Trigger Point Massage Guide

Trigger Point Guide

Theory

Karri Koivula

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Legal notices Disclaimer Huge effort is made that this book represents generally accepted medical practises and that this information doesn’t pose a risks for anybody who uses it. But it is very important that you realize that you read this book at your own risk. All material provided in this e-book is for informational and educational purposes only, and not to be construed as medical advice. No action should be taken solely based on this e-book

Absolutely consult you physician before you take any actions related to your you health By downloading/reading this book  You understand and agree that in no event shall the author nor the publisher of this e-book be liable to you or any other user of this e-book for the use of the information. Statements mentioned within this e-book are not intended to diagnose, treat, cure or prevent any disease. The statements made within this e-book have not been evaluated by the Food and Drug Administration. If you don’t understand or agree these terms then please quit reading this book right now and delete this book from your computer. Thanks. Copyright Copyright n otice It’s illegal to copy any material from this book and distribute it. I regularly search the internet for illegal copies. And I will press criminal charges against those who illegally distribute it. Copyright. 2004 Karri Koivula

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Legal notices Disclaimer Huge effort is made that this book represents generally accepted medical practises and that this information doesn’t pose a risks for anybody who uses it. But it is very important that you realize that you read this book at your own risk. All material provided in this e-book is for informational and educational purposes only, and not to be construed as medical advice. No action should be taken solely based on this e-book

Absolutely consult you physician before you take any actions related to your you health By downloading/reading this book  You understand and agree that in no event shall the author nor the publisher of this e-book be liable to you or any other user of this e-book for the use of the information. Statements mentioned within this e-book are not intended to diagnose, treat, cure or prevent any disease. The statements made within this e-book have not been evaluated by the Food and Drug Administration. If you don’t understand or agree these terms then please quit reading this book right now and delete this book from your computer. Thanks. Copyright Copyright n otice It’s illegal to copy any material from this book and distribute it. I regularly search the internet for illegal copies. And I will press criminal charges against those who illegally distribute it. Copyright. 2004 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 trigge tr iggerr 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 your pain, then t hen 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 bands of stretched muscle attached to these contraction knots that t hat 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 effect you want to aim center. you’ll locate the center/trigger center/trigger point po int by its pressure tenderness t enderness,, 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.

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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, happen, or you can’t can’t always a lways 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 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 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.

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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…

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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 vanishedI 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

1

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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

2

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Head and Neck pain

3

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

I pain/muscle index Top of head sternocleidomastoid splenius capitis

Back of head pain

Ear and chin joint pain

Trapezius sternocleidomastoid semispinalis capitis semispinalis cervicis splenius cervicis suboccipital group occipitalis digastric temporalis

sternocleidomastoid massater lateral pterygoid trapezius buccinator Platysma orbicularis oculi zygomataticus major digastric medial pterygoid

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

Tooth pain temporalis massater digastric

Back of neck Trapezius multifidi levator scapulae splenius cervicsis

Front of head sternocleidomastoid Frontalis zygomaticus major semispinalis capitis

Front of neck sternocleidomastoid digastric medial pterygoid

korva ja leuka nivel särky lateral pterygoid massater sternocleidomastoid medial pterygoid 4

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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 fi nd the right spots. picture:

5

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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.

6

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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.

7

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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

8

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Splenius Capitis

Splenius Cervcis

Tool against wall or against floor.

9

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Semispinalis Capitis

Tool against wall or against floor.

10

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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 11

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

Lateral pterygoid 12

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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 13

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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 l ooking for tender points. The black patch describes the muscle.

zygomaticus, levator labii

14

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

15

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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.

16

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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.

17

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Upper back, shoulder, upper arm

18

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teres minor subscapularis serratus posterior superior triceps brachii trapezius scaleni lats erector spinae

Index II Upper back pain Scaleni levatorscapulae trapezius multifidi splenius cervicis supraspinatus rhombodei triceps brachii biceps brachii

Shoulder front infraspinatus deltoid scaleni supraspinatus pectoralis major pectoralis minor biceps brachii coracobrachialis sternalis subclavius

Back of shoulder deltoid levator scapulae supraspinatus teres major latissimus dorsi

scaleni biceps brachii triceps brachii

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

subclavius supraspinatus sternalis infraspinatus Deltoid brachialis latissimus dorsi

Front of upper arm

19

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scalanes

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

.

20

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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.

21

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Levator Scapulae

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.

22

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Latissimus Dorsi

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.

23

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Rhomboid

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.

Serratus posterior superior

24

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supraspinatus

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

infraspinatus

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.

25

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Teres Minor

Teres Major

26

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Subscapularis

coracobrachialis

27

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deltoid

28

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Triceps

Biceps

29

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

30

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hamstrings soleus

Index III Middle back pain

Buttock/ sacral pain spinae erectors multifidi rotatores rectus abdomis serratus anterior serratus posterior inferior latissimus dorsi intercostals

quadratus lumborum erector spinae gluteus minimus gluteus medius gluteus maximus piriformis hamstring soleus

Low er back pain gluteus medius gluteus maximus gluteus minimus psoas multifidi rotators (syvät elkälihakset) spinae erectors ( pinnalliset selkälihakset) quadratus lumborum rectus abdomis obiliques

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

31

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Gluteus maximus

32

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Gluteus medius

Gluteus minimus

33

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piriformis

Quadratus lumborum

34

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Spinae erectors & multifidi ja rotatores

Rectus abdomis

35

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liopsoas

obiliques

36

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Hamstring

37

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Chest, abdominal, genital pain

38

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latissimus dorsidiaphgram

Index IV

Abdominal pain

Chest p ain pectorals scalenes sternocleidomastoid sternalis intercostals superficial spinal muscles subclavius rectus abdomis diaphgram

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

Side pain serratus anterior abdominal obiliques intercostals

39

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Pectorals

40

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Serratus anterior

Latissimus Dorsi

41

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Rectus abdomis

Obiliques

42

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Hip, thigh, knee pain

43

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rectus femoris vastus medialis abductor longus

Index V Groin P ain

I nner knee

pectineus abductor longus abductor magnus rectus abdominis abdominal obiliques psoap intrapelvi muscles

vastus medialis gracilis rectus femoris sartorius adductor longus

Outer knee vastus lateralis

Hip pain

Back of thigh

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

gluteus minimus semitendinosus biceps femoris piriformis intrapelvi muscles

I nner thigh pectineus vastus medialis grazilis adductor magnus

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

Back of knee gastrocnemius biceps femoris popliteus semiteninosus semimembranus soleus plantaris

Front of knee

44

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Tensor latia fascae

Vastus intermedialis

45

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Vastus medialis

46

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Rectus femoris

vastus lateralis

47

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Pectineus 48

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Abductor brevis

Abductor longus 49

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Abductor magnus

Gracialis

50

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Hamstrings

51

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plantaris

Popliteus

52

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Leg and ankle pain

53

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Side of leg Gastrocnemius gluteus minimus peroneus longus peroneus brevis vastus lateralis

Index VI Front of leg Tibialis anterior adductor longus

inner ankle

Front of foot

Abductor hallucis flexor digitorum lonngus

tibialis anterior peroneus tertius extensor digitorum longus

outer ankle peroneus peroneus peroneus abductoe

Back of leg Soleus gluteus minimus gastronomicus semitendinosus semimembranus flexor digitorum longus tibialis posterior Plantaris

longus brevis tertius digiti minimi

back of ankle soleus tibialis posterior

54

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tibialis anterior

extensor hallucis longus

&

extensor digitorum

55

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peroneus longus

&

Peroneus brevis

peroneus tertius

56

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gastrocnemius

57

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soleus

tibialis posterior

58

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Flexor digitorum longus & flexor hallucis longus

59

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Foot pain

60

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Index VII

Top of foot

Bottom of the foot Front

extensor digitorum brevis extensor hallucis brevis extensor digitorum longus extensor hallucis longus flexor hallucis brevis interosseus tibialis anterior

flexor hallucis brevis flexor digitorum brevis adductor hallucis flexor hallucis longus interosseus abductor digiti minimi flexor digitorum longus tibialis posterior flexor digigti minimi brevis

Big toe to p tibialis anterior extensor hallucis longus flexor hallucis brevis under flexor hallucis longus flexor hallucis brevis tibialis posterior

Bottom of the foot middle gastrocnemius flexor digitorum longus adductor hallucis soleus interoseus tibislis posterior

Other toes to p interosseus extensor digitorum longus under flexor digitorum longus tibialis posterior

Heel pain soleus quadratus palnatae abductor hallucis tibialis posterior abductor digiti minimi

61

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Extensor digitorum brevis & extensor hallucis brevis

introsseus

Abductor hallucis

62

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abductor digiti minimi

flexor digitorum brevis

quadratus plantae

63

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Abductor hallucis & flexor hallucis brevi

Flexor digiti mininmi brevis

64

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Elbow, arm, wrist, hand pain

65

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Index VIII Elbow

W rist outer arm extensors subsscapulari sascalenes latissimus dorsi serratus posterior superior coracobrachialis

supinator brachioradialis extensor anconeus triceps brachii supraspinatus pectoralis major serratus anterior serratus pos terior superior

W rist inner hand pain flexors palmaris longus pronator teres opopnens pollicis pectorals latissimus dorsi serratus anterior

Outer elbow trticeps scalanes extensors brachioradialis brachialis flexors infraspinatus teres major cocabrachialis supraspinatus subclavius

I nner finger pain flexores digitorum superficialis and profundu s introssei abductor digiti minimi lats serratus subclavius

I nner elbow pain

Top of finger pain

palmaris longus pronator teres serratus anterior triceps brachii latissimus dorsi pectoralis major serratus posterioer superior

extensor digitorum introssei scalene abductor digiti mininimi pectorals

66

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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

67

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extensor carpi radialis longus

brachioradialis

68

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supinator

extensor carpi radialis brevis

69

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extensor carpi ulnaris

anconeus

70

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extensor digitorum

Extensor indicis

71

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flexor carpi radialis

flexor carpi ulnaris

72

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palmaris longus

flexor digitorum

73

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pronator teres & pronator quadratus

flexor pollicis longus

74

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opponens pollicis & abductor pollicis

75

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