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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 Gordon J. Wallis on
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What muscle is the sore spot on? Spinal erectors or trap or? Sounds like multiple trigger points.
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Permalink Reply by Therese Schwartz on
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Hi Gordon! It's on the upper trap, and I think the supraspinatus is also involved. I agree with you that it could be multiple trigger points, including ones in the skin layer (hence the burning sensation). I haven't had any real training on trigger point therapy so I'm doing what I can with the little I know. It hurts her so much to put any pressure on it at all - some days she can let me do some deeper work on it and others she can't take it (I'm the same way so I understand that!).
I really want to help her - this is her main issue that she's coming to me for, and it's better but it's frustrating me that it's not getting resolved!
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? Not being there..its easy for me to say things...uhm, but a trigger point in the upper trap is usually easy to eliminate. Pulling the neck muscles at a right angle at the C4 area usually shuts it off. Like pulling a bow string.
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Cool! Do you pull toward or away from the spine? Do you put any pressure on the trigger point while you are doing that?
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Permalink Reply by Walt Fritz, PT on
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Therese,
Whenever I encounter this type of chronic issue, I feel deeper into the flexibility and landscape of the ribs. Often, due to a variety of reasons, there is a rib/ribs that stick up, so to speak, in comparison to their neighbors. As the scular glides over this high rib, irritation/inflammation occurs. No amount of soft tissue work to the spams will eliminate the issue unless you delve deeper into the landscape of the ribcage. You can see a bit about this onone of the videos I made for Oakworks.
Walt
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You pull towards the spine... You gather up the neck tissue on the side of the TPed upper trap like a bow string...But dont hurt the client.. Shouldnt be painful...You only keep the finger of your free hand to monitor the trigger point with just enough pressure so she can feel if it turns off or not...You arnt working the trigger point directly...If the pain vanishes(usually does).. You hold the pull for 20 seconds. If its really a TP in the upper trap... That makes it go away 9 out of 10 times...Its really hard to describe techniques just with text... But, that being said...for me, thats the easiest way to make that TP go away. I do that almost every day. PS- easiest if the client is laying on their stomach with the head in a head rest. Don't use oil.
Therese Schwartz said:Cool! Do you pull toward or away from the spine? Do you put any pressure on the trigger point while you are doing that?
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Walt - thank you! I will watch the video later tonight when I'm done with my clients. I'm becoming more interested in the rib cage as I learn how much it affects people when it's problematic!
Gordon - thank you too! This is great - I will try this on Saturday with her and see how it goes.
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Whenever I am confronted with trap or similar pain issues, I always check rib symmetry and landscape. Best of luck.
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Thanks Walt! It's amazing - I learn something new all the time. It keeps me excited!
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Permalink Reply by Stephen Jeffrey on
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Hi Therese, make sure you treat the other shoulder, (deep work if poss) balance the brain, neuroplastic changes with chronic pain mean an enlargement/takeover and over excitement of neural pathways.
I would treat both arms and hands as well.
Regards Steve
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Permalink Reply by Daniel Cohen on
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Also oscillate gently and feel for lines of tension. Follow them where you lead as the source may not be the shoulders. Other areas I would check are low back, glutes, and even calves. Be thorough, one of the things I like about massage is we treat holistically rather than simply a limited zone. I work well with Physicians and Physical Therapists helping to locate areas they are not looking at because of their protocols. It allows me to recommend they look at other parts of the body as causes and has often changed treatments.
And by all means do leave time for the other shoulder as Stephen mentioned. Remember the Chest (rib relationship mentioned by Walt). It all works together.
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Stephen - Thanks! It's been a long time since I've worked on her hands and arms. I know better - but I've fallen into the trap of being focused on her neck and shoulder. And it sounds like a bit of CranioSacral Therapy will help too, to bring the overall CNS down in tone.
Daniel - Thanks to you too! I love the idea of the gentle oscillations; that will prove useful for my clients in general. I've never worked on her legs - mistake on my part! It's definitely time to change things up.
Thanks to everyone - I greatly appreciate your willingness to share what you know.
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