Trigger Point Therapy

Mobility Myth #1

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Great stuff from our friends at Shape.com:

Myth: Stretching and foam rolling will address all of my mobility problems.

Truth: Stretching and soft tissue work (like foam rolling and massage) may seem like the bread and butter of mobility, but there’s more to know. “If you have a true mechanical mobility problem, soft tissue work and different stretching techniques are definitely great options,” says Ardoin. But you might experience tightness or a loss of motion that doesn’t have anything to do with tissue restrictions like tight muscles or joint stiffness.

“In these particular people, they actually have the mobility needed, but their brain doesn’t know how to access it,” says Ardoin. This sort of muscle-brain disconnect could be because of current pain, previous injuries, or, “sometimes people just forget how to move,” he says.

In this case, your muscles are working against each other instead of synergistically—and it’s not something stretching or foam rolling will fix. The good news is that there’s not actually anything physically wrong. The bad news: This is tough to diagnose on your own. “If you have a loss of motion while you perform the motion yourself but have full ROM when performed passively, then it’s safe to assume that you have the ROM available but your brain doesn’t know how to access it,” says Ardoin.

For example, let’s say you have a “tight” shoulder. Make a large, slow circle with your right arm. Then totally relax your arm while someone else rotates your arm in a circle for you. Did it go farther while you let the motion happen passively? Ding, ding! Could be a brain problem, not a muscle problem. Think this might be you? Seeing a trainer or physical therapist to confirm it (and help you work on the issue) can’t hurt.

Trigger points in the adductor longus and brevis.

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These muscles are located in the groin. The longus originates on the pubic body just below the pubic crest and inserts on the middle third of the linea aspera.The brevis muscle originates on the inferior ramus and body of the pubis and has its attachment to the lesser trochanter and linea aspera of the femur. Trigger points in these muscles are the most common muscular cause of groin pain. Distal trigger points refer pain to the upper medial knee and down the tibia. Proximal trigger points refer into the anterior hip area.

The Most Common Work Injury We See? This Might Be It…..

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Your “lumbar spine”, or low back, is made up of five bones stacked on top of each other with a shock-absorbing disc between each level. Your low back relies on muscles and ligaments for support. “Sprains” and “strains” are the result of these tissues being stretched too hard or too far, much like a rope that frays when it is stretched beyond its normal capacity. The term “sprain” means that the

tough, durable ligaments that hold your bones together have been damaged, while “strain” means that your muscles or tendons that move your trunk have been partially torn.

Most people experience low back pain at some point in their lifetime, and 70% of those patients can attribute their symptoms to sprain/strain injuries. Lumbar sprains and strains may result from sudden or forceful movements like a fall, twist, lift, push, pull, direct blow, or quickly straightening up from a seated, crouched, or bent position. Most commonly, sprains and strains are not the result of any single event, but rather from repeated overloading. The spine can generally manage small isolated stressors quite well, but repetitive challenges lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of these stressors include: bad postures, sedentary lifestyles, poor fitting workstations, repetitive movements, improper lifting, or being overweight.

Symptoms from a sprain/strain may begin abruptly but more commonly develop gradually. Symptoms may range from dull discomfort to surprisingly debilitating pain that becomes sharper when you move. Rest may relieve your symptoms but often leads to stiffness. The pain is generally centered in your lower back but can spread towards your hips or thighs. Be sure to tell your doctor if your pain extends beyond your knee, or if you have weakness in your lower extremities or a fever.

Sprain/strain injuries cause your normal healthy elastic tissue to be replaced with less elastic “scar tissue.” This process can lead to ongoing pain and even arthritis. Patients who elect to forego treatment and “just deal with it” develop chronic low back pain more than 60% of the time. Seeking early and appropriate treatment like the type provided in our office is critical.

Depending on the severity of your injury, you may need to limit your activity for a while, especially bending, twisting, and lifting, or movements that cause pain. Bed rest is not in your best interest. You should remain active and return to normal activities as your symptoms allow. The short-term use of a lumbar support belt may be helpful. Sitting makes your back temporarily more vulnerable to sprains and strains from sudden or unexpected movements. Be sure to take “micro breaks” from workstations for 10 seconds every 20 minutes. Following acute injuries, you can apply ice for 15-20 minutes each hour. Heat may be helpful after several days or for more chronic origins of pain. Ask your doctor for specific ice/heat recommendations. Some patients report partial relief from sports creams.

A weak lateral chain will stop you in your tracks.

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One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.
Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place. The exercises listed below are critical for your recovery.

Trigger points in the Quadratus Lumborum muscle.

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The quadratus lumborum muscle is a commonly overlooked source of low back pain and is often responsible for “pseudo disc syndrome”. This muscle originates on the inferior border of the 12th rib and lumbar transverse processes. It inserts on the iliac crest and iliolumbar ligament. The q.l.’s main actions are extension and lateral flexion of the spine. It also acts as a stabilizer of the lumbar spine. Trigger points in this muscle refer pain into the sacroiliac joint and the lower buttock. Pain can also spread anteriorly along the crest of the ilium into the lower abdomen and groin and to the greater trochanter.

Trigger points in the temporalis muscle

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The temporalis muscle is located in the temple area of the skull. It originates on the temporal lines on the parietal bone of the skull, and inserts on the coronoid process of the mandible. It’s main action is to close the jaw. The posterior and middle fibres bilaterally retrude the mandible. Acting individually, this muscle will deviate the mandible to the same side. Trigger points in this muscle refer into the teeth causing hypersensitivity, and into and above the eye and temple, causing headaches.

I’ve got ITB Syndrome Doc! Now What?

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Your iliotibial band is a fibrous band of tissue running from the crest of your hip, down to your knee. A muscle near the crest of your hip called the tensor fascia lata, attaches to this band to help control movements of your leg. Your iliotibial band passes over the point of your hip and over another bony bump on the outside of your knee called the lateral epicondyle. When the band is too tight, it can become painfully inflamed as it repeatedly rubs over the top of either of these bony projections. Irritation at the bony bump near the knee is called iliotibial band friction syndrome.


The condition usually presents as pain on the outside of your knee that becomes worse with repetitive knee flexion or extension. This condition is the leading cause of lateral knee pain in runners, especially slower “joggers.” The pain usually develops 10-15 minutes into the workout. You may sometimes feel or hear a click during movement. Symptoms generally ease at rest. Running on slick “wintry” surfaces may aggravate the condition. Excessively worn running shoes may be a culprit.

This problem is commonly caused by weakness in your gluteal muscles. When these muscles are weak, the muscle that attaches to your iliotibial band must contract harder to stabilize your hip. Having one leg longer than another is a known aggravating factor.

Runners should minimize downhill running and avoid running on a banked surface like the crown of a road or indoor track, as well as wet or icy surfaces. Runners should reverse directions on a circular track at least each mile. Bicyclists may need to adjust seat height and avoid “toe in” pedal positions. Avoid using stair climbers or performing squats and dead lifts. Sports cream and home ice massage may provide some relief of symptoms.

Trigger points in the lateral pterygoid

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The lateral pterygoid muscle plays an important role in prober jaw function. It originates on the greater wing of the sphenoid bone and the lateral pterygoid plate, and inserts on the condyloid process of the mandible. It’s action is to pull the head of the mandibular condyle out of the mandibular fossa while opening the jaw. When trigger points develop they refer pain into the temporal mandibular joint and maxillary sinus. This referral is commonly mistaken for TM arthritis. In addition to the referral pain, trigger points in this muscle can also effect proper movement of the jaw.

I’ve never baked anything in my life; how do I have a Baker’s Cyst?

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Your body has strategically-placed, fluid-filled cushions called “bursa” around each joint. Bursa act to reduce friction where muscular tendons rub on bone. Your knee is surrounded by several bursa that share fluid with the inside of your knee joint and with each other. You can think of this like a chain of lakes connected by streams. If the inside of your knee joint or any of the bursa around your knee becomes inflamed, the entire system fills. When swelling exceeds each individual bursa’s capacity, this fluid creates a soft balloon-like swelling of the popliteal bursa behind your knee called a “Popliteal cyst”, or more commonly a “Baker’s cyst”.
This swelling is usually not from a problem with the popliteal bursa itself, but rather, inflammation somewhere else in the joint that has distended the popliteal bursa. This swelling is often the result of arthritis or damage to a ligament or cartilage within the knee.

A Baker’s cyst is often painful, and the discomfort may increase when you attempt to move your knee. Depending on the severity of your swelling, your symptoms may vary between a feeling of fullness and significant pain. It is not unusual for a Baker’s cyst to change in size from day to day, depending on the amount of swelling. Be sure to tell us if your pain progressively increases when you walk or if you notice warmth, redness or swelling in your calf, as these could be signs of a more significant problem.

Sometimes rest and elevation of your leg help to alleviate pain and swelling. Initially, you may need to avoid activities, like squatting, kneeling, heavy lifting, climbing stairs, or running. Wearing a brace on your knee may compress the cyst and cause an increase in your pain. Since Baker’s cysts are generally a problem that is secondary to another condition, treatment is most effective when directed at the underlying problem.

Trigger points in the serratus anterior

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The serratus anterior muscle is located along the sides of the ribs. It originates on the outer surface of the upper 8-9ribs, and inserts on the medial border of the scapula. This muscle acts on the scapula in several different ways. First it rotates the scapula to turn the glenoid fossa upward. It also protracted and elevates the scapula. And lastly it helps to prevent wining. This muscle is often shortened from prolonged sitting and work on a computer. Active trigger points in this muscle refer pain locally around the trigger point with spillover down the inside of the arm. Pain can also radiate into the inferior angle of the scapula.