The momentum of a wave can take down huge ships, in much the same way that the momentum of a trigger point can paralyze giants. In this episode, Allison dives into why trigger points are so painful and how approaching them as you might approach an octopus in the ocean is the key to calming the waters.
Allison’s column in Massage & Bodywork magazine:
“The Muscle, the Beast, and a Cup of Tea: Conquering Sternocleidomastoid Fears,” by Allison Denney, Massage & Bodywork magazine, March/April 2021, page 80, www.massageandbodyworkdigital.com/i/1338685-march-april-2021/82.
This podcast sponsored by:
Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.
At Structural Elements, we view ourselves as Body Engineers. We evaluate the human body according to its structural integrity and establish proper balance between compression and tension elements. Through identifying patterns in the body, we are able to locate areas of compensation to treat the cause of the imbalance, not the site of pain. Our patients achieve lasting results as we reduce structural imbalances, improve connective tissue health, and reeducate movement patterns. Now, we have taken our education, operations, and communications infrastructure from our franchise company and made it available to the industry through (se) Connect.
(se) Connect is the only interdisciplinary knowledge sharing platform that exists in the wellness industry. Participants gain access to treatment tools, business tools, and the ability to connect with other professionals in a variety of modalities. Through our community, massage therapists, physical therapists, chiropractors, athletic trainers, acupuncturists, and others all learn to look at the body through the same lens, which allows for rich discussions on patient care and treatment options. Our training staff brings decades of experience in massage, manual therapy, acupuncture, chiropractic, and business, and we look forward to sharing that with you.
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0:01:04.5 Allison Denney: Hi, my name is Allison Denney, and this is the Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow, but the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peek at what's under the surface.
0:01:52.3 AD: Standing at the edge of the beach where the sand meets the sea, it is hard not to look out and wonder where waves come from. That wave right there that just reached out and licked your toes. Where did it start? How far did it travel? What did it see along the way? And is that it? Is that the end of its life, ashes to ashes and all that, or is it more like reincarnation and will be the beginning of another wave? It is nearly impossible to look out at the ocean and not wax philosophical. And as a body worker, I find myself asking very similar questions when I come across a trigger point. Where did it come from? How long did it take to form? What is its origin story? And why oh why does it cause so much pain? Obviously, there are some discrepancies here, waves and trigger points aren't paralleled in the universe, but their stories are fascinating and their uncanny abilities to make us question everything is even more astounding.
0:02:53.1 AD: Here is what I mean. Let's first look at a wave. I did a little research and this is what I learned. A wave is not so much a thing as it is an energy. If you're already thinking about the correlation here to trigger points, I am totally with you, but let's stay focused. Waves are almost always started by wind. Wind pushes the top of the water in a series of bumps that are called capillary ripples, and no, it is not lost on me that the word capillary is chosen here to describe this phenomenon. As the wind blows, it gives the water energy, and as it keeps blowing, that energy builds until the water ripples grow into what are known as gravity waves. Eventually with enough energy, they begin their long journey across the open ocean as a swell.
0:03:41.8 AD: The size of the swell depends on, how fast the wind was blowing, how long it was blowing for, and the area of the sea where it originated. And at this point, there are a number of different factors that send waves into various possible trajectories, that include storm surges, earthquakes or random other waves. Every once in a while, we even hear about rogue waves, which have been reported to measure three stories tall and are powerful enough to take down enormous ships. So we've got a story about a little energy that finds a host, builds in intensity, travels a great distance, is influenced by what happens along the way, and can become so big, it can take down a giant. Sound like a trigger point to you? Yep, me too. But what is a trigger point exactly? Well, here are the details. I'll start with the Travellian definition that most of us are probably familiar with. Janet Travell, an internist of general medicine in the 1940s, became the leading expert of myofascial pain when she discovered what she coined a trigger point. In her words, a trigger point is, "A hyper-irritable spot in skeletal muscle that is associated with a hyper-sensitive palpable nodule in a taut band."
0:05:00.0 AD: When we deconstruct this definition, what we are really talking about is what happens when a muscle contracts, or at least how it is supposed to contract, and then what we eventually find as the result of an abnormal contraction. Diving deep into anatomy, what we see is that a muscle is just a big collection of bundles of fibers. Those fibers are made up of even smaller fibers. Of course, they aren't called fibers at that teeny tiny level, each muscle fiber is in fact a muscle cell and has all the normal cell components that you probably had to build out of jello or clay or something like that at some point in your life, the nucleus, the mitochondria, the endoplasmic reticulum, etcetera. But a muscle cell, unlike a liver or a bone cell, also has these hair-like filaments that give muscles the ability to do what they do best, contract. These little bitty parts, this deep down are called myosin and actin. Like an octopus and its tentacles, they have this natural talent to grab on to each other, pull tight and get small, and then get long, let go and swim free. This is how a muscle contracts. The myosin and actin grab onto each other, pulling the ends of the muscle and the bones they are attached to closer together, and then they let go, allowing the bones to move farther apart.
0:06:26.4 AD: It is more complicated than this, but you get the idea. So these contractions happen in all skeletal muscle and in an ideal world, contract frequently, relax frequently, get stretched and massaged frequently, are fed the proper nutrients, are well hydrated, and get a good night sleep. Sounds like everyone you know, right? Exactly. This is very rarely the case. And when muscles are put under stress from any of the aforementioned categories, they get angry. Picture that octopus again, he's tired, hungry and has had no downtime in weeks. He is stressed out and now clinging onto a rock for dear life and not letting go. This is a trigger point. The myosin and actin are grabbing on to each other and they have forgotten how to let go. When you ask a muscle to perform an action over and over and over again, it thinks you're training it. So if you constantly keep your shoulders in your ears, but never stretch or relax them down to a neutral position, the myosin and actin in the muscles that create that action will forget, eventually, how to let go of each other. Tired little filaments.
0:07:39.8 AD: The exhaustion is not lost on the surrounding tissues. Any connective tissue here will start to wise up that these little guys are exhausted and call in the troops to help out. It will actually surround the area and create a little thickening as a sort of band-aid, because it thinks the muscle is experiencing some sort of trauma. Can you blame it? The reinforcement here may have good intentions, but the combination of clinging muscle tissue and sticky connective tissue is not good for any blood, lymph or nerve vessels that are trying to find passage here. Now the energy is starting to find momentum, that ripple of a trigger point has found its sea legs, and if it joins forces with any number of elements that will fuel its fire, that little irritation will become a serious pain in a very short period of time. Like the wave in an ocean that is influenced by elements like the shape of the sea floor, a tropical storm or surrounding pieces of land, a trigger point will gain strength from reinforced behavior, a blunt force from the outside, or the constant stream of cortisol from an environment filled with anxiety.
0:08:49.0 AD: Now we have this little angry bundle of muscle fibers. They are gripping down and starting to wreak havoc. Depending on the intensity, severity and frequency of the various factors that go into creating that trigger point, it may only be a little angry, come up against a strategically applied pressure and dissipate back into the ocean of human biology, or it may have been gathering speed and velocity for years, rearing its ugly head now and again, and has suddenly joined forces with a traumatic event, say a financial blow or a car accident, to create a rogue wave that would bring down the Titanic. For real, I have seen trigger points strong enough to paralyze Arnold Schwarzenegger. People commonly refer to them as knots, and they are a lot like knots, a tangled collection of fibers that are impeding the normal flow of things. Some of them are minor irritations, like the constant spray of water in your face when you're on the boat on a windy day, and some of them are like a vice grip that are hell bent on unleashing the rage of a thousand tsunamis. In any instance, the body sounds the alarm and sends signals to the brain that things aren't right. This happens in the form of pain. What techniques work then? It's important to start from the premise that no two trigger points are the same, in the same way that no two waves are the same.
0:10:13.1 AD: So how you handle a trigger point can be very different from client to client, but if you keep in your pocket, the knowledge that a trigger point is essentially a collection of energy, you can use this information to your advantage. There are lots of methods taught in handling trigger points, some of them require total silence, some of them suggest distracting the client with conversation, some use tools that date back to the Paleolithic age, and some believe that the most modern technology is the way to go. There are benefits to all of these techniques, the key is to whether or not you're applying the right approach to the trigger point that you have before you. As with waves, you can learn a lot by simply watching or listening to them. What is it that you feel? What is it that your client is feeling? What do you notice about how they describe it? Do they seem full of anxiety? Do they seem stuck? Do they seem weighed down? Most trigger points are some kind of personification of dysfunction that your client is experiencing. All trigger points want relief. What you can do with your client, but you can't do with a wave is ask questions. Once you have located a trigger point, your best starting point is to check in.
0:11:28.5 AD: Apply a little pressure and get a little feedback. Start with a gentle pressure and sneak up to it like a scuba diver approaching that octopus. Any sudden movements and there is no shot he's letting go. The more slowly you sink in, the more information you will get. The mistake most massage therapists make here is to let go if you've gone in too fast or too deeply. Any inkling that you are scared is going to be detected for miles. Stay confident, stay present, back up just a little and reassure your client that you were just testing the waters, now you know your limits, but you're still right there with them. At this point, there are lots of theories with lots of specific steps to follow in order to successfully deactivate a trigger point, but the basics are the same throughout. You wanna give that trigger point some push back. If you have a quiet unsure client, use a reserved amount of pressure, if you've got a more energetic experienced client, sink in a little deeper and find that comfortable discomfort. Now you can start your trigger point therapy.
0:12:34.7 AD: Let's say you've got a minor trigger point that has only formed within the past year. It's in the rhomboids, it's not radiating anywhere, and it's irritating the client, creating a pinching pain when they sit at their computer or sleep funny. Using a supported thing or a thumb pad, sink in until your client tells you the pressure feels productive. Or let's say you've got a more severe trigger point, it's in the QL and your client is no stranger to back pain. Position your client on their side so that the affected QL, let's say the one on the right, is up off the table. Have them bend their left leg up toward their chest, have them straighten their right leg but relax it down to the table, and then have them reach their right arm up over their head and grab on to the face cradle or the head of the table. This opens up the QL, which makes the trigger point way easier to access. It's a little like trying to grab on to an octopus who lives in shallow, narrow waters as opposed to a vast deep ocean.
0:13:32.7 AD: From here, use a supported thumb, fingers, knuckles or even an elbow and start to dive in. In either scenario, once you are here, put on your research scientist hat and do some exploring. Does the pain feel more or less intense if you move slightly, and by slightly, I mean slightly in any direction or coming into that spot from a slightly different angle? And once you've found the perfect position, does stillness feel the most effective to the client? Does friction? Does passive movement? Does active movement? Start very slowly in each of these directions and take mental notes on what works and what doesn't. What needs to stay consistent is your presence. If at any point you are not focused and listening and understanding what the trigger point and this client are telling you, you have disconnected. This is probably the most difficult aspect of working with trigger points. It is easy to get distracted. It is easy for the client to get distracted. It is incredibly easy for that trigger point to slip into a cave and come out again later when it feels like things are safe.
0:14:42.9 AD: The crazy part is, that even if you find what works for one trigger point on one client, it doesn't mean that it will work on all trigger points for all clients. It doesn't even mean that it will work on the same trigger point for the same client the next time they come in. Those things have a life of their own and they will move and shift and change like the tides. The last and quite possibly most important step of this work is the conversation you have with your client before they leave. Remind them that body work is holistic work, which means that there are no quick fixes. This trigger point may not feel resolved after one visit. It will probably move around a bit. Their muscles may feel a little sore from any intense work. And this is the key, consistency is everything. Teach them how to access that point on their own. Talk to them about how working through pain is a lot like working out, you don't just get buff after one trip to the gym, and suggest that they make a series of appointments, so that you can continue to work with them and get to the root of where this angry energy may be coming from in the first place. Remember this, waves after long periods of time, shape and sculpt the appearance of our lands. The same is true for trigger points. Deep-seated pockets of pain will eventually begin to dictate how we act and what we do in our lives. Help your clients choose who they are in the world, don't leave that up to a trigger point.
0:16:14.9 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at email@example.com. That's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions, or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com, where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other rebel massage dabblings. I'm impressed you've made it all the way to the end, but because you have allow me to offer a glimpse into our next episode. Tune in next time as we compare connective tissue to tectonic plates, contemplate the eruptive nature of the IT band, and consider celebrating wrinkles and age spots.