A Trigger Point Is Not Where Roy Rogers’ Horse Stands

I frequently mention trigger points in these ramblings, as in, who has them, and where they are located, and the treatment thereof, though always in passing, as if I assume everyone knows what a trigger point is.

Every good massage therapist knows this, of course, but I should say a few words about trigger points for everyone else, so I will.

You have them, and by you I mean anyone reading this. Trigger points are merely places in everyone’s musculature that get wrapped up too tightly from time to time, and grab hold of nerves and squeeze them so that the nerves think they are supposed to do something, so they clench any other muscles they might be attached to.

So then what happens is, you’ve got a whole bunch of muscles clenched for no good reason, which, even if it isn’t actually painful, makes a person feel unnecessarily tight and stressed.

All these trigger points are located in about the same places on everybody’s body. But the good news is that not all your trigger points are clenched at any given time, and in fact most of them are not clenched at all on most people, and then too, there are degrees of clenchiness.

For instance, if I push on a trigger point and the client whimpers, I can be pretty sure that that trigger point (and let’s call it a TPT from now on, like I do in my client notes) is wrapped up pretty tightly and will need some serious sorting out in order to let go, assuming the client can stand the discomfort.

Because the way I sort out a TPT is to mash the dickens out of it, with a thumb, finger, elbow, or possibly knee, though I have never had to go that far.

Mashing the TPT further stimulates already overstimulated nerves within the TPT, eventually to the point that the nerve is so overstimulated it literally cannot take anymore and gives up, releasing not only the muscle it innervates, but also the muscles that are innervated by nerves that THAT muscle was squeezing and causing to clench.

These other muscles that the TPT is making clench could be several inches or even farther away. If the TPT is squeezing the nerves that go to this distant muscle hard enough to cause discomfort, we call that ‘referred pain.’

Even if the client doesn’t feel the pain in that distant location in the normal course of things, very often he or she will feel it keenly when I squeeze the TPT. There is a TPT, a cluster of them in fact, right at the top of the shoulder, where the trapezius attaches, which, when pressured, the client will feel up the neck to the ear and scalp, or down the shoulder and arm to the fingers, or both.

In fact, most of the active TPTs I find are in the shoulders and upper back, and that is not surprising since that’s where all of us keep our tension.

Another really likely spot, especially for folks with low back pain and stiffness, is in the QL, the quadratus lumborum. This is the most posterior, that is, farthest back, abdominal muscle. In fact it’s so far back it’s right up against the very lowest bunch of muscles that border both sides of the spine.

And so quite often I find really strong, nasty TPTs underneath the lower spinal muscles, between the top of the sacrum and the lowest ribs. These TPTs really hurt when I have to mash them, and I usually warn the client that I’m going in after them.

But when I do get those suckers to let go, the whole back relaxes, bottom to top, sacrum to cranium.

Of course I do have clients who can’t take that kind of pain, or prefer not to, and for them I will coddle the nastier TPTs, stroke and caress rather than pin down and maul into submission. Usually I can get the TPT to let go somewhat if  I give it a lot of time and patience, but the release is never as complete as if I slammed it full force.

Still, if that’s what the client wants, that’s what I will do. 

Another place I find a lot of active TPTs is in the gluteal muscles, as in the gluteus maximus, gluteus medius, and so on. These are wide, strong, thick muscles at the center of the body. Everyone’s big bits pivot around the gluteals – both of the legs, as well as the whole torso, so of course this area is going to be stressed, even if you do nothing but sit down and stand up all day.

When the glutes are strained, tense, hypertonic, they feel tough and crinkly beneath the skin, like old leather that has got wet and then dried. If I feel that, I know there are active TPTs in the gluteal.  These are not hard to find because they feel like little clumps of weeds, or like half a small grape.

And fortunately, most gluteal TPTs are quick to release, though not always.

But when released, whether it’s one or two, or eight or nine (yes, unfortunately I have seen this) the TPTs let go of the entire rest of the muscle, and then the entire cheek, to use the vernacular, can rest easy. The difference in texture that I feel in the overall muscle tone, once the TPTs are silent, is quite literally that between stiff leather and silk.

Now most people don’t even know they have the stress they do, or at least to the extent they do. I often hear people say they had no idea they hurt so much until I touched them in those spots.

Which is quite all right. Because when it quits hurting, even if you didn’t realize it was hurting until it wasn’t anymore, it feels ever so much better.

Doesn’t it?

That is all.

Mark out.


Deep Tissue Massage

As with anything as personal as massage, there are no absolutes involved. One person’s too deep might be another client’s not quite firm enough, but the point for the therapist is to have an effect on the muscles.

In the photo above, you see that the therapist is using her forearm. (And also the client’s head is properly positioned for once, which is why I chose this picture from Photobucket.)

I can’t be sure, but it looks like the thereapist’s elbow is on top of what I call the spinalis, which is the stack of several muscles that run along both sides of the spine. A lot of tension is stored in these muscles, as one would reckon given that they are holding the back upright all day, so getting in to stretch, separate, and relax these thick muscle groups will naturally take some doing.

But digging an elbow right in anywhere on the human body should never be attempted without some kind of warm up, so even when a client insists on deep work, and even when it’s obvious to my fingers that she or he needs deep work, I always start out easy and ramp it up from there.

This not only warms the client’s tissues and helps the muscles start to stretch and separate, but also brings more blood and oxygen to the area so that when I do start seriously digging with my thumbs, knuckles, and elbows, the client’s body is prepared to deal with the onslaught.

And of course I go into onslaught mode only on muscles that really require that, such as trapezius muscles, the ones that stretch across the shoulders and upper back, that feel like sheets of armor plating.

A lot of that stiffness and tension is due to trigger points, of course, which I usually squeeze out with my thumbs to release the nerves that are causing the localized and sometimes distant tension, that ‘clenching’ feeling, and that also hurts a bit, but often in a ‘good hurting’ way, as I am often told by my clients.

It also matters a great deal where the deep tissue pressure is needed as to how much is enough. For instance I would never put the same kind of pressure at the base of the neck as I would in the gluteals, the butt muscles. The gluteals are wide and thick, and I can lean into those if necessary, while the neck muscles are much smaller and more fragile, and also very near to the spine and the spinal nerves.

So with very severe cases, I will use the side of my forearm on the lower neck sometimes, though I prefer to use my thumbs if possible. And then too, some people can’t take very much pressure in the gluteals, where most of us have at least some trigger points. Here too I am very good at finding the trigger points, and if the client is willing, mashing them out with my thumbs.

Usually this works because trigger points in the glutes most often are superficial, though not always. If they are very stubborn, the client often is used to deep work anyway, and can stand an elbow point jammed in there for a minute or so.

The other place that very often requires deep work is the lumbar region, the small of the back. If a client has any stiffness at all there, nearly invariably I find trigger points right in the lumbar curve, underneath the spinalis muscles in the quadratus lumborum, which is actually an abdominal muscle.

These are a bear to take out and I always ask permission to go after them, because they’re so close to the spine. They do hurt, squeezing these things away, but once they’re gone it truly does feel a lot better when it stops hurting.

I go deep just about everywhere on the body if necesary, but those are the main places on most of my clients. Athletes, runners, and weekend warriors often have leg issues in the hamstrings, calves, and quads, but they’re used to deep and hard sports massage, so I drop the table a little and really lean into them. They need it.

That is all.

Mark out.

Epsom Salt Sermon

Jessica Alba with her supply of Epsom salt. No, really.

Here is the speech about Epsom salt that I preach to most of my clients at one time or another. This usually is prompted by my discovery of just how hypertonic (clenched) and ischemic (congested with old blood that can’t circulate out) and generally jacked up the client’s muscles are.

It goes something like this, with more or less full orchestration and four-part harmony depending on my energy level and the client’s condition.

Epsom salt is not salt, it’s magnesium sulphate. (Most clients don’t know this and perk right up at the three-dollar words.)

Magnesium is a natural muscle relaxer. When you soak in a concentrated solution of the stuff, it gets into your body through your pores, straight into the tissues, the muscle fibers, and makes them relax.

It also helps the muscles flush out waste products and toxins, which is why you should soak a sprain, strain, insect bite, or bruise with Epsom salts. There’s a really good article on the subject here –  Planet Green – which is well worth the read.

But as far as simply relaxing jacked up muscles, which I have all the time because of my job, I recommend a couple of measuring cups full of salt in a warm bath. The temperature of the water isn’t as important as whether it’s comfortable for you, because you need to be able to relax and stay there for at least half an hour.

Epsom salt is cheap, less than a dollar a pound most places, and you can get it at any drugstore and most grocery stores. Look in the aisle with the first aid stuff, Ace bandages and so forth. For just a bit more money, you can get it scented with lavender or rosemary and mint.

In the photo above, Jessica just bought her four pound bag of the plain store brand at the Rite-Aid in Beverly Hills. I imagine world famous singers get jacked up muscles just like the rest of us.

I take three or four salt baths a week. You might not need that many, or have a schedule that allows such, but do make some time for yourself once in a while.

You’ll be glad you did.

That is all.

Mark out.

If It Feels Good …

I spent all day Saturday giving half-hour massages at a clinic on Nine Mile Road. It was a great experience, despite the two no shows.

And I can’t really imagine that – not showing up for a massage. Sure, miss your procto exam, totally space that two-hour root canal thing, forget you agreed to meet your life insurance agent for coffee, but not show up for a massage?

You get a massage because it feels good! Doesn’t it?

I’ve never had one that didn’t. Even amateur massage feels good; even when Sean used me for a test dummy for Sports Massage class and twisted me up like a pretzel and did something called the Peanut Grinder on me, even THAT felt good once I decided he really didn’t intend to leave me permanently with my left foot behind my right ear.

Intentional, therapeutic, goal-oriented touch feels good, and it’s good for you.

But unfortunately there’s a pseudo philosophy or quasi-ethos whose main principle is that what feels good probably isn’t good for you, and conversely that in order to feel good one has to first feel bad. Sometimes the espousers of this philosophy are correct, though not always.

Alcohol and recreational drugs, and even prescription drugs, make you feel good but they really aren’t good for you. Junk food makes you feel good for a bit, but definitely isn’t good for you. (I do draw the line at Ben & Jerry’s Cherry Garcia ice cream, which, if taken in moderate doses, will in fact make one immortal.)

Then of course I could talk about sex, or TV, or films, or trashy novels, or the internet, all of which have abuse potential, along with the potential to make us feel good, if only temporarily.

And then there is medicine, and the practice thereof. Its entire reason for being is to make us feel good, or to get us back up to functional normal. But a lot of the stuff medical doctors, chiropractors, psychiatrists, acupuncturists, dentists and so on do to us in the course of treatment doesn’t feel good at ALL.

They tell us it’s just a pinch; there may be a bit of nausea/swelling/discomfort; when I shoot this in you may experience something similar to burning napalm in your rectum; this may taste exactly like toxic factory waste, but it’s for your own good!

It’s as if the more horrific the treatment, the surer the cure, and I just don’t buy that.

Sure I get down deep in clogged up, jacked up muscles, and sort them out. Every therapist I know does. You should hear Ted’s clients yelling some mornings. But they love him and they come back week after week, and frankly I think the yelling is just to reassure Ted that the client appreciates what he’s doing, and that he’s on target.

But feeling better can feel good right from the start, and don’t let anyone convince you otherwise. You don’t have to suffer, or feel bad in order to feel better. The protagonist’s descent into hell and subsequent renewal is great as metaphor and as story device, and some really good authors have used it.

Only you don’t have to. Go find a massage therapist and tell him or her, or me for that matter, that you want to feel better NOW.

Chances are he or she or I will sort you out straight away, and send you off a bit drained but all smiles.

That is all.

Mark out.

Clinical Massage

All the massage I do is more or less clinical, as opposed to spa massage. I work at Emerald Coast Massage Specialists which isn’t a spa although it has somewhat of a spa atmosphere – quiet, nice pictures on the walls, low lighting and good music.

But even when a client asks for relaxation massage I always find out, or simply find, that there is something that needs therapy, some muscle not acting right, some painful area, some reason to do more than fluff and buff.

And then this past Saturday I worked in an actual clinic. I was supposed to simply shadow Sean, watch what he did with clients referred by their physicians, but I wound up doing 5 half-hour sessions.

Obviously these folks have clinical problems, and their doctors prescribed massage therapy to treat whatever is going on. Some are car crash victims, and some just folks who have ongoing muscle issues of one kind or other.

But regardless what the client is there for, it’s my job to make him or her feel better, even if I have to make him or her feel worse for a few minutes. Very often treating muscles that hurt requires hurting them in a good way, a retraining and restructuring way, to help them respond and rejuvenate.

And honestly, if done right, it really does feel better when it quits hurting.

Then there are times when no matter how deep I dig into someone’s muscles, the client responds with, “Yeah, that’s good,” or something similar. These usually are people who are in pain all the time, and even just a different sort of pain for a while seems a relief.

Anyway, my point is that doing what I do makes people feel good, or at least better, and that makes me feel better.

That is all.

Mark out.

Happy Fourth of July, Everyone!

Somewhere among the hamburgers and the corn on the cob and the cold beer and the fireworks at the fairgrounds grandstand, take a minute or two and remember what and who this is all about.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty, and the pursuit of Happiness.”

Don’t disappoint your founding fathers, much less the guys in the video up there. Heroes every one, they are doing their best to make sure you have Liberty. You’ve got Life or I would be very surprised to find you reading this. So go get some Happiness.

Call your massage therapist first thing tomorrow and book an appointment. And do it proudly, whether you’re an American or not.

Americans love to share – happiness, C-rations, relaxed muscles, whatever we’ve got.

That is all.

Mark out.

Getting Onto the Table

One thing massage therapists need maybe even more than anyone else is massage therapy. Our business is physically intense, so naturally our muscles get lots of wear and tear, and need to be worked on. Last week and this week both I worked on one of the other therapists here at ECMS, Clary, and then a fellow student from Pensacola School of Massage Therapy called Saturday with fairly serious muscle issues she had trouble coping with herself.

Miranda dropped by my apartment in the afternoon and I worked on her, and then we had a nice long visit catching up with everything that’s been going on since we graduated. She asked how long it had been since I’d got onto the table, and I had to admit it had been quite some time, so she urged me to call her and let her return the favor.

So I gave her a ring Wednesday and asked if she had time Thursday morning, which she did, so I drove out to Head to Toe Spa in Pace, and she gave me a good working over. I hadn’t been hurting anywhere in particular, or didn’t realize I had, but my neck felt SO much better after she stripped a few muscles and gave me a good bit of torsion with a folded pillow case.

And just so you know, therapists don’t charge each other. That’s why I was able to work on Miranda in my apartment – just a friend massaging a friend at home. Otherwise one gets into things like establishment license requirements and so on, and I’m not ready for that yet.

So this afternoon I have my second ever real, paying client, whom I will work on at ECMS. And now that I’ve not only practiced this week but been practiced on, I feel more than ready to help my client with whatever she needs.

That is all.

Mark out.