Trigger Points – Getting Rid of Pain

Posted on September 29, 2011 by Josh

Want to get rid of that pain in your neck or shoulder that has been there for years, or that just pops up now and then?

Or the pain in your lower back or hip?

The first thing to do is to figure out what’s actually causing the pain. This might involve a trip to a doctor (MD or DO), physical therapist, or other medical professional.

But a lot of times we can figure out and “treat” our own pain. That’s what I intend to help you with here.

Surrounding your muscles is a layer of tissue called fascia. It’s both a connective tissue and a contractile tissue. Fascia is the thin white layer of material that you might find on a chicken breast or piece of beef. It separates muscle bundles. It provides structure and support to the body.

When fascia gets bound up or “knotted” (basically getting into a state where it’s contracting non-stop), it causes pain. The nerves around that area get compressed and irritated. That point where the fascia is knotted is called a “trigger point.”

Since fascia is a sheet-like covering, and it spans such a huge area in your body, a knotted-up portion of fascia can also lead to pain in other places (“referred” pain).

The way to tell if something is a trigger point is through experience!

There are two approaches to trigger points. One is to feel where you have a general area of pain or irritation, and then to look at the charts below and find the trigger point for that area. Use your finger or thumb to push around where the trigger point should be and feel for a spot that’s especially sensitive and resistant to pressure. Voila! You’ve found the trigger point.

The other way is just to search around for trigger points themselves.

Once you’ve found a trigger point press into (or squeeze) it deeply enough that you feel the referred area “light up” and hold that pressure for one minute. If that’s too intense, use 5-second heavy/light alternations for one minute.

After that minute, put some ice on the area and “sweep” the ice from the trigger point to the area of referred discomfort while stretching that muscle group as far as possible.

You just want to use the ice to cool the area, not to deep-freeze it. Keep ice “sweeps” intermittent enough that the area gets cool, but not COLD.

Same goes for stretching – don’t try to beat your personal-best stretch in this area (if you have one), just gently stretch the muscle.

Here are some great Trigger Point charts I found online:

NOTE: Trigger points in the neck/shoulder area should be squeezed (pinched between the thumb and fingers), not pressed into.

You can get to your back and neck using something like the Backnobber:

ALSO: Only treat trigger points this way once per day. If the pain (of the point or the referred area) isn’t diminished when you’re done, there might be some other cause of the pain, and you should check in with your physician again.

Resources
There are a ton of good books out there that go through this type of treatment in-depth. Janet Travell and David Simons wrote the “classic” in-depth/technical manuals on this type of therapy:

But Leon Chaitow’s book “Instant Pain Control” is a great self-help guide:

Somewhere in the middle of the two is Bonnie Pruden’s “Complete Guide to Pain-Free Living”:

Just realize that you can do it yourself, with just a little self-experimentation and discovery!

What’s Happening In There?
I saved this part for last, since some people might not really be that interested in what makes this type of therapy work, but here it is!

To the best of my understanding, a “knot” is an area of constant contraction (what’s called “tetany” – where the term for the disease “tetanus” comes from). When you press into an area like this, you’re doing two things – 1. You’re shortening the fibers of that area even further, which sends a signal to the spinal cord telling those fibers to relax (since they’re exceeding their “normal” resting length), and 2. You’re sending a signal to the brain that the area in question needs attention. Over time, when a muscle goes into “spasm” (or tetany) the body attempts to “normalize” that situation. That is, it ignores it and attempts to keep going about its business. Bringing attention to the area is often as big a help as any sort of “manual” therapy.

Hope you enjoyed the post! Please leave questions or comments below!

Pain

Posted on October 15, 2009 by Josh

My friend Aaron Schwenzfeier sent me a great article by Ronald Melzack, Ph.D.

Dr. Melzack proposes a neural network that has it’s own “signature” – which would be similar to your individual voiceprint, fingerprints, or heart-rate variability signature. That network “produces” pain.

What that means is that the old model of there being a single place in the brain that generates pain signals, or a single pathway from afferent neuron (the way you feel things external to you – in pain, if you were to touch a very hot stovetop) to single processing site in the brain would be incorrect.

The truth would be that pain arises as the result of diverse signals as processed by this neural network. Things like your stress level (and accompanying changes in cortisol/adrenaline levels, etc.), inflammation (and accompanying changes), and/or actual trauma to tissues (etc.) would all feed into this network, creating a susceptibility to pain.

This model would definitely help to explain the different “pain thresholds” or “tolerances” in different individuals. For one thing, one person might have a more robust network, capable of handling more stress than another. Or, they might have less chronic activity in the pain neuromatrix than the other person.

I like this theory, and hope it is explored more fully. That being said, I think it’s actually a little limited.

My first question is – where does the differentiation exist between the neuromatrix in the brain, and the neural-matrix that stretches throughout the body?

As we know, the separations we make between structures in the body are largely arbitrary, and this scientific/analytic approach to the body has hidden as much as it has revealed.

On a side note, I wanted to add some personal reflections about pain that came up while I was reading Dr. Melzack’s article.

I’ve had a few people over the years tell me to “make a friend of pain.”

That statement is much different from what old high school coaches said – “no pain no gain,” or “stop being a wuss.”

Make a friend of pain.

The first person who comes to mind as saying that to me was Luo Dexiu, the head of the bagua school I practice within. Luo is a master of Baguazhang and the internal arts. He’s been practicing the martial arts for roughly 40 years at this point.

Luo said it specifically in the context of getting through prolonged static-standing exercises. Invariably, when you’re holding static stances, your muscles start to rebel, your limbs start to shake, you start to sweat, and your body screams “pain!”

But there’s no real risk of injury in these positions. It’s just uncomfortable. So, what Luo was saying was basically – you need to reeducate your pain neuromatrix…teach it to differentiate true pain from discomfort. Or boredom.

The second person who came immediately to mind was Deric Stockton. Deric is a 40 year old powerlifter who recently squatted over 800 pounds. And he’s clean (not on steroids).

At his Symmetricore seminar a few months ago, Deric said “pain is my friend.”

He didn’t mean that he hangs out with pain on a Friday night. He doesn’t call pain up and invite it over for dinner. Rather, he sees pain as a very clear, immediate, and real way in which his body communicates with him. When he experiences pain, he can learn what his body needs.

These two people have a very different perspective of pain than what we commonly have. Pain is communication. It is a message. And, like all communication, most of us are only good at very surface levels of dialogue.

First, you have to want to communicate. Then, you have to be willing to listen. Communication is only good as long as you pay attention to it.

For many, communication consists of hearing the top of what someone’s saying, the most explicit level. The words. And then reacting to those. Not responding. Reacting.

In pain, most people, in a similar way, will feel and react to the immediate/surface stimulus. Then they’ll pop a handful of Advil and call it a day. It’s like listening to someone talk to you and going “uh huh…uh huh [when will this person shut up?] uh huh…uh huh…”

Neither party gets anything out of it.

The discipline that Luo was pointing toward (and perhaps “discipline” in general) is one that our culture works against vehemently – to pay attention, to stop and listen, and not only listen, but to hear.

It takes time. It takes effort. It takes willpower to do this.

Things the U.S. culture acts to destroy. Because when you listen, when you hear, when you feel, and consider yourself, are considerate of yourself, you don’t “impulse buy.”

Consider which path you’d rather take.

Community…in training, and out

Posted on September 30, 2009 by Josh

My last post was about community as well. Read that one too.

By “community” I also mean “culture.” It’s a group of like-minded individuals who want to accomplish a similar task, and who provide support for one another.

JR Atwood just posted on his PlayThink blog about an article that found that people who trained with others experienced a lower perception of pain than when they trained on their own.

Most of us can relate to this experience. The run was much easier when we ran it that day with our friend. The visit to the dentist’s office was much less psychologically difficult when mom was there holding our hand. The test (or studying for the test) seemed much easier when we had our friends in our class and had a study group with them.

Community, even among two people, lessens the burden, lightens the load, allows for freedom – allows for play.

This is why group exercise has always been really popular (even though we often do it in a way that keeps people separated, standing at their “stations”). We have a common goal, we suffer a common pain, we pull together, we help one another. We are able to laugh at our mistakes.

Our culture, however, is one that places high emphasis on individuality, individualism, and individual achievement. Beware this cultural tendency in yourself. It isn’t necessary, or necessarily good. For you, or anyone else.