Wednesday, February 14, 2007

Treating Trigger Points with Exercise Instead of Massage

I've been reading a lot about how trigger points actually work at a microscopic level. This one article in particular discusses a structure called the sarcomere and how they get stuck in the contracted position.

The normal contraction of a sarcomere actually pumps blood through the muscle fiber's capillaries. Fresh blood is exactly what a sarcomere in contracture is not getting because its stuck.

Massage forces blood into stuck sarcomeres enabling them to come out of contracture. That got me thinking about other ways to do the same thing. Ways that might work better than massage.

Massage doesn't always seem to work very well and some sarcomeres stay in contracture. They are, after all, microscopic. A therapist can only tell if there are large concentrations of sarcomeres in contracture. That makes it easier for a larger trigger point to return.

Since contracting a muscle pumps blood in healthy sarcomeres, it seems that exercise that contracts a muscle might get blood into the unhealthy ones.

The article also explains how stretching and lifting heavy weights don't really help and can aggravate a muscle with trigger points.

So I tried doing a bunch of reps with no weight and just contracting semi-hard (50% of the max probably) at the top of the movement. On the way back, I fully extend the muscle but don't stretch it with any significant effort. I did about thirty reps.

This seems to work more effectively and easily than massage. I'll keep you posted on my progress.


Blogger jeb said...

Any progress to report on trigger point exercise??? FYI, I have been self treating myofascial trigger points, based primarily on Clair Davies' Frozen Shoulder Workbook and other methods noted via online research, to include various stretching techniques and movements such as chi gong, and have actually seen some significant improvement in range of motion, but pain has subsided very little if at all. My personal opinion -- I doubt that stretching by itself will provide much relief... My feeling is that applying pressure on the trigger points, ie myofascial release, has provided the most beneficial therapy (areas that I am unable to reach to do this have not improved...)...

4:39 PM  
Blogger jeb said...

Me again, as i felt compelled to make you aware of the following note, which would seem to express caution on "stretching" for trigger points...

Muscles contract because sarcomeres contract. A sarcomere consists of threads of protein that overlap like the tines of a fork, grab onto each other like Velcro, and pull towards each other. In a sick muscle, a patch of sarcomeres contracts excessively and cuts off its own blood supply — a muscle knot — while sarcomeres up and down the line get overstretched. This imagery makes it easy to understand four things: (1) how trigger points are kept alive by a vicious cycle, (2) why massage helps to relieve them by mechanically “squishing” the shrivelled sarcomeres apart, (3) that sick muscles aren’t really “tight” so much as partly contracted and partly overstretched, and therefore stretching is often futile or even dangerous, and (4) how the overextended sarcomeres make muscles weak and unresponsive to intense weight training.

5:50 PM  
Blogger Al Brown said...

Jim, massage definitely is the thing to do when a trigger point is active or large portions of a muscle make up a trigger point. My post here may not indicate that, but I have since refined my opinion.

I did have some success with high repetition exercise. I think its helping when there is some ability to contract sarcomeres in a muscle and thus increase the flow of blood to sarcomeres that are contracted. Its doing the same thing as massage.

And this kind of exercise is the only thing that works on individual sarcomeres if they are adjacent to sarcomeres that operate normally.

Getting ALL of the affected sarcomeres is how you condition the muscle so trigger points don't come back.

But when massage is the thing to do when many, many sarcomeres are involved and not many can be contracted. It's quicker too. But after you get past a certain point, exercise is the thing.

I do think stretching is very useful. However, I believe that many people stretch too hard and that is not good to pull on a traumatized muscle.

When you stretch too hard, the muscle defends itself by tightening up. This is the opposite of what one needs. Stretching should be a gentle, non-forceful, full extension of the muscle. In such a stretch, a muscle should further relax on its own after a bit. If one is not experiencing that further relaxation, one is probably not doing it lightly enough.

Like so many things in life, effortless doing or wu wei works best.

Clair Davies book on trigger points is a great resource and I recommend his stuff too. Thanks for your helpful comments.

9:47 PM  
Blogger Al Brown said...

Another thing about stretching. A lot of people seem to get the idea that stretching is how you get flexible. Its really only how you STAY flexible.

If you have trigger points or myofascial adhesions, stretching won't help much until you resolve these other problems.

2:13 PM  
Anonymous Anonymous said...

I have a 14-year history of myofascial pain that started with a simple one-spot TrP inside the shoulder blade, today it is widespread, and a phenomenon called "ipsilateral pain", which refers to a pattern wherein an entire hemisphere (either one side)wakes up to a triggering event, with cascading TrPs from the neck to the calves.
Exercise is THE only way out of myofascial pain. Yes, stretching and ischemic compression (massage) do get me out of semi-acute flares, but I see a clear correlation between my desk and keyboard time and my pain. Being active throughout the day is best way to prevent acute TrPs, however I have also been theorizing that forcing blood into sarcomeres through vigorous exercise, but I am yet to find the fine point between full resistance training and light areobic, such as walking, and it is an elusive point. I need to strenghten my muscles, certainly plain walking will not do it.

2:13 PM  
Blogger Al Brown said...

Since I added this post, I've learned about Qi Gong and found it very effective at improving circulation through muscles. Check it out.

I've also learned more about stretching and when it works and when it doesn't and why manipulating the fascia in some fashion is so important for keeping trigger points from returning.

I've started a new blog on this topic at where I get into this some more.

By the way, blogs are so inadequate for documenting one's understanding of complex topics like this. I'm a software engineer and am working on something better in the back corner of my mind :-)

2:35 PM  
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2:49 AM  
Anonymous Ra said...

That's pretty good thinking...
I have been getting massage therapy for trigger points in my shoulder for two weeks now and all I have achieved is intense soreness after the massage, the trigger point (the main one) is still there! (I can feel it, sorta knobbly feeling)
Going to try it today.
Do keep us posted on your progress! Thanks!

6:05 PM  
Blogger Al Brown said...

Thanks, Ra. I've actually been working a concept for a machine that will use gentle pressure in strategic ways to unlock the tension in muscles.

This problem is perpetuated by the interaction of several phenomena.

There's the muscle sheaths that have stiffened by the lack of use of the full range of motion and the constant deposition of collagen. This impairs blood flow to a muscle, especially when engaged for quite awhile.

That lack of healthy blood flow can cause the sarcomeres to get stuck in their contracted position. That's what causes a muscle to be tight and actually get shorter.

The trigger points are just an area where many sarcomeres are tight. We certainly notice trigger points, but the muscle gradually hardens for a while before a trigger point develops.

The hard muscles are shorter and thicker and this makes manipulating the sheath to break up the collagen much harder. But if the muscle is softened first, it can be done.

Massage is how you soften the muscle and get the sarcomeres in it functioning again. Massage pushes depleted blood out and then new blood is pulled in from the capillaries.

But there's still one other factor and that is the way muscles communicate with each other to accomplish work. When one muscle is engaged, other muscles receive nerve signals to help. And if there is a trigger point in one muscle, other muscles are affected.

So you may have a tense muscles but it may be another muscle that is the root cause. All of the muscles need to considered and massaged in a systematic way.

This is a difficult thing for people to do, although it is certainly possible. I think its primarily a data problem and that's why I'm applying technology to the problem.

6:54 PM  

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