Last week we talked about trigger point pain. Those annoying knots in our muscles that are incredibly tender to the touch. Have you ever watched anyone contort themselves in different ways, trying to stretch out that one irritating spot? It’s a dance most of us know all too well. But what do we do when that doesn’t work?
Here are some ideas:
Start with a little self help- rub it away
Rub in what way?: Either simply press on the trigger point directly and hold for 20 seconds or apply small kneading strokes, either circular or back and forth. If you happen to know the direction of the muscle fibers -sometimes it’s obvious-then stroke parallel to the fibers as though you are trying to elongate them, because that might be more effective.
Rub how hard?: Massage is mostly about having a conversation with your nervous system, so you want it to have the right tone: friendly and helpful. Not loud and rude. You’re not trying to kill it, you’re trying to soothe it. The intensity of the treatment should be strong enough to satisfy, but easy to live with. Too much intensity can backfire. Aim on the side of gentle at first. You can always get more aggressive if it doesn’t work.
Rub how much, how often?: Start small—a single session of about 60 seconds might be enough. Five minutes is roughly the maximum that any trigger point will need at one time. As long as you aren’t experiencing any negative reactions, you can massage any trigger point multiple times a day. Beware of excessive pressure it can make things worse.
Rub with what?: Rub the trigger point with your fingertips, thumbs, fist, elbow … whatever feels easiest and most comfortable to you. Tennis balls are surprisingly effective. Stay warm! Chills are the top trigger point aggravator. Lightly exercise treated muscles-just enough to increase circulation. When all else fails, recruit help. Sometimes being able to relax while someone else does the massaging makes all the difference.
- Pain relievers: Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help some people if there’s no contra indication (i.e. you’re on blood thinners), have indigestion, kidney or liver issues. Your provider may prescribe stronger pain relievers. Some of the best options I’ve found are available in patches or creams that you apply directly over the area of pain.
- Antidepressants: Many types of antidepressants can help relieve pain. For some people with myofascial pain syndrome (groups of muscle knots) helping to reduce stress and anxiety while aiding sleep can help. Amitriptyline appears to do both.
- Muscle relaxants: These can help release the spasm. They can range from less sedating- to take during the day- to more sedating to help troubled sleep so they’re better in the morning.
Acupuncture and acupressure
Used for thousands of years in China, acupuncture promotes relaxation and wellness to treat a variety of issues. Another alternative -acupressure is often thought of as simply acupuncture without the needles.
Acupressure is just one of a number of Asian bodywork therapies (ABT) with roots in traditional Chinese medicine (TCM). Examples of other Asian bodywork therapies are medical qigong and Tuina. Shiatsu is a Japanese form of acupressure.
Traditional Chinese medical theory describes special acupoints, or acupressure points, that lie along meridians, or channels, in your body. These are the same energy meridians and acupoints as those targeted with acupuncture. It is believed that through these invisible channels flows vital energy — or a life force called qi (ch’i). It is also believed that these 12 major meridians connect specific organs or networks of organs, organizing a system of communication throughout your body. The meridians begin at your fingertips, connect to your brain, and then connect to an organ associated with a certain meridian.
According to this theory, when one of these meridians is blocked or out of balance, illness can occur. Acupressure and acupuncture are among the types of TCM that are thought to help restore balance.
A physical therapist can devise a plan to help relieve pain based on your signs and symptoms. It may involve:
- Stretching: A physical therapist may lead you through gentle stretching exercises to help ease the pain in your affected muscle. If you feel trigger point pain when stretching, the physical therapist may spray a numbing solution on your skin.
- Posture training: Improving your posture can help relieve myofascial pain, particularly in your neck. Exercises that strengthen the muscles surrounding your trigger point will help you avoid overworking any one muscle.
- Massage: A physical therapist may massage the affected muscle to help relieve pain using long hand strokes along the muscle or place pressure on specific areas in the effected muscle to release tension.
- Heat: Apply heat, via a hot pack. You can do this at home too. A hot shower or bath can help relieve muscle tension and reduce pain.
- Ultrasound: This type of therapy uses sound waves to increase blood circulation and warmth, which may promote healing in muscles affected by trigger points or myofascial pain syndrome.
Many active trigger points will respond to conservative treatments, especially in the early stages of trigger point formation. However, for chronic ones, trigger point injection and needling is an effective treatment alternative.
Injecting a numbing agent or a steroid into a trigger point can help relieve pain. In some people, just the act of inserting the needle into the trigger point helps break up the muscle tension. Called dry needling, this technique involves inserting a needle into several places in and around the trigger point. Some locations require the assistance of ultrasound- a technique where X-rays are used to insure proper placement of the needle and medication.
Optimally, a trigger point resolves after one injection, especially if there’s one isolated trigger point caused by an inciting event that’s no longer an issue, like trauma. Trigger points caused by chronic conditions such as fibromyalgia and myofascial pain syndrome tend to recur due the underlying problem. In these cases, trigger point injections may be administered on a regular or as needed basis and several trigger points can be injected at one visit. The frequency of trigger point injections depends on the medication being injected. If only lidocaine or a mixture of anesthetics is injected, then the injections can be administered as ongoing therapy as frequently as monthly. If a steroid medication is injected, TPIs should be administered much less frequently.
Trigger points can be painful and debilitating. Ask your provider what treatment may be best for you.