Anthony Marchand Bicycle Repair And Maintenance information And Tips

Trigger Point Therapy
Anthony Marchand bicycle repair and maintenance information and tips

Trigger Point Therapy

Muscle pain associated with exercise can result from acute trauma, a rip or tear in a muscle, tendon or ligament, or infection, and in such cases is often severe and persistent requiring medical attention. However, for most athletes, pain occurring with or after exercise is often temporary (but may be recurrent or chronic) and is usually associated with either over use. The pain may present through out the muscle or at other times in small painful knots that radiate pain in a specific manner along the muscle. These latter painful knots we call trigger points. In the material below, "treatment of trigger points" and "the use of massage therapy", overlap and both are worth understanding. I highly recommend the treatment plans of Rich Poley (i and ii below) which are a gentle start in the technique of self massage and work up to the more vigorous massage technique in the ATxAvideos (i through iv below). Be sure to ice the areas after your self massage for about 15 minutes total (we will demonstrate this an up coming video). Always start slowly at low intensity and work your way up.

Trigger Points: Trigger points, also known as trigger sites or muscle knots, are described as hyper-irritable spots in skeletal muscle that are associated with palpable nodules (not caused by acute local trauma or infection).[1] Such irritable sites can cause referred pain such as those sites (trigger points) at the base of the neck between the scapula and clavicle causing pain from the mid lateral neck up to the base of the ear or even the jaw. Palpation of the trigger point or muscle knot reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point. The pain cannot be explained by findings on neurological examination. The main culprit causing such nodules is felt to be overuse which often occurs in athletes or from poor posture. Some medical specialist or therapist can recognize the trigger points by the area of pain radiation (see "Trigger Point Guide" [B] below). Some refer to this as myofascial pain believing that overlying or adjacent fascia  may be involved but the fascia relationship is poorly understood.

The trigger points (tender knots in the muscle and fascia) are shown in blue with the associated radiation of the pain shown in red.

By applying pressure to a trigger point or specific types of massage to the point can result in relaxation of the muscle (physiologically, constant activation of the nerves stimulating the muscle at the knot may actually stop the nerve impulses much like everyone trying to talk at the same time on some of the older cell phones).

According to Clair Davies (see reference 2, page 38), "massage of a given trigger point should be relatively brief, nor more then 15 to 20 seconds. Never force a release. Trigger points will release on their own when they get frequent daily treatment. Treatment failures are usually the result of being too aggressive or simply treating the wrong point."

Trigger Point Therapy:  Further explanation and treatment modalities.
  1. What Is a Trigger Point Massage?   from ehow. A trigger point massage targets specific points in the body located on sensitive areas of the muscle, and manipulating these trigger points helps to relieve pain in other areas.
  2. Trigger points are muscle spasms that feel like knots. Placing pressure directly to these points and holding the pressure often will result in relaxation of the muscle (I won't go into the physiology of the technique but you can find it on the internet. See Trigger Point Guide.
  3. How to use a tennis ball in the treatment of trigger points  from Beverly Dunford, LMT licensed and certified massage therapist practicing in the Logan Utah UT.
  4. Use of Tennis Ball  from TheDepthOfTouch. This video concentrates Soleus muscle but can be used on knots and trigger points found in other myofacial areas.
  5. Remove Muscle Knots Yourself for Low Back Pain (Tennis Ball Release)   Dr. Paula Moore shows you how to use a tennis ball on trigger points in your lower back. A similar technique can be use for painful nodules (trigger points) by lying prone or supine on a rug or mat and placing the tennis ball under the muscle of the leg. Find the point of pain and using the weight of the body or limb, rotate the ball in a similar fashion to that of Dr. Morre.
  6. The Indexknobber   Makes it much easier to apply pressure to those trigger points as well as use in self massage. For under $10.00 from Amazon   
  7. Trigger Point Therapy: Quads  Robb Beams show how to relieve trigger points in the quads using a roller. You can get a foam roller from Walmat  for about $15.
Massage Guidelines from Clair Davies:
  • Use a tool if possible and save your hands.
  • Use deep stroking massage, not static pressure.
  • Massage with short, repeated strokes.
  • Do the massage in one direction only.
  • Aim at a level of seven on a scale of one to ten.
  • Limit massage to six to twelve strokes per trigger point.
  • Work a trigger point 3 to 6 times per day.
  • If you get no relief, you may be working the wrong spot.
Self Massage: Our concern here is overuse resulting in muscle knots, trigger points, or pain in fascia  unrelated to acute trauma or infection. Inflammation of fascia from overuse is felt to be the cause of "iliotibial band syndrome" (see reference 8 below). Massage therapy at the muscle knot, trigger point or fascial areas has been successful in relieving pain in many cases. Decreasing the rate or intensity of the particular activity associated with overuse can also significantly decrease such problems if they persist or recur. But remember, persistent or severe pain or that related to trauma or infection should be a signal to consult your physician.
  1. Introduction to Self Massage  by Tony of tony10speed: Some basic techniques and advise on starting self massage. Here we cover calves and quads but the techniques can be applied to other areas. Includes precautions against being to aggressive and the importance of post massage application of ice.
  2. Thera Cane Use  Thera Cane is a tool that makes it easier to get at trigger points and resolve muscle pain, myofascial pain, and more. We'll show you what it is and how to use it.
  3. Quad Massage: Do It While You View It  by Rich Poley: Excellent techniques for quad massage. And as he says: "Do it as you view it."
  4. Knee Massage: Do It while You View It  by Rich Poley. Gentle knee self massage.
  5. Self Massage Intro  from ATxAvideos. This video introduces the three techniques that will be using during the Athletes Treating Athletes self massage series. These techniques include: elongation with a foam roller, cross friction with a tennis ball, and trigger point release with a tennis ball.
  6. Quadriceps Self Massage  from ATxAvideos. This video demonstrates how self massage the quad muscles using a foam roller and tennis ball
  7. Calf self massage  from ATxAvideos. This video demonstrates how self massage the muscles of the calf using a foam roller and tennis ball.
  8. ATxAvideos Channel  More videos from ATxA.
  9. The Stick  Shows a fast routine to roll out and massage your legs using "The Stick". The Stick is often referred to as a massage stick or muscle roller.
  10. Home Self Massage: Back, Leg & Butt Pain   Some relatively easy exercises and use of a tennis ball or soft ball for the back, gults, and thigh.
Suggested Tools to Save Your Hands (essential are in italics):
  • Instead of using your fingers, use your knuckles, fist, or elbow.
  • Massage Roller  from Walmart for $14.77
  • Tennis Ball
  • Index Knob II Massage Tool   form Amazon for $19.95 which gives you better ability to apply pressure then the less expensive $10.00  Jacknobber II , although both work.
  • Body Back Buddy to reach inaccessible points on the back for those with back pain.
  • Ice packs or styrefoam cups filled with ice. The latter you can peal away the edges like an ice cream cone and place back in the freezer.
  1. Trigger Points   from Wikipedia: A good review of the topic despite the fact that it's not a standard medical site.
  2. The Trigger Point Therapy Workbook. Clair Davies NCTMB with Amber Davies NCTMB, New Hampshire Publications Inc., 2004, ISBN-10-57224-375-9.
  3. Information about Trigger Points and their Treatment   compiled by Dr Diana Cross of "Pain", a website describing a series of interventions undertaken in a "Private Chronic Benign Pain Management Clinic" setting over a ten year period.
  4. WebMD  Myofascial pain syndrome: The statement: "It refers to pain and inflammation in the body's soft tissues" is not quite correct. Both muscle and fascia may be affected but there is still much we don't understand.
  5. Trigger Points: Diagnosis and Management   by David J. Alvarez, D.O., and Pamela G. Rockwell, D.O., University of Michigan Medical School, Ann Arbor, Michigan, Am Fam Physician. 2002 Feb 15;65(4):653-661.
  6. Iliotibial band syndrome   from Wikipedia. Another good review.
  7. Myofascial pain syndrome  from the Mayo Clinic: A quick overview.  
  8. Trigger Point Therapy  from Healthline: definitions, origins, and treatment.
  9. Human Anatomy and Physiology. John W. Hole, Jr., 5th Edition, Wm.C.Brown Publishers, 1990, ISBN 0-697-05779-8.
  10. Netter's Atlas of the Human Body. Frank H. Netter, MD, 1st Edition, Barron's Educational Series, Inc., 2006, ISBN-13: 978-0-7641-5884-1.
  11. Massage & Cycling  from Massage
  12. What Does the Research Say about Massage Therapy?  University of Minnesota: The difficulties in conducting research on the therapeutic effect of massage therapy.
  13. Massage  University of Maryland Medical Center: An overview of massage therapy.
  14. Reviews of Effectiveness  form WebMD
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