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Really stubborn muscle knot
I know that a lot of this has been discussed on other threads. In this case, none of the information from the other threads has helped me with this one particular client, so I'm hoping for some creative help! She is 23 and has had pain in her right upper trap since high school. She has a very painful muscle knot (or something like a muscle knot) that runs from her collar bone in the front all the way under the scapula in the back. It runs in a line that follows her bra strap; she actually can't tolerate having a bra strap over it. Sometimes it burns like a sunburn. When I palpate it, most of it causes referred pain up to almost the top of her head. There's a part of it that feels like a really hard pea, and that part is particularly painful.
I've tried everything I can think of - many types of massage, photonic (red light) therapy, energy work, Somato-Emotional Release dialoging (sp?), MFR, trigger point therapy...I'm out of ideas. Have any of you come across something like this before and if so, what did you do? If not, do you still have ideas that might help??
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Replies to This Discussion
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Permalink Reply by Stephen Jeffrey on
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Hi Therese
Don't become overly worried about that knot. If its become a myogelosis it may never respond as you would like it too.
In these situations I look for what is feeding the pain/triggerpoints by working more and more globally, feet, hands, face even!
She may not even be ready to let go of this pain at this moment in time, sounds like you are doing a great job. But maybe time to refer on.
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Permalink Reply by Sherrie Genetti on
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Hi have you tried propreceptive neck stretches? It usually affects all those shoulder cuff muscles and lengthens them. It has given me a lot of relief when I try them.
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Permalink Reply by Therese Schwartz on
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Stephen - thanks! Yes, it's time to quit worrying about the knot, and she's OK with that. I'm concerned that it's a myogelosis; I haven't told her about that possibility yet! At her last session (Saturday) I suggested that we start working globally and she thinks that's great. I was her horse riding instructor before I was her massage therapist and she trusted me there, and it's carried over to the massage. That makes it easier to carry out a treatment plan!
Sherrie - yes I have. I need to do more though. They've helped get her to where she can sleep at night! Thanks!
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Permalink Reply by Paul Lewis, RMT, NCBTMB,MFHT on
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Hello Theresa just thought I would try to suggest a few things that may help with your client's issues as described here.
1. I will make the assumption that you did a clinical assessment therefore you have determined where her pain stems from and the contributing muscles or impingements.
2. Sounds like you have narrowed it down to the anterior clavicle and under the scapula to mid back. Sounds like a combination of muscles contributing to the restrictions. Also based on the location where you are palpating you are effecting Splenius capitis which would refer pain to the head and has the attachment site by the occipitals. In addition, are her shoulders anteriorly rotated? Lets assume yes, Slight Kyphotic neck area due to rounded shoulders?
3. Is the discomfort coming from the middle 1/3 or lateral 1/3 of the clavicle this will give you an idea as to short and tight muscles contributing to pain.
4. Lets also assume that you did a cervical assessment and if she is experiencing pain at the back of the head close to the top...and you tested for short and tight levator muscles then below is a quick treatment plan based on the assumptions...
only a suggestion: (works for my clients)
Place your client in a supine position and start off on the biceps, Triceps using DAP , release the pectoral and deltoids from there move to the subscap (do this for both sides should take about 15 to 20 minutes) Then go into the upper traps, occipitals, SCM and strip the splenius capitus...
next move the client into prone:(supportive pillowing)
Releasing the upper traps, and levators from there splenius capitis, errectors, rhomboids, wing the scapula and do 60 seconds of positional release ..this is done to both side and your client should be smiling ...
Hope this helped...If you have any other comments you can reach me at www.paullewis.ca have a good day.
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Thanks Paul! I appreciate you taking the time to post this for me. All of that sounds great - I've done pieces of it but not all, and putting it all together in a coherent way will be excellent. She will be here again tomorrow so I can put this into practice right away!
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