Trigger points in the adductor pollicis muscle.

The adductor pollicis muscle is a key mover of the thumb. This muscle has two heads. The transverse head originates on the third metacarpal. The oblique head originates on the base of the second and third metacarpals and the capitate and trapezoid bones. This muscle inserts on the base of the proximal phalanx and ulnar sesamoid. Adduction and flexion of the thumb are the main actions it produces. Trigger points cause an aching pain along the outside of the thumb and hand. Pain can also be felt in the thenar eminence in extreme cases.

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Trigger points in the trapezius muscle.

The trapezius muscle is a large diamond shaped muscle in your back and neck. It originates on the nuchal ligament and the spinous processes of c6-t12. It inserts on the scapular spine, acromion process, and the distal clavicle. It’s upper fibres act to elevate the shoulder and rotate the glenoid fossa upward. The lower fibres assist this motion. The middle fibres strongly adduct the scapula. This is the most common muscle in the human body to get trigger points. Trigger points in the lateral upper edge refer pain into the lateral neck and temples. Points in the mid and lower parts of the muscle refer pain into the posterior neck and shoulders. Trigger points in this muscle are a common cause of headaches.

Elbow pain and trigger points.

Did you know that tennis elbow and golfers elbow pain can be caused by trigger points? Points located in the forearm flexor and extensor muscles can cause pain, stiffness, and weakness in the elbow, forearm, wrist, and hand. Quite often these trigger point symptoms are mistaken for inflammation of the tendons which is what a true tennis/golfers elbow actually is. Failure to address the trigger points can lead to an incomplete recovery .

Trigger point massage

Session Description

A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

After treatment, it is usually recommended that the client apply moist heat to the area treated.

Problems associated with trigger points

Trigger Points in muscle and other soft tissue are one of the most common causes of a wide variety of pain and dysfunction, including (but not limited to):

• Achy persistent pain
• Severe local pain
• Arm / leg pain
• Back pain
• Radiating pain
• Weakness
• Stiffness

• Pain resulting from a medical condition, such as
– Migraines
– Sciatica
– TMJ dysfunctions
– Arthritis
– Fibromyalgia
– Carpal tunnel syndrome
– Soft tissue injuries
– And more…

Trigger points in the levator scapula

The levator scapula is a muscle located in your neck. It originates on the transverse processes of C1-C4 vertebrae. It inserts on the superior part of the medial border of the scapula. This muscle acts to elevate the scapula and rotate the glenoid fossa downward. At the cervical attachment it acts to rotate the neck to the same side and assists extension. Trigger points will refer pain into the angle of the neck with spillover into the scapula. When this muscle is tight due to trigger points it will restrict neck rotation causing the classic stiff neck. With a forward head position this muscle often becomes stretched and over worked.

2 Critical Steps to Resolving Ankle Sprains

Efficient treatment of ankle sprains continues well after the pain subsides.  While the majority of inversion (lateral) ankle sprains heal relatively quickly, up to 1/3 of patients, continue to note symptoms at one year, and up to 25% report pain, instability, crepitus, weakness, stiffness, or swelling at three years. (1) Re-injury is frequent, with rates reaching almost 75% in sports, like basketball. (2) Successful management of ankle sprains and prevention of re-injury are predicated on a couple of fundamental principles.

Management of ankle inversion sprains requires two steps; each is equally important.

  • The first step entails the evaluation and treatment of acute pain.
  • The second step involves preventing subsequent sprains – and new research validates the importance of chiropractic care to improve clinical outcomes in these recalcitrant cases.

 

STEP 1—Move for Pain Relief

Early return to activity for acute inversion sprains is supported by the literature.  Exercises and treatments that promote joint motion and early return to weight bearing for acute ankle sprains have proven more effective than immobilization.  While grade III sprains (ligament rupture) may require immobilization, grade I and II ankle sprains should forego complete immobilization and instead focus on regaining full range of motion. In fact, early rehab and return to weight bearing will increase ankle range of motion, decrease pain, and reduce swelling sooner than immobilization.

In a study by Linde et al., 150 patients with inversion ankle sprains were treated with early motion and weight bearing. After one month, 90% of the patients treated with early motion and weight bearing demonstrated pain-free gait and 97% had increased work ability. (3) Early mobility exercises would typically include:

These four exercises promote balance and range of motion – specifically dorsiflexion, which is a key contributor to ankle injury. Patients who have lost an average of 11 degrees of dorsiflexion are five times more likely to suffer lateral ankle sprains. (4)

In office care should also include mobilization and manipulation for restoring function. Joint mobilization has been shown to decrease pain, increase dorsiflexion, and improve ankle function. (5) IASTM or transverse friction massage to the affected ligament may help mobilize scar tissue and increase pliability. Myofascial release may help release tightness or adhesions in the gastroc and soleus. (Side note: The FAKTR concept seamlessly incorporates all of these tools to produce top-tier outcomes.)

Knowing when to treat and when to refer is critical. Whitman’s clinical prediction rule identifies four variables to predict the success of manipulation and exercise for the treatment of inversion ankle sprains. (6) The presence of three out of four of the following variables predict greater than a 95% success rate for manual therapy and exercise:

  • Symptoms worse when standing
  • Symptoms worse in the evening
  • Navicular drop greater than 5 mm
  • Distal tibiofibular joint hypomobility

 

STEP 2- Prevent Re-injury

The second step is shorter and easier than the first.  The most crucial variable in the successful prevention of future ankle sprains is improving BALANCE. Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and joint position sense in athletes. (7) A study by de Vasconcelos et al. (2018) found that balance training reduced the incidence of ankle sprains by 38% compared with the control group.  (7)

Two of the most common exercises used for balance and proprioception include the single-leg stance exercise and Veles.  A simple explanation stressing the importance of balance training may be necessary to promote patient compliance.

Finally, encourage your patients start walking “normal” as soon as possible. As evidence-based chiropractors, we need to return patients back to their normal gait as soon as tolerable. Patients with foot and ankle pain will often favor a supinated gait in order to unload the soft tissues of the foot and arch in favor of their bony architecture on the lateral foot. The lateral column of the foot affords stability but at the expense of a very inefficient gait. Over an extended period, these patients may develop a Tailor’s bunion, i.e. 5th metatarsal head bursitis. However, in the case of ankle sprains, a rapid increase in activity may overload the metatarsal fast enough to cause a Jones Fracture. Return to normal gait will minimize these compensations.