Trigger Point Massage Guide

Trigger Point Guide Theory

Karri Koivula

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Start here Foreword The focus here is in practical advice. The bottom line, And all that matters, Is that trigger points cause referred pain, And that they “relax” trough massage. And that the pain symptoms they cause will vanish along them… Call to action Read some theory below then go to the pain patterns section and… Look at the body part pictures and try to pin point your pain, then look at the muscle pain index and see which muscles are generally involved. Then go to work, use the side menu to easily jump to what ever muscles you need to massage, and use the pictures and written guidelines if any to get the job done.

Theory section starts Trigger points are hyper contracted bundles of muscle cells. Also because of this contraction there are taut bands of stretched muscle attached to these contraction knots that run to both directions and end up in the muscles attachments points. Putting pressure on the trigger point will eventually make them relax. Even pressing at the taut band can make this happen as it forces a stretch to the contracted knots that are in the center. But for best effect you want to aim center. you’ll locate the center/trigger point by its pressure tenderness, pressing it moderate/hard force should cause noticeable pain both ate the spot and in the pain referral zone. You can test this by pressing a spot few centimetres of the spot, and see that you can barely feel the pressing. Normal muscle tissue can take a lot of force applied to it; until you start to feel even slight discomfort.



Trigger point identification -important Pressure tender spot Spot that hurts to press Twitch reaction When you press the spot or taut band you can feel the taut band to twitch violently. It’s good indicator from trigger points, but it doesn’t happen, or you can’t always feel it. Reappearing of referred pain symptom When you press the tp you feel something on the actual pain zone were the symptom that bothers you exists. Sometimes it’s the exact feeling of the pain but most cases you just feel some weird sensations in the general area of you pain zone. Brief massage guide lines Find the spot and the direction of applying pressure massage that hurts the most. Massage multiple short session though out the day. As long as it takes for the spots to become none-tender, or as long as it takes to get relief. This will in most cases take weeks. Ways to massage Repetitive stroke massage or continuous pressure Il like the best from continuous pressure applied by tool and using bodyweight for applying the pressure. It’s the lazy person’s way to do it and works just perfect. Continuous pressure Hold 8-15 seconds pressure move to another spot come back later repeat about 2-3 per spot 2-5 times per day Massage Massage 10 strokes move to another spot come back repeat 2-3 times per spot 6-10 times per day There are no rules once you get the hang of it youll make you own system.



Case example Acute pain phase Massages points in many sessions a day for two weeks Holy smoke I am full of these buggers it seems that every inc of my body is is a tender spot. Pain symptoms regress backwards old injuries start to feel again maybe resulting in more pain. My muscles are twitching like there no tomorrow. Where is this all going to lead.. Then every other day for couple of weeks Things start to normalize I got to tell everybody about this. This is pretty cool, why the doctors didn’t tell me about this. Upkeep/ maintenance Then once a week, or when needed. Massage is getting boring but some of the points are still a bit tender, although generally it gets harder and harder to find them Then once a moth, one session holding for 5 seconds,per spot. I’m so lazy I should do the massage more often. Some spots may get tender but they don’t seem to cause those old referred pain symptoms, strange… Where I ever in pain? It seems so distant…



Pain shift - important What you get is a pain shift or the pain gets worse. You can aggravate the current tp and your pain symptom worsens this is common although it doesn’t seem to postpone the relaxation of the tp. Which is bit odd, but that’s the practice of things. And thus some use very rough methods from the beginning to get things handled as quickly as possible and suffer a little extra pain. Pain shift can be like going back in time. Pain shift happens when the pull of the muscles changes and it flares old latent trigger points. For example if you hurt you foot and got longstanding knee pain that eventually settled in you hip. You can experience the same knee pain again as the trigger point will flare upp again as the balance between the pull of the muscles changes as you massage tps. But at this point don’t call me and get angry at me but continue to massage the points that are responsible of this newly appeared symptom. They should vanish eventually. I don’t know a case where this pain shift or regression back to old symptoms haven’t vanished- I don’t see any logic reasons for this but realize that there is a risk for this.



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Trigger Point Guide Pain patterns

Karri Koivula



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Index 1. Head and neck pain 2. Upper back, shoulder, upper arm pain 3. Middle back, lower back ,hip and buttock pain 4. Chest, abdominal and groin pain , 5. hip, thigh, knee pain 6. Leg and ankle pain 7. Foot pain



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Head and Neck pain



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I pain/muscle index Top of head sternocleidomastoid splenius capitis

Back of head pain Trapezius sternocleidomastoid semispinalis capitis semispinalis cervicis splenius cervicis suboccipital group occipitalis digastric temporalis

Side of head Trapezius sternocleidomastoid temporalis splenius cervicis suboccipital group semispinalis capitis

Front of head sternocleidomastoid Frontalis zygomaticus major semispinalis capitis

korva ja leuka nivel särky lateral pterygoid massater sternocleidomastoid medial pterygoid

Eye area pain Sternocleidomastoid Temporalis slpenius cervicis massater occipitalis orbicularis oculi suboccipital group trapezius

Ear and chin joint pain sternocleidomastoid massater lateral pterygoid trapezius buccinator Platysma orbicularis oculi zygomataticus major digastric medial pterygoid

Tooth pain temporalis massater digastric

Back of neck Trapezius multifidi levator scapulae splenius cervicsis

Front of neck sternocleidomastoid digastric medial pterygoid



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Trapezius

Use Stick and tennis ball against the wall. Picture: For trigger points, lower down in the trapezius, lye down in the floor and use tennis ball and use it to apply the pressure and find the right spots. picture:



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Sternocleidomastoid

Just grab the muscle like in I am doing, bend the head to the side you are pinching the muscle to give it some slack and make it easier to grab. Just go trough the whole muscle pinch gripping it and find the trigger points. The muscle two branches on top of each others, you can see them divide in the lower attachment point. But for the most part of the muscle you don’t have to distinguish them.



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Temporalis

Use your knuckles or some hard tool to locate temporal trigger points. But go easy on them. Its really spooky kind of pain that they can make and reappear when pressed.



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massater

I find it helpful to press little towards ears to hit the muscle in right direction. Use fingers, knuckles or tool



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Splenius Capitis Splenius Cervcis

Tool against wall or against floor.



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Semispinalis Capitis

Tool against wall or against floor.



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multifidi , rotatores

Tennis ball is too big to hit the trigger points but some tool that is smaller works fine. Be little extra careful when applying pressure near vertebrae, use common sense. To be extra cautious use tool with your hands not against floor or wall- Buccinator



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It refers pain to the teeth near the muscle Use your fingers for pressure Lateral pterygoid



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The x is the trigger point spot and grey areas on both side it the referred pain areas. use fingers to locate and hit the spot. Medial pterygoid

To reach this muscle you need to press it from below your chin. It is on the x spot orbicularis oculi



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No it’s not the Frankenstein’s bride wearing an eye patch, even thou it kind of a looks like it. The pain pattern is the grey shadow that seems to sculpt the nose and the trigger point is the small x just in the eye brow line or little below, like it is in this case. Just track down the bones around the eye looking for tender points. The black patch describes the muscle. zygomaticus, levator labii



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Indian war painting, or maybe not. Use fingers to locate and aply pressure



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digastric

Again you need to venture to the underneath of the chin. Use fingers an to search tender spots and referred pain.



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frontalis occipital

Move your eyebrows and try to wiggle your ear can you feel the occipital muscle in the back of your head. Fingers, knuckles or a tool there aren’t any rules. suboccipitalis

Use a tool to reach the muscle easily, against wall if necessary.



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Upper back, shoulder, upper arm



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Index II Upper back pain Scaleni levatorscapulae trapezius multifidi splenius cervicis supraspinatus rhombodei triceps brachii biceps brachii Back of shoulder deltoid levator scapulae supraspinatus teres major

teres minor subscapularis serratus posterior superior triceps brachii trapezius scaleni lats erector spinae Shoulder front infraspinatus deltoid scaleni supraspinatus pectoralis major pectoralis minor biceps brachii coracobrachialis sternalis subclavius

latissimus dorsi Back of upper arm scaleni teres major triceps brachii deltoid subscapularis supraspinatus teres minor latissimus dorsi serratus posterior superioir coracobrachialis scalenus minimus

scaleni biceps brachii triceps brachii subclavius supraspinatus sternalis infraspinatus Deltoid brachialis latissimus dorsi

Front of upper arm



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scalanes

Locate your collar bone use your fingers o pull to the collar bone.

.



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trapezius

Tennis ball or similar tool against the floor is the way to go, just lye on it and move it to the tenderest spots and hold for awhile.



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Levator Scapulae




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Latissimus Dorsi




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Rhomboid


Serratus posterior superior



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supraspinatus

Stick as a tool is great to reach this, tennis ball on the floor can work also. infraspinatus




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Teres Minor

Teres Major



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Subscapularis

coracobrachialis



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deltoid



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Triceps

Biceps



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Middle back, lower back, hip and buttocks/sacral pain



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Index III Middle back pain spinae erectors multifidi rotatores rectus abdomis serratus anterior serratus posterior inferior latissimus dorsi intercostals Lower back pain gluteus medius gluteus maximus gluteus minimus psoas multifidi rotators (syvät elkälihakset) spinae erectors ( pinnalliset selkälihakset) quadratus lumborum rectus abdomis obiliques

hamstrings soleus

Buttock/sacral pain quadratus lumborum erector spinae gluteus minimus gluteus medius gluteus maximus piriformis hamstring soleus

Hip pain quadreceps vastus lateralis gluteus minimus gluteus maximus. piriformis quadratus lumborum tensor fasciae latae



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Gluteus maximus



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Gluteus medius

Gluteus minimus



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piriformis

Quadratus lumborum



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Spinae erectors & multifidi ja rotatores

Rectus abdomis



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liopsoas

obiliques



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Hamstring



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Chest, abdominal, genital pain



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Index IV Chest pain pectorals scalenes sternocleidomastoid sternalis intercostals superficial spinal muscles subclavius rectus abdomis diaphgram Side pain serratus anterior abdominal obiliques intercostals

latissimus dorsidiaphgram Abdominal pain rectus abdomis abdominal obliques superficial spinal muscles deep spinal muscles quadratus lumborum Groin pain Rectus abdomis Abdominal obiliques intrapelvic muscles adductor magnus psoas piriformis



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Pectorals



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Serratus anterior

Latissimus Dorsi



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Rectus abdomis

Obiliques



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Hip, thigh, knee pain



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Index V Groin Pain pectineus abductor longus abductor magnus rectus abdominis abdominal obiliques psoap intrapelvi muscles

Hip pain gluteus minimus vastus lateralis piriformis qiadratus lumborum tensor fasciae latae vastus intermedialis gluteus maximus

Front thigh pain Abductor longus psoas abducto magnus vastus intermedialis pectineus sartorius quadratus lumborum rectus abdominis

Front of knee

rectus femoris vastus medialis abductor longus Inner knee vastus medialis gracilis rectus femoris sartorius adductor longus Outer knee vastus lateralis Back of thigh gluteus minimus semitendinosus biceps femoris piriformis intrapelvi muscles Inner thigh pectineus vastus medialis grazilis adductor magnus Back of knee gastrocnemius biceps femoris popliteus semiteninosus semimembranus soleus plantaris



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Tensor latia fascae Vastus intermedialis



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Vastus medialis



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Rectus femoris

vastus lateralis



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Pectineus



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Abductor brevis Abductor longus



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Abductor magnus

Gracialis



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Hamstrings



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plantaris Popliteus



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Leg and ankle pain



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Index VI Front of leg Tibialis anterior adductor longus Front of foot tibialis anterior peroneus tertius extensor digitorum longus Back of leg Soleus gluteus minimus gastronomicus semitendinosus semimembranus flexor digitorum longus tibialis posterior Plantaris

Side of leg Gastrocnemius gluteus minimus peroneus longus peroneus brevis vastus lateralis inner ankle Abductor hallucis flexor digitorum lonngus outer ankle peroneus longus peroneus brevis peroneus tertius abductoe digiti minimi back of ankle soleus tibialis posterior



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tibialis anterior

extensor hallucis longus & extensor digitorum



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peroneus longus & Peroneus brevis

peroneus tertius



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gastrocnemius



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soleus

tibialis posterior



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Flexor digitorum longus & flexor hallucis longus



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Foot pain



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Index VII Top of foot extensor digitorum brevis extensor hallucis brevis extensor digitorum longus extensor hallucis longus flexor hallucis brevis interosseus tibialis anterior Big toe top tibialis anterior extensor hallucis longus flexor hallucis brevis under flexor hallucis longus flexor hallucis brevis tibialis posterior Other toes top interosseus extensor digitorum longus under flexor digitorum longus tibialis posterior

Bottom of the foot Front flexor hallucis brevis flexor digitorum brevis adductor hallucis flexor hallucis longus interosseus abductor digiti minimi flexor digitorum longus tibialis posterior flexor digigti minimi brevis Bottom of the foot middle gastrocnemius flexor digitorum longus adductor hallucis soleus interoseus tibislis posterior Heel pain soleus quadratus palnatae abductor hallucis tibialis posterior abductor digiti minimi



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Extensor digitorum brevis & extensor hallucis brevis

introsseus

Abductor hallucis



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abductor digiti minimi

flexor digitorum brevis

quadratus plantae



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Abductor hallucis & flexor hallucis brevi

Flexor digiti mininmi brevis



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Elbow, arm, wrist, hand pain



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Index VIII Elbow supinator brachioradialis extensor anconeus triceps brachii supraspinatus pectoralis major serratus anterior serratus posterior superior Outer elbow trticeps scalanes extensors brachioradialis brachialis flexors infraspinatus teres major cocabrachialis supraspinatus subclavius Inner elbow pain palmaris longus pronator teres serratus anterior triceps brachii latissimus dorsi pectoralis major serratus posterioer superior

Wrist outer arm extensors subsscapulari sascalenes latissimus dorsi serratus posterior superior coracobrachialis Wrist inner hand pain flexors palmaris longus pronator teres opopnens pollicis pectorals latissimus dorsi serratus anterior Inner finger pain flexores digitorum superficialis and profundus introssei abductor digiti minimi lats serratus subclavius Top of finger pain extensor digitorum introssei scalene abductor digiti mininimi pectorals



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lats subclavius

Thumb pain supinator scalene brachialis brachioradialis opponenns pollicis abductor pollicis extensor carpi radialis longus first dorsal introsseus flexor pollicis longus subclavius infraspinatus brachialis



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extensor carpi radialis longus

brachioradialis



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supinator

extensor carpi radialis brevis



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extensor carpi ulnaris

anconeus



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extensor digitorum

Extensor indicis



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flexor carpi radialis

flexor carpi ulnaris



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palmaris longus

flexor digitorum



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pronator teres & pronator quadratus

flexor pollicis longus



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opponens pollicis & abductor pollicis



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introsseus



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