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.

Advertisements

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…

A treatment with Bryan Cobb RMT.

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.

 

What the Heck Is a Trigger Point?

By Bryan Cobb, Advanced Remedial Massage Therapist

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce, at some time in your life.

TP’s were first brought to the attention of the medical world by Dr. Janet G. Travell. Dr. Travell, physician to President John F. Kennedy, is the acknowledged Mother of Myofascial Trigger Points.  In fact, “Trigger Point massage, the most effective modality used by massage therapists for the relief of pain, is based almost entirely on Dr. Travell’s insights.”2  Dr. Travell’s partner in her research was Dr. David G. Simons, a research scientist and aerospace physician.

Trigger Points are very common. In fact, Travell and Simons state that TP’s are responsible for, or associated with, 75% of pain complaints or conditions.1 With this kind of prevalence, it’s no wonder that TP’s are often referred to as the “scourge of mankind”.

Trigger Points can produce a wide variety of pain complaints. Some of the most common are migraine headaches, back pain, and pain and tingling into the extremities. They are usually responsible for most cases of achy deep pain that is hard to localize.

A TP will refer pain in a predictable pattern, based on its location in a given muscle. Also, since these spots are bundles of contracted muscle fibres, they can cause stiffness and a decreased range of motion.  Chronic conditions with many TP’s can also cause general fatigue and malaise, as well as muscle weakness.

Trigger Points are remarkably easy to get, but the most common causes are

TP’s (black dots) can refer pain to other areas (red)

Sudden overload of a muscle

• Poor posture

• Chronic frozen posture (e.g., from a desk job),  and

• Repetitive strain

Once in place, a TP can remain there for the remainder of your life unless an intervention takes place.

Trigger Points Not Well Known

With thousands of people dealing with chronic pain, and with TP’s being responsible for — or associated with — a high percentage of chronic pain, it is very disappointing to find that a large portion of doctors and other health care practitioners don’t know about TP’s and their symptoms.

Scientific research on TP’s dates back to the 1700’s.  There are numerous medical texts and papers written on the subject.

But, it still has been largely overlooked by the health care field.  This has led to needless frustration and suffering, as well as thousands of lost work hours and a poorer quality of life.

How Are Trigger Points Treated?

As nasty and troublesome as TP’s are, the treatment for them is surely straight-forward.  A skilled practitioner will assess the individual’s pain complaint to determine the most likely location of the TP’s and then apply one of several therapeutic modalities, the most effective of which is a massage technique called “ischemic compression”.

Basically, the therapist will apply a firm, steady pressure to the TP, strong enough to reproduce the symptoms.  The pressure will remain until the tissue softens and then the pressure will increase appropriately until the next barrier is felt.  This pressure is continued until the referral pain has subsided and the TP is released. (Note:  a full release of TP’s could take several sessions.) 

Other effective modalities include dry needling (needle placed into the belly of the TP) or wet needling (injection into the TP).  The use of moist heat and stretching prove effective, as well. The best practitioners for TP release are Massage Therapists, Physiotherapists, and Athletic Therapists.  An educated individual can also apply ischemic compression to themselves, but should start out seeing one of the above therapists to become familiar with

the modality and how to apply pressure safely.

1 Simons, D.G., Travell, D.G., & Simons, L.S. Travell and Simons’ Myofascial Pain and Dysfunction: the Trigger Point Manual.

Vol. 1.  2nd ed. Lippincott, Williams, and Wilkins, 1999.

2http://www.muscletherapyworks.com/MTW%20Biography%20T%20&%20S%2001.htm 

Trigger points in the adductor pollicis

The adductor pollicis is a muscle in the hand and acts on the thumb. It originates on the transverse head of the third metacarpal, the oblique head of the base of the second and third metacarpals, and the trapezoid and capitate bones. It inserts on the base of the proximal phalanx and ulnar sesamoid. This muscle acts to adduct and flex the thumb. Trigger points cause pain and aching along the outside of the thumb and hand, spillover pain may reach the thenar eminence.

Pathophysiology of trigger points.

A large number of factors have been identified as causes of trigger point activation. These include acute or chronic overload of muscle tissue, disease, psychological distress, systemic inflammation, homeostatic imbalances, direct trauma, radiculopathy, infections, and lifestyle choices such as smoking. Trigger points form as a local contraction of muscle fibres in a muscle or bundle of muscle fibres. These can pull on ligaments and tendons associated with the muscle which can cause pain to be felt deep inside a joint. It is theorized that trigger points form from excessive release of acetylcholine causing sustained depolarization of muscle fibres. Trigger points present an abnormal biochemical composition with elevated levels of acetylcholine, noradrenaline and serotonin and a lower ph. The contracted fibres in a trigger point constricts blood supply to the area creating an energy crisis in the tissue that results in the production of sensitizing substances that interact with pain receptors producing pain. When trigger points are present in a muscle there is often pain and weakness in the associated structures. These pain patterns follow specific nerve pathways that have been well mapped to allow for accurate diagnosis or the causative pain factor.

Diagnosis of trigger points.

Diagnosis of trigger points typically takes into account symptoms, pain patterns, and manual palpation. When palpating the therapist will feel for a taut band of muscle with a hard nodule within it. Often a local twitch response will be elicited by running a finger perpendicular to the muscle fibres direction. Pressure applied to the trigger point will often reproduce the pain complaint of the patient and the referral pattern of the trigger point. Often there is a heat differential in the local area of the trigger point.