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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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Permalink Reply by Randel Mosley on January 20, 2012 at 6:59am

Unfortunately I can't think of any type of massage treatment that may help other than doing some shoulder stretching perhaps. How long have you been seeing the client? Have you discussed her seeing a doctor for an MRI to see if it's a growth on a nerve or something else? I'm sure you would have suggested it especially if you've been seeing her for a while and that "pea" has changed in any way.

Just a suggestion.

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Permalink Reply by Therese Schwartz on January 20, 2012 at 10:05am

Hi Randel - I've been seeing her for a while, well over a year, maybe a year and a half. Her shoulder has gotten progressively better, and other issues have also gotten better for her. (That sounds a little defensive - sorry! It sounds awful to say that I haven't been able to solve this in that amount of time! But only recently have we both been OK with working directly on it!) Yes, we've talked about an MRI a couple of times; one of those was this past Saturday. Both of us have realized that, while the massage and other work has helped a lot, it's time for some serious investigation.

Thanks for the suggestion! It's definitely an option that needs to be on the table.

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Permalink Reply by Randel Mosley on January 20, 2012 at 10:12am

I didn't mean to insult you and your capabilities at all. Not knowing how long you've been working with her I just thought it may be an option. The body is a miraculous thing and so complicated to figure it out quickly at times. Also having these threads here others can have a fresh perspective when we are focused so closely on the matter. I hope it goes well with you and her continued improvement.

Therese Schwartz said:

Hi Randel - I've been seeing her for a while, well over a year, maybe a year and a half. Her shoulder has gotten progressively better, and other issues have also gotten better for her. (That sounds a little defensive - sorry! It sounds awful to say that I haven't been able to solve this in that amount of time! But only recently have we both been OK with working directly on it!) Yes, we've talked about an MRI a couple of times; one of those was this past Saturday. Both of us have realized that, while the massage and other work has helped a lot, it's time for some serious investigation.

Thanks for the suggestion! It's definitely an option that needs to be on the table.

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Permalink Reply by Therese Schwartz on January 20, 2012 at 10:49am

I know! That's why I said something about sounding defensive; really it's just the frustration coming through. Thanks - it's good to remember how complicated and miraculous the body is. I think about that more and more as I keep learning! And you are so right - some of the posts in this thread have reminded me of what I already know, and even use with other clients!

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Permalink Reply by Stacy DeJong Barnes on January 20, 2012 at 10:19pm

Has she seen a doctor for it? Sounds almost like a blocked lymph or something like it. Is there any pain under or in her breast? Does she allow you to massage around the breast tissue? If so, is there anything there?

I would highly recommend her seeing a doctor if she can! There's just too much that could be going on there.

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Permalink Reply by Therese Schwartz on January 20, 2012 at 10:37pm

Hi Stacy, I don't know about the breast tissue. I haven't asked or checked, but she'll be here tomorrow so I can ask then. I agree - I think it's time to see a doctor and get some scans done. Thanks!!

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Permalink Reply by Therese Schwartz on January 21, 2012 at 2:08pm

Walt, I finally had time and brain power at the same time so I watched the video! Thanks! I will check out my client's ribs today, and I can see that this will be very useful with several of my clients.

Walt Fritz, PT said:

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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Permalink Reply by Stacy DeJong Barnes on January 23, 2012 at 11:06am

So how did the last session go?

Therese Schwartz said:

Walt, I finally had time and brain power at the same time so I watched the video! Thanks! I will check out my client's ribs today, and I can see that this will be very useful with several of my clients.

Walt Fritz, PT said:

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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Permalink Reply by Therese Schwartz on January 23, 2012 at 11:52am

Thanks for asking Stacy! That muscle knot won't budge, even with the wonderful techniques I've gotten on this thread. I did the gentle oscillations that Daniel suggested and found tension in her low back (lateral on the right) and both hips. That lead me to doing some MFR on her glutes and hips. I found a LOT of tension in both hips and her SI joints.

It's one of those things - I knew it was there because I used to teach her horse back riding and I had to put her on my own horse to teach her how to loosen her hips. He won't go if your hips are tight...Anyway, it was one of those "Why have I not worked on this?!" moments! She was happy to branch out into other areas of her body; I guess ultimately if we always try and do the right thing, everything happens when it's time.

So now we have a new plan of working on her more globally which of course is going to be fantastic! But I needed to get her neck and shoulders to the point she could sleep at night before we could progress...every client is such a different and amazing puzzle!

I also suggested again that she think about an MRI. Given that she was already wondering if that would be helpful, I think she'll get that done.

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Permalink Reply by Stacy DeJong Barnes on January 23, 2012 at 1:44pm

That's awesome! I too have had clients that I focused on one area for so long before finding something more later. But the body can only handle one major thing at a time.

Since you did find issues in her low back, I would suggest to your client that if/when they see a doctor to have the whole spine (C1 to S5) looked at and or scanned. Your client may have to be persistent with the doctor, but it will hopefully save her time and money in the long run.

I know the horrors first hand not having the full spine scanned. I was in a serious car accident and the chiro I saw only took upper body x-rays because that's all I complained about. Over 6 weeks later, my low back and hips hurt really bad and tried to get the insurance to cover it and they wouldn't because it wasn't in the initial exam. When x-rays were finally taken, my low back was shaped like an S, and I had to pay to get that restored out of pocket!

Hope all continues to move forward!!

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Permalink Reply by Kimberly Campbell on January 23, 2012 at 5:11pm

The problem could actually be Levator Scapulae. Start by working slowly to release the upper layers of tissue using MFR techniques from neck to shoulder and upper back. Next start to work on the lev scap. Always work the origin and insertion first then the belly of the muscle. If you strip first from the origin to the insertion in small lines covering the whole length of the muscle and still find no TrP, try from insertion to origin. If you find the trigger point, only apply a pressure up to 7 which should be the point where the client is uncomfortable but can still stay relaxed. Never hold a trigger point longer than a count of 30 and make sure the client tells you if the feeling is fading or almost gone.

It's possible that I'm wrong. But my NMT book shows the pain pattern that you described as being a Lev Scap issue. But again, the best therapy is the one that works! Best of Luck!

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Permalink Reply by Therese Schwartz on January 23, 2012 at 10:04pm

Stacy - thank you! That is really good information. I really appreciate that you are willing to share your story and what you learned so that someone else can do better. I will definitely pass this info along to her.

Kimberly - Thanks! I don't have an NMT book; I appreciate you looking that up!! I have worked a lot on her Lev Scap's, but mostly at the insertions. It's something else to try, and that's a good thing!