|
There is growing evidence
that most of our common aches and pains—and many other puzzling physical
symptoms—are actually caused by small contraction knots, or trigger
points, in the muscles of the body. Pain-clinic doctors skilled at
detecting and treating trigger points have found that they are the
primary cause of pain roughly 75 percent of the time, and are at least a
part of virtually every pain problem.1 Nearly all
fibromyalgia patients have myofascial trigger points that are
contributing significantly to their total pain problem.2
The difficulty in treating trigger points is that they typically send
pain to some other site. This poorly understood referral of symptoms is
what misleads almost everybody in the health-care community. Travell and
Simons, in their classic medical text, Myofascial Pain and Dysfunction:
The Trigger Point Manual, repeatedly warn that physicians and other
practitioners too often go wrong by treating the site of a pain problem
andoverlooking the myofascial cause—the triggerpoint—that may be some
distance away.
The great contribution by Travell and Simons and their brilliant
illustrator, Barbara Cummings, has been in establishing that the
referral of pain and other symptoms by trigger points occurs in very
predictable patterns. Once you know where to look, trigger points are
easily located by touch and deactivated by any of several methods.
Although massage therapy is probably the most straightforward way to
deal with trigger points, some massage therapists may not know how to
troubleshoot trigger points. They may have had inadequate training about
trigger points in school. Or, those who have tried studying myofascial
pain on their own may have found that the Travell and Simons books can
be difficult to take on without a scientific background. In general,
massage therapists need to learn more about trigger points than they do.
What is the best way for you to improve your competence in treating
trigger points and referred pain? The answer is so obvious that you may
not have thought of it: Study them on your own body; be your own
research laboratory. We all have trigger points, at least the latent
sort, and even massage therapists have some kind of pain that isn’t
getting the attention it needs. Being able to fix your own pain has
clear benefits for anyone, but the advantages are even greater for a
massage therapist. Self-treatment is an excellent way to test your
knowledge and the validity of your therapeutic methods. If you can learn
how to troubleshoot and treat your own trigger points, you will know
exactly what to do when you encounter similar problems in your clients.
It’s the same ancient advice that is given to physicians: First, heal
thyself.
In studying trigger points and myofascial pain, the front of the neck is
a perfect place to start. Though frequently involved in stresses,
strains and injuries, this vulnerable part of the body is not often well
understood by therapists, and easily can be neglected. Trouble in the
major muscles of the front of the neck, the scalenes and
sternocleidomastoids (SCMs), is known to cause an astonishing variety of
symptoms in the upper body. The odd thing about these two sets of
muscles is that, despite being located in essentially the same place on
the body, they send their symptoms in opposite directions. The SCMs
refer upward into the face, jaws, ears and head; the scalenes refer
downward into the upper back, chest, shoulders, arms and hands. It’s a
fascinating paradox.
Sternocleidomastoids
An important function of a sternocleidomastoid muscle (see Figure 1) is
to help turn the head to the opposite side by pulling the mastoid bone
toward the sternum. Working as a pair, the SCMs help maintain a stable
position of the head during movements of the body. The differential
tension in them helps monitor the position of the head in space. A
single incident of heavy lifting can strain the sternocleidomastoids.
Falls and whiplash accidents can overstretch or overcontract them. An
auxiliary function of the SCMs is to raise the breastbone when you
inhale, which is why habitual chest breathing can overwork them. Other
conditions that encourage SCM trigger points are a tight collar, a short
leg, a curvature of the spine, a chronic cough, emotional stress and
habitual muscle tension.1
The following case history illustrates some of the unexpected effects
that SCM trigger points can have, and the dramatic and swift relief that
can occur with appropriate treatment.
Kate, a 51-year-old piano tuner, had frequent headaches and chronic pain
deep in her left ear. Her teeth fit together poorly, and she had
suffered recurrent temporomandibular joint pain since the age of nine,
after the removal of several teeth to compensate for a small jaw.
One day, while reading an article about self-applied trigger-point
massage, she was startled to find a big knot in the left side of her
neck that she hadn’t realized was there. She said it felt just like an
egg. While massaging the knot as suggested in the article, she
experienced a release in her left jaw that was so sudden and intense
that it frightened her. The side of her neck seemed to be expanding like
a balloon. She ran to look in the bathroom mirror to see what damage she
had done but could see no swelling or anything else wrong. Then she
noticed that the pain in her jaw and her left ear was gone, and the fit
of her teeth felt different. Her dentist, after inspecting the change,
told Kate that her jaw had somehow shifted position, and she now had a
proper bite.
Long-standing trigger points in Kate’s sternocleidomastoid muscles had
been directly to blame for her headaches and ear pain. They had also
maintained secondary trigger points in the jaw muscles that were the
cause of her jaw pain and the misalignment of her temporomandibular
joints. Working with a massage therapist, Kate learned correct
techniques for massaging her jaw muscles and SCMs, which she now uses to
ward off her symptoms whenever she feels them coming back.
People are rarely aware of trigger points in
their SCMs, though their effects can be amazingly widespread in the
head, neck and jaw. They cause four kinds of symptoms: 1) pain, 2)
balance problems, 3) visual disturbances and 4) autonomic abnormalities.
Pain can be sent to
the top, sides, back or front of the head (see Figures 2 and 3). A
frontal headache is practically a signature of sternocleidomastoid
trigger points. Pain is also sometimes sent to the back of the neck
and occasionally spills over to the sides of the face, mimicking
trigeminal neuralgia (not shown). SCM trigger points can send pain
deep into the ear and to the eye and the sinuses. They can make the
back teeth and the root of the tongue hurt. Dizziness and a
tendency to lurch or fall unexpectedly can be the result of trigger
points in the clavicular branch of an SCM muscle. They can be the
reason for otherwise unexplainable loss of appetite, nausea, sweating
of the forehead and fainting. They can also cause a degree of
reversible hearing loss, due to their effect on the inner ear. Doctor
Travell believed that the distorted perception caused by trigger
points in SCM muscles was a hidden cause of auto accidents. A droopy eyelid,
excessive tearing or reddening of the eyes can often be traced to SCM
trigger points, as can blurred, dimmed or double vision. Excess mucous in the
sinuses, nasal cavities and throat can come from the effects of SCM
trigger points, as can sinus congestion, sinus drainage, and
persistent hay fever or cold symptoms. A persistent dry cough or sore
throat can often be stopped with massage to the sternal branch near
its attachment to the breastbone. SCM trigger points can be the source
of a painless neck stiffness that keeps your head pulled over to one
side.
The good news about this
confusing conglomeration of symptoms is that you can fix all of them
yourself with self-applied massage. To massage a sternocleidomastoid
muscle, simply take it between the fingers and thumb of your opposite
hand and knead it firmly, aiming at a therapeutic pain level of seven on
a scale of one to 10 (see Figure 4, opposite page). Try to discriminate
between the two parts of the muscle. The sternal branch is in front of
the clavicular branch, each about as big around as a finger. Search for
trigger points from behind your earlobe all the way down to your
collarbone and sternum. When sternocleidomastoid trigger points are bad
enough, a little squeeze will actually reproduce or accentuate a
headache, giving you a very convincing demonstration of what trigger
points do. SCM massage can often make a headache better almost
immediately. The same is true for dizziness and many other SCM symptoms.
It’s unfortunate that many massage therapists have been taught that it’s
dangerous to work on the front of the neck for fear of damaging the
carotid arteries. These fears are unwarranted if you’re mindful of the
location of these arteries and avoid direct pressure on them. Their
heavy pulse along each side of the windpipe lets you know exactly where
they are.
 |
 |
 |
| Figure
1. SCM muscles, attaching to the sternum, clavicles and mastoid
processes. |
Figure
2. Sternocleidomastoid, sternal branch trigger points and
referred pain pattern. |
Figure
3. Sternocleidomastoid, clavicular branch trigger points and
referred pain pattern. |
continued on next
page.............
|
