The Trigger Point Therapy Workbook.pdf

The Trigger Point rfherapy \ Vorkbook YOUR $ELF-TREATMENT GUIDE FOR PAIN RELIEF

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of the trigger point to the other. Rather than sliding your finger across the skin, move the skin with the fingers. Worl< deeply, mashing the trigger point against the underlying bone Release at the end of the strok e, then go back to where you started, reset your fingers, and repeat Each time you release the pressure, fresh blood immediately flows in, bringing a renewing charge of oxygen and nutrients. The trigger point has been deprived of these essential substances because the knotted-up muscle fibers have been keeping a stranglehold on the capillaries that supply them. Although you'll hear that you should always move the fluid toward the heart, it's not a critical issue. You can depen d on the system to carry the junk away once you get it squeezed out of the trigger point. Stroke in whatever direction feels best. If you don't make trigger point therapy as easy as you can, it will wipe you out and you won't 1i.J.l often pop right back into -'-1 · ' place when the trigger point is deactivated. (1999: 445-459) Multifidi and rotatores trigger points may occur at any level in the neck. Massage them against the vertebrae with supported fingers (see Figures 4.23 and 4.24). If you can't reach them with your hands, use a ball Figure 4.30 Multlfldi and rotatores trigger points and referred pain pattern while lying on your back (see Figure 4.22).

Chaptu 4---HEnd and Neck Pain

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Muscles of the Jaw, Face, and Head Although there are a great number of muscles in jaw, face, and head, self-treatment is directed mainly at the two chewing muscles, the masseter and the temporalis. Trigger points in these two muscles, along with those in the trapezius and sternocleidomastoid muscles, account for much of the pain in the jaw, face, and head, including the infamous temporomandibular joint (TMJ). Trigger points in the other muscles of the jaw, face, and head usually exist secondary to trigger points in these four primary muscles. Symptoms from the smaller muscles may subside spontaneously when the trigger points in the primary muscles are deactivated. (339) Trigger points in the jaw muscles have a variety of causes, including excessive gum chewing, tooth d ecay, abscesses, and grinding the teeth at night. Dental work frequently leaves patients with trigger points in the strained or exhausted jaw muscles. Emotional tension, mouth breathing, and the h ead-forward posture also cause trigger points in the jaw muscles by promoting habitual tension in them. Trigger points in sternocleidomastoid and trapezius muscles resulting from whiplash, falls, and other kinds of physical strain tend to promote trigger points in the muscles of the jaw, face, and h ead. (1999: 335-336; Hong 29-59)

Masseter The masseter (MASS-uh-ter) muscles are the power muscles of the jaw, exerting the major force in biting and chewing. In the mirror, you can see your rnasseters contract right in front of your earlobes when you grit your teeth. Masseter comes from the Greek word for "to chew.n Pain from masseter trigger points can fool even the experts. Mary, age twenty-nine, was a dentist wlw was frustrated in the trl?Jltment of wme of her patients wlw complained of tooth pain lrut had no problems that she could find. She also had pain in her own jaws and in her own perfectly healthy t.eeth. She suspect.ed the pain was myofascial but she didn't feel competent to diagiwse or tre.at it. In dental sclwol, they'd been told about trigger points lrut hadn't spent much time on them. A due to Mary's own trouble lay in the chronic headaches and neck pain she had suffered since dental sclwol, caused by leo.ning over all day and twisting to look into mouths. The straill of her work had caused trigger points in her sternocleidomastoid muscles, which in

turn were generating secondary trigger points in her mnsseter muscles. Her headaches were coming from her st.ernocleidomastoids, the pain in her jaws and t.eeth from her masseters.

Trigger points in the masseter muscles cause pain in several places (Figure 4.31). The trigger point in the deep layer

( Figure 4.31 Masseter trigger points and referred pain pattern

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~ Trlggtr Point 1111!rapy Workbook

right in front of the ear is especially important as a cause of pain m the temporomandibular joint. Masseter trigger points can also increase muscle tension to such an extent that it restricts opeiring of the jaw. 1his jaw tightness encourages tightness in the vocal mechanism. Singers have 1eported hitting their high notes with gieater ease aftet they've worked on their masseters and other jaw m uscles. (1999: 334-335) , Masseter trigger points cause pain in both upper and lower teeth. They are also a common source of tooth hypersensitivity to heat, cold, and touch. Misinterpretation of these symptoms can result in unnecessary dental work, including n eedless tooth extraction. Masseter trigger points may cause you to neglect to br ush and floss sensitive teeth, which can lead to their deterioration. (1999: 329-339) Trigger points in the masseter muscles also cause pain in the front of the face, under the eyes, and over the eyebrows, symptoms often mistaken for sinusitis. They can even cause sinus drainage. When sinus medicine doesn't help your sinus pain, masseter trigger points may be the problem. (1999: 330) Bags under the eyes and twitching of the eye or eyelid can be traced to trigger points in masseter muscles. They can also cause pain deep in the ear, accompanied by a sense of stuffiness or the sound of low roaring. They're often responsible for that maddening itch inside yew ear that you can't quite seem to reach. (1999: 338) Trigger points can be found at any place in the massetei, from the cheekbone to the bottom edge of the jaw. You'll find that attempts to massage the masseter from the outside will not be effective. It's n ecessary to put your thumb inside your mouth and knead the muscle between thumb and fingers (Figure 4.32). The masseter fee~ VJ!."fY fi!'.IDJ__thick,_and rubbe!Y:lf you're working the right place, you'll feel the tip of your thumb touchilig the coronoid process, the sharp-edged. fin-shaped piece of bone rising from near the back of the jawbone. Seek out each exquisitely tendet knot, from the cheekbone to the bottom of the jaw, and massage it as strongly as you can bear. Massaging the masseters is extremely painful when they're afflicted with trigger points, and you should expect to experience soreness afterwards for a day or two. This residual soreness only indicates how badly the muscles need the attention. Don't Let the discomfort make you give up. Work on them eveiy day until squeezing the muscle no longer

hurts.

Figure 4.32 Masseter massage wi1h 1hunb and f119ers (thumb Inside the mouth)

You can go a long way toward p reventing trouble with the jaw muscles by giving up chewing gum. In addition, avoid biting your nails, don't chew on ice, and d on't open things with your teeth. Fmd out what you can do to stop giinding your teeth in your sleep. Train yourself not to clench your jaws when you're tense and under pressure.

Chapter 4-Head and Neck Pain

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Pterygoid Muscles The pterygoid (TEHR-uh-goyd) muscles are well hidden by the lower jawbone, which is very inconvenient, since their trigger points are a frequent cause of pain in temporomandibular joints of the jaw. The word pterygoid comes from the Greek for "wing-like," a reflection of their shape. The root word is similar to that of "pterodactyL" the name of the winged dinosaur. The me.di.al pterygoid muscle causes pain in the temporomandibular joint and the ear (Figure 4.33). It can also refer pain to the Figure 4.33 Medial ptel'ygoid trigger DOints and referred pain pattern back of the mouth, hard palate, and tongue and can make it hurt to swallow. Medial pterygoid trigger points make it difficult to open the mouth wide. A sense of stuffiness in the ear can come from a tight medial pte:rygoid when it prevents the eustachian tube (in the middle ear) from opening. The function of this muscle is to help close the jaw. Its problems are therefore strongly associated with those in the masseter. (1999: 365--%6; Bell 154-160) You can massage the medial pterygoid by pressing up with your thumb inside the inner edge of the back of your lower jaw (H.gure 4.34). This can be an exceedingly painful spot As with the masseter, massage of the pterygoids can leave you sore, so go easy at first. The other pte:rygoid muscle, the lateral pt,erygoid, is the number-one myofascial source of pain and temporomandibular joint (TMJ) dysfunction (Figure 4.35). Constant trigger point--generated tension in the lateral Agure 4.34 Medial pte