Best Trigger Point Massagers for Trigger Point Release [EXPLAINED]
Real Myofascial Release
Fascia, or connective tissue, in the body response best to GENTLE, SUSTAINED PRESSURE. In this case the connective tissue start to soften, lengthen and "melt".
SUSTAINED - 3-5 minutes of pressure in the area of restriction. May be even 10 minutes.
GENTLE PRESSURE.
BREATHING. Make soft, deep, long inhalation and long exhalation to make your autonomous nervous system elicit a parasympathetic response, which is opposite of "fight-or-flight", or stress response.
Anything less than 3 minutes just gives a quick stretch in the elastic component of the tissue and it's not long enough for the collagenous part of the tissue to soften. After a quick stretch the tissues just spring back in tightness, and symptoms come back in a while.
Anything forceful and agressive is perceived as a "threat" by an autonomous nervous system. It elicits a protective responce which is experienced in "tightening" and "hold".
With the lower portion located deep under the upper trapezius, the levator scapula has its fibers coming out and becoming superficial as it ascends the side of the neck.
This muscle is about two fingers wide with the fibers twisting around themselves.
It attaches to the 4 transverse processes of the neck segment: C1-C4. C1 extends more laterally then other three.
A large group of nerves innervating the arm (the brachial plexus) also exits from the transverse processes of the cervical vertebrae.
Despite the levator scapulae muscle is relatively small it can cause a lot of problems when adaptively short and harboring trigger points.
The levator scapula is accessible for palpation from the side of the neck or through the upper fibers of the trapezius muscle.
If contracts unilaterally (only muscle of one side), it elevates and downwardly rotates the scapula, flexes and rotates the head and neck to the same side.
Bilateral contraction (the two muscles at the same time) extends the head and neck.
The levator scapulae, rhomboids major and minor, the latissimus dorsi together rotate the glenoid fossa of the scapula (the site where the arm attaches to the scapula) downward. Watch the video in the end of this article.
Levator Scapulae Trigger Points Chart
The levator scapula upper trigger point, which is often overlooked, seats in the middle portion of the muscle. The lower trigger point is in the much more obvious trigger area. The tenderness which is frequently found near the site of the muscle's attachment to the scapula is often secondary to a taut band tension associated with the trigger points.
Levator scapulae trigger points are likely to develop because of occupational and postural stresses, overloading and overexercising:
typing with the head and neck turned to look at work placed beside the keyboard;
making long telephone calls when flexing the neck and head to the side to hold the phone;
talking for a long time with the head turned toward a person sitting to one side;
carrying a bag hanging from the affected shoulder;
sleeping with the neck in a tilted position which shortens the levator scapulae (as in an uncomfortable bus seat, with the muscle’s fatigue and a cold draft aggravating the stress);
swimming the crawl stroke losing a proper form when out of condition;
playing vigorous tennis;
sitting closely near the net at a tennis court and repeatedly turning the head and neck tracking the ball;
rotating the head recurrently for a long time.
The inhibited serratus anterior function (one of the reasons for which may be the serratus anterior trigger points) can lead to an overload of the levator scapulae muscle and developing its active trigger points.
Levator Scapulae Referral Pain Pattern
The solid red identifies the essential pain pattern, and the stippled red identifies the spillover pattern. Read the referral pain patterns article to understand the difference.
Levator Scapulae Action along with Rhomboids [VIDEO]
Reaching to a back pocket normally requires a synergist work of the levator scapula, rhomboids major and minor.
The piriformis muscle fibers are parallel to the lower gluteus maximus fibers. Having in mind that the attachments of these muscles adjacent it’s not surprising that piriformis muscle is a partner of the gluteus maximus in lateral rotation of the thigh.
What’s quite counterintuitive is the fact that piriformis becomes a medial rotator (rotates the femur inward) when the hip is flexed. Watch the video below to understand why.
Piriformis Trigger Points Chart
The most common trigger point location is the lateral site closer to the greater trochanter (the right cross on the picture below).
When gluteus maximus is weak a piriformis does a double work, which can be a reason for a trigger points formation.
Piriformis can be fatigued or overloaded by weight-bearing, usually involving a rotation of the hip.
Blunt trauma to the buttock is often cited as a cause of trigger points activation.
In ‘The Trigger Point Manual’ Travel and Simons call this muscle ‘Double Devil’ because myofascial pain which this muscle causes may derive from:
the piriformis muscle itself;
the sciatic nerve entrapment in the area of the greater sciatic foramen caused by the muscle abnormal tension (neurogenic pain);
both reasons.
Piriformis Referral Pain Pattern
The solid red zone is essential pain zone. The red stippling refers to "spillover pain zone" which may be absent.
The neurogenic pain (caused by sciatic nerve entrapment) may spread down the whole posterior thigh, the calf, and even to the sole of the foot.
Piriformis Medial Rotation
This video demonstrates how the piriformis muscle becomes a medial rotator of the hip.
Referred Pain is pain that is caused by a trigger point but is experienced at a distance. It is quite often can be entirely remote from the source TrP. The pattern of this pain is every time reproducible and connected to its locus of origin. However, its distribution seldom coincides completely with the distribution of a relevant dermatomal segment or peripheral nerve.
Referred Pain and Referred Autonomic Responses
Referred pain is part of more generic Referred (Trigger-Point) Phenomena.
Apart from pain, the latter include Referred Autonomic Phenomena:
tenderness;
increased motor unit activity (spasm)*;
vasoconstriction – blanching;
vasodilatation – the widening of blood vessels;
coldness;
sweating;
pilomotor response – “goose flesh”;
ptosis - the upper eyelid droops over the eye;
hypersecretion.
* There is an example in research literature (Headley BJ) when pressure on a trigger point in a right soleus gave rise to a strong spasm response in the right lumbar paraspinal muscles.
These phenomena also usually appear at a remote distance from the trigger point, in the same general zone to which a certain trigger point refers pain.
The intensity and expanse of the referred pain depends on the level of irritability of the trigger point, and not on the size of the harboring muscle. Trigger points in small muscles can be as upsetting to the patient as those in large muscles.
Essential Zone of Reference
The region of the body, where phenomena caused by the myofascial TrP are observed is called Essential Zone of Reference. The essential referred pain area is indicated by solid red in pain charts.
Spillover Pain Zone
The area where certain, but not all, patients feel referred pain outside the essential pain area, due to greater irritability (hyperirritability) of a trigger point is called Spillover Pain Zone. In the pain-pattern trigger point charts it is indicated by red stippling or solid pink to be distinguished from an essential referred pain area (solid red).
The pain referral pattern is characteristic for each muscle. Some patients feel numbness or paresthesia (‘pins and needles’) rather than pain.
A key trigger point can mechanically or neurogenically give rise to a so-called satellite trigger points.
It’s difficult to distinguish the mechanism responsible for the key-satellite relationship by examination only. The association normally is confirmed by simultaneous deactivation of the satellite TrP when the key TrP is deactivated.
Common locations of satellite trigger points may include:
site of reference of the key trigger point;
overloaded synergist substituting for the key muscle – the muscle harboring the key trigger point;
antagonist of the key muscle, because it counters the increased tension of the latter;
a muscle associated only neurogenically with the key TrP.
Earlier, only a TrP that developed in the referred pain zone of another TrP was considered as a satellite trigger point.
A term “secondary trigger points” was used previously for the TrPs which developed in an antagonist or a synergist of the muscle harboring the key trigger point. This is earlier term for a “satellite trigger point”.
Central TrPs are in the middle portion of the muscle belly, near the center of muscle fibers. They are strongly associated with dysfunctional endplates, contain many electrically active points, and many contraction knots.
Central Trigger Points can be found near midfiber (not necessarily in the middle of a muscle) in various portions of the muscle.
Attachment Trigger Points
Trigger Points which are in a region of muscle attachment (at the musculotendinous junction or/and at the osseous attachment of the muscle) are called attachment trigger points. They are believed to be caused by unrelieved tension of the taut band that is associated with a central TrP.
A palpable nodule and associated taut band (tense muscle fibers) are characteristics of a trigger point.
The first step in identifying a trigger point is learning how to recognize the nodule and taut band of muscle fibers by palpation.
A taut band restricts range of motion and increases muscle tension.
It extends from a trigger point to muscle attachments.
The cause of the tension of the muscle fibers is contraction knots ("micro-cramps") which are in the site of the trigger point. Reflex contraction of the fibers in the taut band gives rise to the local twitch response (LTR).
The taut band always respond with a twitch response when the trigger point is penetrated by a needle.
The taut band can be identified by gently rubbing across the muscle fibers of a superficial muscle. If it is present, one can feel a nodule at the trigger point and a rope-like thickening that runs from this nodule to the attachment of the taut muscle fibers at each end of the muscle.
It can be snapped or rolled under the finger in palpated muscles. When the TrP is deactivated, the taut band becomes less tense, often (but not necessarily) disappears, sometimes instantaneously, and range of motion returns to normal.
However, the presence of a palpable taut band alone, by itself, cannot be a reliable sign of the TrP because it can occasionally be observed in pain-free individuals without evidence of trigger point phenomena.*
*Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Travell & Simons' myofascial pain and dysfunction: The trigger point manual. Baltimore: Lippincott Williams & Wilkins. Volume 1. P.34
