck with your fingertips (still holding onto those fleshy muscles), you will press right into the scalenes.

The scalenes are much tighter than the outer muscles.  Scalene trigger points can be very painful, sometimes feeling like you have hit a nerve.  Trigger points can be found anywhere on the scalenes.  Work each about six times per session.

There are three, sometimes four, bands of scalene muscles.  They basically attach your neck bones to your collar bone.  Some of the muscles are under the softer, outer muscles, so you need to move them out of the way while you work them.  The scalenes extend from under your ear to your collar bone, and from about 1-2 inches behind your ear down to the collar bone. There is also a horizontal band that is in the triangular depression between your collarbone and the big thick muscle of your upper back (the trapezius).  I am thinking that this is probably the one that was causing my swelling.

I have found that using supported fingers works well for scalenes.  It works better if you have fairly short finger nails.

I show just one side of the neck here, but it is a good idea to always work both sides of the body when you are working trigger points.

Start just below the ear.  The hand underneath (from the opposite side of the body) grabs the outer muscles and pulls them forward.  The hand on top pushes on the "tool hand."  The tool hand does not push down.  The top hand is exerting the force.  About six small strokes about one or two seconds each (not too fast) on each trigger point.

Note:  Any time you do massage, if you feel a pulse, just move over a bit.  You should never massage a place where you feel a pulse.  (You would have to go really high up under your chin to get a pulse, and if you are there, you are in the wrong place.)

The opposite hand pulls the outer muscles forward.

Continue down, moving the outer muscles out of the way.

The outer hand exerts the pressure.  

As you proceed lower, there will be fewer muscles to pull out of the way.   Proceed all the way down to the collarbone.  There can be some pretty hot trigger points right by the collar bone so don't quit early.

Continue with the back scalene, which is located in back of the first.

The last scalene actually runs more horizontally, and is located between the bulgy part of your trapezius and your collar bone.  

The stroke goes from under the trapezius (the big, bulgy muscle in back), parallel to the collar bone, and toward the neck.

Written October 5, 2011.

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.)