The Sternocleidomastoid muscle is a strap like muscle in your neck. It originates on the manubrium and medial clavicle. It inserts on the mastoid process of the temporal bone, and the superior nuchal line. This muscle acts alone to rotate the face to the opposite side and lift it two rod the ceiling. Together they flex the head and neck. Trigger points in sternal division of this muscle refer pain to the cheek and along the supraorbital ridge. The lowest points refer down to the sternum. The highest points refer to the occipital ridge and vertex of the head. Trigger points in the costal division refer to the into the forehead. The most superior trigger points refer into the ear, and can postural dizziness.
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.
Temporomandibular joint dysfunction is a blanket term that refers to pain and dysfunction of the jaw muscles and the tempomandibular joints which connect the mandible to the skull. The most common symptoms are pain and restricted mandibular movement as well as grinding noises coming from the joint. This condition is more common in women then in men, and affects a large portion of patients suffering from fibromyalgia. Trigger points in the muscles of mastication are frequently involved in TMJ dysfunction. Trigger points in the pterygoid and masseter muscles for example will not only refer pain into the tempomandibular joints, but will also cause a dysfunctional movement pattern that can restrict range of motion. Trigger point therapy can be an effective modality to treat TMJ dysfunction.
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.
Whiplash Associated Disorders (WAD) is the appropriate terminology to use when addressing the myriad of symptoms that can occur as a result of a motor vehicle collision (MVC). In a recent publication in The Physician and Sports Medicine (Volume 43, Issue 3, 2015; 7/3/15 online:1-11), the article “The role of the cervical spine in post-concussive syndrome” takes a look at the neck when it’s injured in a car accident and how this relates to concussion.
It’s estimated about 3.8 million concussion injuries, also referred to as “mild traumatic brain injury” (mTBI), occur each year in the United States. Ironically, it’s one of the least understood injuries in the sports medicine and neuroscience communities. The GOOD NEWS is that concussion symptoms resolve within 7-10 days in the majority of cases; unfortunately, this isn’t the case with 10-15% of patients. Symptoms can last weeks, months, or even years in this group for which the term “post-concussive syndrome” (PCS) is used (defined as three or more symptoms lasting for four weeks as defined by the ICD-10) or three months following a minor head injury (as defined by the Diagnostic and Statistical Manual of Mental Disorders).
There have been significant advances in understanding what takes place in the acute phase of mTBI, but unfortunately, there is no clear physiological explanation for the chronic phase. Studies show the range of force to the head needed to cause concussion is between 60-160g (“g” = gravity) with 96.1g representing the highest predictive value in a football injury, whereas as little as 4.5g of neck acceleration can cause mild strain injury to the neck. In spite of this difference, the signs and symptoms reported by those injured in low-speed MVCs vs. football collisions are strikingly similar!
Research shows if an individual sustains an injury where the head is accelerated between 60-160g, it is HIGHLY likely that the tissues of the cervical spine (neck) have also reached their injury threshold of 4.5g. In a study that looked at hockey players, those who sustained a concussion also had WAD / neck injuries indicating that these injuries occur concurrently. Injuries to the neck in WAD include the same symptoms that occur in concussion including headache, dizziness/balance loss, nausea, visual and auditory problems, and cognitive dysfunction, just to name a few.
The paper concludes with five cases of PCS that responded well to a combination of active exercise/rehabilitation AND passive manual therapy (cervical spine manipulation). The favourable outcome supports the concept that the neck injury portion of WAD is a very important aspect to consider when treating patients with PCS!
This “link” between neck injury and concussion explains why chiropractic care is essential in the treatment of the concussion patient! This is especially true when the symptoms of concussion persist longer than one month!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Whiplash, we would be honoured to render our services.