Troublesome Trigger Points

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Most everyone has experienced the uncomfortable sensations of a trigger point.  It’s that dull ache or sore spot in your muscles.  You think – if only I could stretch it out – and then go to town with stretching – but it doesn’t really help. 

Then you try taking ibuprofen or another anti-inflammatory drug – but it doesn’t decrease the discomfort by much.  Taking a hot shower or bath feels good and decreases the nagging pain – but doesn’t last as long as you like. 

You may have some pesky trigger points! Currently the more official way to describe them is as myofascial trigger points or myofascial pain syndrome if you have a bunch of trigger points influencing your body. 

One more thing – trigger point discomfort sneaks up on you.  You don’t yell ‘ouch’ and think – I have a new trigger point!  They often appear after muscle strains have healed but the area still feels stiff and sore.  You may or may not feel a lump or knot in the muscle.  The pain seems to come out of nowhere!  

They can be quite challenging to get rid of – but hopefully some of the following suggestions will be useful.  You’ll know by how your body responds – and of course – if you have continued pain or can’t seem to make any headway from your own efforts – please seek medical guidance. 

Here are a few suggestions for treating trigger points

Don’t chase the pain!  

It’s really tempting to focus right where it hurts.  Trigger points often refer pain into other areas and if you just work where it hurts, you might not be working where the problem is. 

Massage

There are many gifted massage therapists out there with varying abilities to work with myofascial pain syndromes.  One of the cool things I always loved about going to get a massage was becoming more aware of where I had muscle tension.  You may want to explore having a true myofascial session where the therapist works the fascial lines of the body.  

Even a whole body massage will wake up your sensory systems and you become more aware of hidden tension patterns.  Thomas Hanna coined a phrase called SMA (Sensory Motor Amnesia) and basically it means that your sensory connection to that area has decreased.

It wasn’t unusual that after working with a client who had a chronic condition to have them come back the next week and say something like “my knee feels better, but now my hip hurts”.  Good, I replied – let’s see if we can peel a few more layers off the onion!  Feedback is feedback – and if we can non-judgmentally work with our body it is amazing what information we can gleam over time.  

Be aware of your sleeping positions

If you are stiffest first thing in the morning – analyze your sleeping position.  Is your spine able to rest in neutral or are you curled up like a pretzel with one leg in passé while side bending towards it:). Mattresses that are too soft or too hard can also be a culprit.  There is no one ‘right’ mattress for everyone.  Depends on whether you are a side sleeper or back sleeper along with your pattern of hip flexor tightness, etc.  

Traveling was always interesting to me as I got to try out lots of different mattresses and always looked at what the brand and type was when I had a super duper night of sleep.  Pillows are important to me as well as I am a side sleeper and need my top arm and bent top leg on a pillow.  I have created pillows by folding up bath towels in hotels if I didn’t have enough to have on either side of me so I can easily flip from side to side.  Perhaps not the most romantic way to sleep – but my spine, shoulders and neck are so much happier.  

Pinkie balls and foam rollers

Both of these tools along with a wide variety of other balls such as lacrosse balls, tennis balls, etc. can be very useful for targeting trigger points.  The challenge is to go firmly and sometimes slowly enough that you can feel the tissue easing up.  I like to find a point of soreness and then hold… breathing and trying to release tension in the spot and also all around it.  

I’m sitting on the sofa right now and just finished a break with my backnobber, a S-shaped tool that I’ve had for decades.  I found a pesky spot in my right gluteal area… worked the area around it as well for a minute and then came back to ‘the spot’.  Then I spent probably 2-3 minutes just holding pressure on the spot until I felt it release.  Much better!  

Release or relief doesn’t always happen as quickly as it just did for me.  It might take days or even a few weeks to feel like you have made progress.  What I will tell you is that after releasing that spot stretching my turnout muscles immediately feels much deeper and easier.  

Heat

A hot bath or sauna can feel SO good!  I’ve known a few people who  like to stretch in  the bath and even use a lacrosse or other rubber balls to work the outside of the hips and back of the the pelvis while in the tub.  I’ve used the backnobber on my upper back for a few minutes while sitting in an infrared sauna and then just relaxed and came out feeling noodle-like.  Best of both worlds… release work and heat!  

Stretching

Stretching typically isn’t at the top of the list for trigger point relief although I like stretching after working with the pinkie ball or foam rolling.  The combination is a good one for me – but may not be for everyone.  

So there are some tips to try.  I’m sure there are more techniques and certainly other tools that are out there that can address trigger point discomfort.  Please share in the comments below if you have other suggestions!  

I’ve posted below a cool YouTube clip that has an explanation of what is going on in the muscle when you get a trigger point.  

And finally… I’ve started working on a 2 hour zoom/webinar on stretching. Stay tuned for more details!

To your success, 

Deborah 

Shoulders Down or Back?

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I love your newsletter and I was reading your explanation on how to stretch and exercise to keep your shoulder blades flat. I’m a 17 year old dancer and I’ve been told both to keep my shoulders down and my shoulders back. Now my question is what is the difference? And if these to things require different ways of strengthening and/or stretching I would love to know.

What a great question! Love that you are learning and questioning and seeking answers to confusing concepts. Certainly how to get proper shoulder carriage is one of those challenging areas.

The first place to check is the spinal alignment. Too often I see dancers trying to correct their shoulder placement by pulling their shoulders down or back when they need to get the spine aligned correctly. Try sitting on a chair, close your eyes, and elongate and lengthen the spine upwards without doing anything with the shoulders.

As you lengthen the spine upwards while keeping the shoulders where they are do you feel some engagement below your armpits? That’s the serratus anterior muscles.

When these muscles are working correctly they will help keep the shoulder blades properly placed on your back. I believe when teachers say put your shoulders ‘down’ they are attempting to get these muscles to turn on and your trapezius muscles to release.

Pressing your palms together while lengthening your spine upwards will also activate these important stabilizers.

Make sure you can easily move your neck when doing this to keep the neck muscles soft.

Before doing the exercises offered in How to get the shoulder blades flat you’ll want to mobilize the scapula aka the shoulder blades. Did you know that they don’t actually connect to the spine or ribs but should be able to move freely in multiple directions? I’ve found the quickest way to free them up is by doing figure 8’s. In fact, if you look at your shoulder line before doing them, then do one arm, look again at your shoulder line, you’ll find that shoulder and arm of the side you just mobilized, hanging lower. Below is a short clip demonstrating the figure 8.

Figure 8’s mobilization exercise

I don’t often tell dancers to take their shoulder blades back – although I do work to help them open up the front of the chest if its tight. (ie: slumping or rounded shoulders) Remember when a situation has both tight and weak muscles involved, generally if you release the tightness first, the muscles that need to engage will be in better placement to do so.

So stretching out the front of the chest, the pec muscles can be useful so that the rhomboids or the muscles that pull your shoulder blades towards the spine can work better. The challenge I see is when a dancer is directed to pull their shoulder blades back it often creates unnecessary tension in the upper back and doesn’t address tightness in the pecs.

The last suggestion I have for you is to see how your arm is placed in the shoulder joint. If you stand and rotate your arms inward (medially) you’ll see how the shoulders round forward. This is many people’s normal position.

Next rotate the whole arm outwards (laterally) and notice how the front of the shoulder/chest open up when you do so. You want to keep that upper arm bone more laterally rotated and then when doing port de bras have the lower arm bones rotate to give a beautiful line. I should probably do a post solely on that issue sometime!

Bottom line, more than shoulders ‘down’ or ‘back’ I think if you focus on the alignment of the spine to shoulder girdle and getting the arm properly placed in the joint you will resolve 80% of the corrections about the shoulder blades.

Last note… there are still some spots left for the June 21-23, 2019 workshop I’m offering in Fort Worth, Texas! Come play with me and other amazing teachers in an intimate setting on the beautiful TCU campus.

To your success!

Deborah

How to get the shoulder blades flat on the back?

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“What suggestions do you have to help dancers get their shoulder blades to lie flat on their back?”   Felicia

Okey dokey!  Let’s first talk about the anatomy of the shoulder girdle so it will make sense. It really is important to get those shoulder blades lying flat on the back so they can support the arms in port de bras as well as stabilize the shoulder girdle in multiple movements and decrease the potential for injuries.

Anatomy of the shoulder girdle

The shoulder blades, aka your scapulas, are a fairly flat, triangular bones that hang on the backside of the ribs.  They connect the upper arm bone to the collarbone.  There are 6 movements of the scapula.  You can elevate and depress (essentially a shoulder shrugging motion).

You can protract and retract which is pulling them together and separating them.  Picture on left is retraction.  That is what I often see dancers do wrong when they are doing their port de bras.

And you can rotate the scapula upwards and downwards, which is describing how the bottom of the scapula moves towards or away from the spine.

We’ve all heard of ‘winging’ shoulder blades, and that is when the inside border of the scapula moves away from the ribs.  Some teachers call them chicken wings:) This happens when there is an imbalance in the muscles of the shoulder girdle and may require both doing some stretching and strengthening in the area.

What are common reasons for winging of the scapula?

If they have a rounded of slumped standing posture when they aren’t at the barre, it’s quite possible they have tightness in the pec minor and the latissimus muscles.  Those muscles will need to be stretched as you work to strengthen the stabilizer of the shoulder blades, the serratus anterior muscle. This is the primary muscle that will need to be strengthened.

Here are pictures of the 3 muscles I’m talking about.

 

 

 

 

 

 

Stretching the lat and pec minor

There are many different ways to stretch and strengthen these muscles but I’ll give you a couple of my favorites.

I like to stretch the lats by doing a doorway or what I call a C Curve stretch.  You may feel the stretch more at the armpit area or more towards the waist and lower back.  I’ll move gently looking towards and rounding my lower back to find the sweet spot of the stretch. Another stretch is called the prayer stretch and you can google that one.

A really nice way to stretch out the pec minor is lying on a foam roller and placing your arms on a high diagonal (sometimes I start by first doing slow angel wings to move through a range of motion) Breath and allow your arms to hang towards the floor.  Move your arms slightly to find your best places to stretch.

Strengthening the serratus anterior

Now onto the serratus anterior.  It is important to properly identify when this muscle is working.  Start standing, in good alignment, and draw your hands down towards the floor.  Feel the muscle engagement under your armpit?  That’s your serratus anterior.  I want you to keep that muscle engaged through the next exercise.  Start lying on your back with your elbows at a 90 degree angle and the back of your palms lying on the ground by your head.  (like the picture above on the foam roller but without the foam roller) Keeping your back lengthened, ribs dropped, slowly slide your forearms and back of the hands upwards. You are using the serratus anterior to keep your scapula drawing towards your pelvis the whole time.  This is not easy!  Keep them engaged!

If you want a challenge you can do the same thing as a wall slide – starting with your back against the wall, feet slightly away with knees bent.  Same instructions – keep the shoulder blades drawing downwards as the forearms keep contact with the wall and are sliding upwards.

Now have them stand and place their hands in a prayer position, pressing the palms together while drawing the scapula downwards. Maintain the placement of the scapula and open thearms easily to second position and notice how wide and open their chests are! Over time they will create better muscle balance and improve their port de bras line.

To your success!

Deborah