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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 

Buttock Pain

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Greetings!

I hope everyone’s Thanksgiving holidays were wonderful…. I am grateful to have all of you in my dance community!

The new website is nearly done…. hoping by the next newsletter it will be up and running!

Here’s the question of the week…

My daughter is 14 and has been dancing for 10 years. She started a very intense dance schedule in June. She was dancing nearly 30 hrs, a week for the summer along with a 4 day intensive. She cut back to 21 hrs a week when school started and has been doing very well growing in her dance ability until now. She takes 3 ballet classes, 3 adv. pointe classes (all 1 1/2 hrs each), 4 jazz classes, 3 lyrical classes, salsa and conditioning. She recently started having pain in her right hip where the sciatic nerve runs. A teacher of her is a certified physical therapist. She felt around and noticed the nerves on both sides were moving and the muscles underneath were knotted up. The pain stayed right there and didn’t travel so we ruled out sciatica. We have iced and heated the area for a week and rubbed out as many knots as possible. It seemed to help and then she went to a jazz class and over did it and now we can’t get the pain to stop for very long. I can feel the knots and deep rubbing seems to help but only for a while. Once she wakes in the morning it starts all over again. What if anything else can we do for it? I know rest is needed but do you have any other advice for knotted muscles? Thank you for your time, Evie

I’m glad you have a physical therapist on board to help you out. I’m wondering whether your daughter could have something called piriformis syndrome. It’s a condition where the piriformis muscles which is the largest of the 6 deep muscles that are the ‘turnout’ muscles irritates the sciatic nerve. Some people only feel pain in the buttock area (this could be your daughter) and sometimes it goes PyrAnatA108down into the leg,
which is referred pain from the sciatic nerve. The sciatic nerve typically passes underneath the piriformis muscle, but in about 15% of the population the nerve goes through the piriformis muscle increasing it’s potential for trouble.

When dancers overwork the piriformis and the other deep rotators as they are trying to achieve more turnout then can create excessive tension in this muscle which presses or compresses on the nerve creating pain depending on where the nerve lies in relationship to the piriformis muscle.

For right now, let’s treat your daughter as if she has really irritated both the sciatic nerve and that the turnout muscles are knotted up and very unhappy!

The massage you are doing is good for releasing tension in the gluteal area, as well as using a pinkie ball or a tennis ball to put between the buttock and the wall to do self-massage. With piriformis syndrome I personally would not use any heat – only ice on the area, and would have her ice as much as possible. This might be a time where a few days of an anti inflammatory such as ibuprofen could be helpful. The next thing I would do is to stretch, stretch, stretch, the turnout muscles to help them release from their painful spasm.

seatedhipstretchShe can do this in a variety of ways. To the left is a sitting chair stretch that is very useful as she can easily do a stretch or two while in school!

Another way would be the traditional sitting on the floor with the legs folded and rounding down over the legs, gently moving from side to side to feel the stretch at the back of the buttocks where her pain is. Make sure to switch which leg is in front as that will change the focus of the stretch to the other side.

Rest is the final part of the treatment program. It doesn’t mean that she would have to take off from all of her dance classes – but it does mean she needs to significantly reduce the amount of classes that she is taking. Her first goal is to be pain free when she wakes up in the morning. If her pain is reduced by pulling back – or totally off classes, then she can slowly bring more classes back in. Working through the pain at this point will most likely increase the length of time for healing – and make for some poor muscle habits as she is trying to engage and work the turnout muscles while they are tender and tight.

Best wishes for a speedy recovery!

Deborah