Trigger points must become deactivated or their effect will linger and
become chronic. Then they will extend their activity by activating other
trigger points.
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A thorough physical examination should be performed, with a focus on the area of pain and discomfort. Your therapist should start by observing the your movements and posture, looking for poor posture, muscle strain, pain that increases guarding, and increased pain in other muscle groups. Trigger points cause muscle shortening with secondary weakness and decreased range of motion which can be observed. A musculoskeletal exam with strength testing and relevant neurological assessment is often preformed. It is important in your examination that careful examination of the total body is carried out. During the examination it is important to talk with the patient and enquire whether they have had any physical injury, strain, knock, bump and so on. A bruise may not necessarily manifest itself visually and since part of the discomfort from a bruise is the broken blood vessels or capillaries which give the discoloration it may require different treatment to acupressure; one should be careful not to be misled in diagnosis. Time is well spent in diagnosis so that the correct treatment is carried out
Direct pressure with the finger, fingers or thumb are all
very penetrating movements. Pressure is magnified many times when applied in
this manner. The hyperaemia this produces will last for several hours
causing capillary dilation to be retained while excess blood and oxygen
softens and prepares the spasm for cross-fibre friction.
To facilitate the identification of trigger points, the you should be as relaxed as possible. Trigger points can be felt by palpating the muscles; trigger points will consist of tender, hard (or ropy) knots or nodules surrounded by what feels like normal muscle tissue. Once a trigger point has been found, the local twitch response may be elicited as muscle or skin twitching. You should feel sour or numb, but not knife-cut like pain when the trigger point is pressed. Be sure to speak out about any pain experienced by wincing or verbalizing this should be encourage before starting, if treating yourself you will know when you find one. The trigger points are usually between or beside the bones and tendons or ligaments, on a depression, never on the bones or blood vessels. Next, the patient should be evaluated for referred pain. Knowledge of reference zones is essential to the diagnosis.
Be that as it may, it is essential that no trigger point is missed as just missing one trigger point may well reactivate the original problem. The slight discomfort experienced during examination is well worth while enduring to ensure the long term relief correct treatment will provide. But is should be slight, if it "hurts" lighten the pressure.
The whole area of pain should be palpated for trigger points, tight bands occurring most likely at the edges of muscle and ensure that the adjoining zone of radiation is thoroughly examined to ensure no satellite trigger point has been missed.
Nonetheless be aware that obvious nerve root pain may also at the same time exhibit less obvious myofascial trigger point pain and vice versa. It is wise, even if in doubt, to treat the trigger point with acupressure.
It is by experience and correct use of the hands that one can “feel” this ‘ah-shi’ point and distinguish it from an acupoint on a definite meridian. Trigger point is a pain-relief techniques to alleviate muscle spasms and cramping. The therapist locates and deactivates `trigger points', which are often tender areas where muscles have been damaged or acquired a re-occurring spasm or `kink' that worsens painfully when aggravated. The major goals are to reduce spasm inducing new blood flow into the affected area. The spasms are partly maintained by nervous system feedback (pain-spasm-pain) cycle.
Spasms also physically reduce blood flow to the trigger point area (ischemia), reducing oxygen supplied to the tissues and increasing the spasm. Pressure is applied to trigger points, for a short time (between about 7 to 10 seconds per point), which can be momentarily painful but is greatly relieving.
Cross-fibre friction may be applied along with any of the direct pressure
techniques by simply moving the fingers to and fro across the muscle fibres.
The hand should not slide on the surface because the depth and effect will
be lost. Hand and tissue must move together. This
cross-fibre action forces bound fiberes apart freeing them up to resume
their normal activity of lengthening and shortening. the entire muscle must
be relaxed. This can be done by a series of compression applied to the
length of the muscle. Compression is the rhythmic thrusting along the muscle
with the heel of the hand or the loosely clenched fist.
It is common to hit the same trigger points several times during a session, but you won't be leaning into a sore spot for several minutes. Often ice or another cooling agent is used to reduce nervous system response, making the area easier and more comfortable to work. Then the muscles are gently stretched to complete the relaxation process.
The use of steroids (cortisone) can initially remove the
pain but this is more than often short lived and the pain returns magnified.
This is because although the injection of cortisone settles the primary
trigger point, it fails to take out the satellite trigger points in the
surrounding muscles. These satellite trigger points start exerting pain in
their own area of radiation and are quite likely to reactivate the primary
trigger point, the cause of the original problem.
To learn more about utilizing acupressure on your own, Self applied acupressure
For a review of other types of massage click here
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