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Knot on each of client's erector spinae muscles

An ABMP member recently spoke of a client he has with a huge knot on each of his erector spinae muscles. What's your approach to working these sorts of knots out?

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Permalink Reply by Gordon J. Wallis on April 28, 2015 at 3:15pm


Ive become very good at deactivating trigger points. Although it happens on rare occations, you cant expect to treat a client just one time and thats it. I have my trigger point clients come back for several follow up sessions. Usually half hour sessions. For the work i do it usually takes about seven sessions before the client is trigger point free. But, if they are seeing other therapists or physical therapists , or on some kind of exercise program, I dont even bother doing trigger point work. Because the other people they are seeing will only undue the trigger point work I am doing. Most of the clients I write about on my Typical Experience thread have already run the guantlet of chiropractic and physical therapy with no results and have been dealing with their pain for weeks, months, or years. So the answer is that the trigger points go away after 4 to 8 sessions.. I had an elderly client that I saw yesterday for the 8th time.. he had upper trap and neck pain that would wake him up at night. He had a couple upper paraspinal and rhomboid TPs , along with a couple stubbern cervical TPs that just hung on.. After about four sessions he could sleep at night but the trigger points were still sore on palpation.. So it took four more sessions before they were completely gone. If you read the TYPICAL EXPERIENCE thread from begining to end, and look at the attachments.. You will get an idea of the way I think and work. Which is not TYPICAL. Chantel Martin said:

Very smart, Gordon. I have a feeling we can all learn a lot from you. I'll probably be hanging around and listening to you more often.

I was told about the Reciprocal Inhibition Reflex, and massage methods associated with it, but I have not yet had any training in it. Out of curiosity and sheer lack of experience in the area, do you find that this method removes the trigger points completely? Or does it just somewhat alleviate the discomfort for a period of time?

Gordon J. Wallis said:

Just something to think about. As a follow up to what Chantel said in the above paragraph.. You could try this technique near the end of your massage or when your client turns and lays on their back. If you dig and dig on a trigger point a little too much, you stand the chance of actually perpetuating the trigger point by causing even more damage to the muscle cells. Here is another way of attacking the lumbar paraspinal trigger point ( or ponts ) that you've already worked on, in a way that will have a lot less chance of causing further cellular damage, and may actually release the trigger point in and of it self. I used the technique today sort of like an insurance policy to help back up the TP work I had done early on in the massage. I've found out over the years that if you get the nervous system on your side when working on deactivating a trigger point, your success is much greater. Its like swiming down stream as opposed to up stream. Uhm, when one muscle gets tight, another muscle gets loose. If that was not the case, we could not move. When one side of the muscle gets tight, the other side gets loose. When one muscle contracts, the opposite muscle, antagonist or whatever relaxes. Thats hard wiered into the body.. No escape from that reflex. Reciprocal Inhibition Reflex. If you are layin on your back and start to do a sit up.. In the very beggining when your neck starts to lift off the floor your SCMs as well as your Abdominals and most of the rest of the front part of your body contracts ( tightens up ). That means, do to the Reciprocal Inhibition Reflex, that your lower back and Lumbars have to relax. The brain actually sends a signal to the lumbars to loosen up and relax..Of course if you continiue to do the entire sit up, there is eventual strain and tightening on the lower back.. but not in the very begining of the exercise.. So i have my client, while laying on their back , lift their chin towards their chest.. Keeping their shoulders on the ground ( not lifting the shoulders ). If it stains the client of course this is not the technique you should do. While they hold that position you will notice the SCMss and Abbs tightening up quite a bit. At the same time before you have your client lift their chin to their chest, you have placed your hand or fingers under the body directly or over the trigger point area. Not pussing on the trigger points... Just resting you hand or palm of hand over the trigger pointed area.. Lumbar 2 and 3 lets say. . With the clients back of the head off the table and their chin towards their chest.. Not much effort on their part. And with your hand resting on ( under ) the trigger point, the nervous system directs signals of relaxation directly to the lower back and specifically to the area where you hand is touching the body( directed by the perifpheral nervous system. The Reciprocal Inhibition Reflex is hard wired into the body.. There is no excape.. Even though the client may not feel anything happening, their brain is sending signals to the lower back to loosen up.. I had my client hold that position for about ten or fifteen seconds.. rest for a few seconsd then repeate that a coupld more times... The client may not feel anything, but the Reciprocal Inhibition Reflex is hard wired into the body. You can read about it in Wikipedia if you want.. Just something to think about.
Permalink Reply by Chantel Martin on April 28, 2015 at 3:20pm

Thank you for the information! It's always interesting to see how other talented therapists work, especially those with a lot of experience like yourself. Keep up the good work!

Gordon J. Wallis said:



Ive become very good at deactivating trigger points. Although it happens on rare occations, you cant expect to treat a client just one time and thats it. I have my trigger point clients come back for several follow up sessions. Usually half hour sessions. For the work i do it usually takes about seven sessions before the client is trigger point free. But, if they are seeing other therapists or physical therapists , or on some kind of exercise program, I dont even bother doing trigger point work. Because the other people they are seeing will only undue the trigger point work I am doing. Most of the clients I write about on my Typical Experience thread have already run the guantlet of chiropractic and physical therapy with no results and have been dealing with their pain for weeks, months, or years. So the answer is that the trigger points go away after 4 to 8 sessions.. I had an elderly client that I saw yesterday for the 8th time.. he had upper trap and neck pain that would wake him up at night. He had a couple upper paraspinal and rhomboid TPs , along with a couple stubbern cervical TPs that just hung on.. After about four sessions he could sleep at night but the trigger points were still sore on palpation.. So it took four more sessions before they were completely gone. If you read the TYPICAL EXPERIENCE thread from begining to end, and look at the attachments.. You will get an idea of the way I think and work. Which is not TYPICAL.
Permalink Reply by Gordon J. Wallis on April 28, 2015 at 3:27pm
Now one of my regular clients that I sees me once a month never has a pain complaint. She just loves a good massage.. She has never even heard the word trigger point. Well one day she came in with a complaint. It was one trigger point in her hip I think. After I released it, it never came back. But like I said, thats a rare deal. PS - she likes to work out.. I told her not to work out for a few days in order to give time for her body to heal. One reason trigger point therapay may seem to not work is because people are reactivating and aggrivating the cellular damage in the muscle tissue which causes the trigger point. I know that goes againts the accepted knowledge of the day, But when Im working on a trigger pointed person. Thats what I strongly suggest they do based on my experience. If they wanna waist their money and keep working out.. Fine. But I dont tell them to expect getting well. Thats one reason I cant work in a PT clinic of chiropractic office. Those professionals work from a different mindset that goes counter to my trigger point work. But then Im just a lowly massage therapist.. lol What do I know??????
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Permalink Reply by Chantel Martin on April 29, 2015 at 4:04pm

I completely agree with you on all of this. This is actually the way I learned it, too, and you're right that it is against modern teachings, but that doesn't make it wrong. I have personally experienced the reactivation of a trigger point, and let me tell you, it hurts!

When I was in school learning trigger point work, we trigger pointed each other's hip flexors. Well, mine are terrible because I drive a lot, especially on the right side, where they worked on me. School was an hour away from where I lived, and I just knew that TrP was going to reactivate on the way home, because I had to use that muscle to drive. Sure enough, about 20 minutes from home, I felt like I got stabbed right in my hip flexor. It was awful. I had to use my other foot to drive for a minute, and thankfully I was at a red light, so I only had to brake. Otherwise, I would've had to pull over.

Gordon J. Wallis said:

Now one of my regular clients that I sees me once a month never has a pain complaint. She just loves a good massage.. She has never even heard the word trigger point. Well one day she came in with a complaint. It was one trigger point in her hip I think. After I released it, it never came back. But like I said, thats a rare deal. PS - she likes to work out.. I told her not to work out for a few days in order to give time for her body to heal. One reason trigger point therapay may seem to not work is because people are reactivating and aggrivating the cellular damage in the muscle tissue which causes the trigger point. I know that goes againts the accepted knowledge of the day, But when Im working on a trigger pointed person. Thats what I strongly suggest they do based on my experience. If they wanna waist their money and keep working out.. Fine. But I dont tell them to expect getting well. Thats one reason I cant work in a PT clinic of chiropractic office. Those professionals work from a different mindset that goes counter to my trigger point work. But then Im just a lowly massage therapist.. lol What do I know??????
Permalink Reply by Gary W Addis, LMT on April 29, 2015 at 4:12pm

Following Gordon's advice, I always advise clients to refrain from even normal everyday activities for 2-3 days after a TP session.  A TP is an injury, and the body needs time to heal it after the restriction is removed.  When they are able to follow this advice, the TP may not flare up again for weeks, months, sometimes years.  But people can't always do that-- you couldn't drive  w/o using your legs and hips, a secretary has to use her hands, emotional stress that settles in the traps won't disappear along with the trp.



Chantel Martin said:

I completely agree with you on all of this. This is actually the way I learned it, too, and you're right that it is against modern teachings, but that doesn't make it wrong. I have personally experienced the reactivation of a trigger point, and let me tell you, it hurts!

When I was in school learning trigger point work, we trigger pointed each other's hip flexors. Well, mine are terrible because I drive a lot, especially on the right side, where they worked on me. School was an hour away from where I lived, and I just knew that TrP was going to reactivate on the way home, because I had to use that muscle to drive. Sure enough, about 20 minutes from home, I felt like I got stabbed right in my hip flexor. It was awful. I had to use my other foot to drive for a minute, and thankfully I was at a red light, so I only had to brake. Otherwise, I would've had to pull over.

Gordon J. Wallis said:

Now one of my regular clients that I sees me once a month never has a pain complaint. She just loves a good massage.. She has never even heard the word trigger point. Well one day she came in with a complaint. It was one trigger point in her hip I think. After I released it, it never came back. But like I said, thats a rare deal. PS - she likes to work out.. I told her not to work out for a few days in order to give time for her body to heal. One reason trigger point therapay may seem to not work is because people are reactivating and aggrivating the cellular damage in the muscle tissue which causes the trigger point. I know that goes againts the accepted knowledge of the day, But when Im working on a trigger pointed person. Thats what I strongly suggest they do based on my experience. If they wanna waist their money and keep working out.. Fine. But I dont tell them to expect getting well. Thats one reason I cant work in a PT clinic of chiropractic office. Those professionals work from a different mindset that goes counter to my trigger point work. But then Im just a lowly massage therapist.. lol What do I know??????
Permalink Reply by Chantel Martin on April 29, 2015 at 7:16pm

Exactly. Unfortunately, in that instance (and most in my school) I was not able to completely rest directly after receiving the massage due to the distance from home. But the education was definitely worth it.



Gary W Addis, LMT said:

Following Gordon's advice, I always advise clients to refrain from even normal everyday activities for 2-3 days after a TP session.  A TP is an injury, and the body needs time to heal it after the restriction is removed.  When they are able to follow this advice, the TP may not flare up again for weeks, months, sometimes years.  But people can't always do that-- you couldn't drive  w/o using your legs and hips, a secretary has to use her hands, emotional stress that settles in the traps won't disappear along with the trp.

Permalink Reply by Gordon J. Wallis on April 30, 2015 at 2:51pm
Well people have to do what they have to do. I tell people not to stop doing what they have to do. Just dont test the area on purpose. If they have a regular exercise program, just stop doing it during the trigger point therapy they are recieving from me. I might have to see them four to seven times. And they are coming every two days or three days. If somebody has TPs in their legs and they have stairs in their house. They cant just stop going up and down the stairs. But they can stop going to the gym, or stretching their leg as soon as they get off the massage table. The vast majority of my clients get well. Even if the trigger point stays released for only ten minutes. Thats ten minutes of time blood has been able to enter what was contracted tissue. Repeatedly releasing the trigger points every two or three days has an accumulative effect towards the healing side of things. They just have to make an effort not to test the area on purpose. One of my clients, I think I posted her testimonial here somewhere was seeing professional medical people, chiropractors and other massage people on and off for ten years with no relief. These people had her doing home exercises and therapies that only perpetuated the trigger points. She would feel worse after their therapy. One of the things she first told me is.. that she is still sore even though she is doing all the exercises.. When I explained to her that those exercises are only perpetuating her problem she stopped doing them.. gosh, in two or three TP sessions she is now pain free. I posted her testimonial in here somewhere. In the medical field/massage therapies.. There seems to be this Idea of a group effort.. The patient goes to a Chiropractor, massage therapist in the chiropractic office. They also see a Physical therapist, an Acupuncturist and so on...On top of that they are members of a gym and do whatever they are doing there. Then come into the spa where I work because they recieved a gift certificate for their birthday.. Then when they come into the room they tell me that they dont want a theraputic massage even though they know its good for them. They just want to relax.. Or they say , Just dig in and do whatever you have to do Id like to get rid of this pain. Most of the time these people just have trigger points. Like 90% of the time. Thats the challenging part for me.. Knowing what I know now. But Im not a medical person and have no political power. I cant tell people to stop seeing their Physical therapist and all the rest of the people they are seeing for their pain. I have not the authority. Here is what I do when I see this situation. It doesnt always work by the way, but often it does. I'm very confident at this point in my career , so that helps. I show them a video clip of me doing trigger point work. I have them read a testimonial. I ask them if they want out of pain? If they say yes. Then I tell them that this service( massage ) will be discounted slightly because I am changing what they expected of a spa massage. And if they are really tired of their pain and see that Im serious about what Im saying( experience brings confidence ), they usually say Go for it...Then I do my thing... And after the session I ask them how they feel. Most are suprised that they feel way better...They will say something like.. Gosh my knee doesnt hurt now? Or I dont feel that pain in my back anymore. Then I tell them.. Well thats the way you can feel all the time.. They go REALLY? I say yes. Other wise you would not be able to feel this way. Then I tell them that they should not work out or test the area on purpose. They need to let their body heal. And then I show them writings and quotations from educated aeorspace medical doctors that say you should not exercise a trigger pointed muscle. And I tell them dont be freaked out if the pain returns because we will have to release them several times before they are gone for good. And I tell them that I dont rip people off. If they are not noticeably better after four or five sessions then maybe I cant help them. They are not going to be seeing me three times a week for months like they been doing. If I fail, I fail fast. Most of those people that i talk to like that stop seeing all those other providers on their own. But I have confidence and experience. I couldnt say or do what I do now ten years ago.. and Ten years ago I had 20 years experience. You can always be a good massage therapist.. But if you are working on someone with pain, You have to feel confident about what you are doing, and know when you are failing. But if they get up off the table and feel noticeably better, and you get them to come in every three days to repete that same therapy. And get them to stop all the extra activities they are doing. There is a very good chance you can help them. All that being said. There is a whole bunch of people that have gone through all these therapies and have just given up.. Now if those people get up off your table and feel noticeably better, its not as politically difficult to help them.. Gosh I hope what Im saying makes sense? And also to re- qualify things... Not telling anybody what to do, or that Im right about everything. Im just telling you what I do. In the testimonial below, this client had stopped going to physical therapy on her own just before coming into the spa on a gift certificate. And the medical docs told her that she would need surgery for her pinched nerve. It was not a pinched nerve though. It was a Trigger Point.
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Permalink Reply by Gary W Addis, LMT on April 30, 2015 at 6:06pm

This is an effective treatment, for sure.  However, it is unlikely to affect a trigger point several layers of muscle deep (i.e., a trigger point in SPS which is covered by rhomboids, trapezius.  Hope we don't argue, but I don't think myofascial trigger points that restrict ROM due to the pain on movement are likely to be affected by working with the skin.  Touch-- mechanoreceptors-- located in the skin can create mild pain, yes, but the more intense nociceptor pain arises from dysfunction in muscles, tendons, ligaments attached to bone.  A TENS unit works by flooding the nerve pathways by mild mechanoreceptor pain so that harsh nociceptor pain is blocked or at least diminished for a while. 

Permalink Reply by Gary W Addis, LMT on April 30, 2015 at 8:08pm

Stacey, I am aware that the CNS originates all perceptions.  However, they are merely in response to messages received from muscles, fascia (yes, it does contain some nerve and muscle cells), internal organs, skin-- the entire body.  The brain doesn't decide in a vacuum, "I think I'll send a stabbing pain to that LMT's shoulder."  Pain is always a result of what is perceived to be harmful.  For instance, your auto is struck from behind at a traffic light.  Whiplash-- muscle fibers, even ligaments in the spine may be injured, but even if the damage is relatively minor, when the CNS gets emergency messages from neck, shoulders, erector spinae, it will send a harsh jolt of pain movement-restricting pain.

There are 3 types of sensation sent to the body.  A mosquito dances across the fine hairs on the back of your neck; the sun heats your skin and sweat is released--that's mechanoreceptors in action.  Someone shoots you with a Taser, that is debilitating nociceptor cascade.  Someone yells Catch and throws a ball, you whip around, your CNS correlates the position of your hands and the speed and location of the oncoming object, and without conscious thought, your arm lurches up and either catches or knocks the ball aside-- that's your proprioceptors in action.  The latter can be trained to reaction faster and more skillfully.  Actually, the power of the conscious mind can decrease and / or increase all physical sensations as recent research has shown.  I am thin compared to the majority of 67 yr old men, so I am sensitive to cold-- hell, I react now to a cool weather that won't arrive till next week.  If a powerlifter couldn't purposely defeat his golgi sensors and muscle spindles, no world records would ever be set.  When I was fourteen, my 96 pound mother lifted a car off my uncle when the jack failed and pinned him beneath the axle; the next day she couldn't lift the spare tire off the ground.  And the body-mind connection sometimes fails; that's how trigger points come to life.

Several friends belong to that FB group, I applied this morning but haven't been accepted yet.  I am more skeptical than most, maybe even more so than you.  For instance, in my opinion CST, Reiki and Reflexology are scams conducted on the gullible-- the practitioners probably believe in a higher percentage than most priests believe in the Jesus they serve.  In a LI discussion this afternoon an obviously intelligent LMT proclaimed that he uses a magic pendant to foretell how many drops of each essential oil he should use on a client.  Seriously?  Yeah, he actually said that!  From browsing the group Skeptical, I get the impression that not all members are as skeptical as their name implies.  I practice evidence-based therapeutic massage.

I believe that adhesions develop in fascia and aid trigger points in restricting movement in what the CNS perceives to be injured tissue (and imo, trigger points are indeed injuries at the sarcomere level). Therefore, I practice MFR and NMT.  I don't torture my clients with Rolfing because the combination of the former does all I and my clients need, in a fraction of the sessions required by structural integration, and without creating nearly as much pain.  Until it is proven with scientific instruments, I cannot accept the notion that cupping the skull in palms for half an hour or half a month is every going to cause a 1 cm shift in the plates of the skull.  Reflexology points in the feet communicate directly to organs in the body, how exactly?  I apply a few droplets of chosen EOs to selected clents, mainly b/c they smell nice and doing so does no harm even though I personally think they provide zero health benefit.  In short, no, they won't challenge / reform my thinking.  Everything I hear and read, I examine with a critical eye, if it doesn't appeal to my logical mind, I move on. 

I know with 100% certainty that trigger point therapy relieves pain and restores client ROM, because I relieve on average 10 or so trigger points every day.  I do not care what some guy in a lab coat writes about TPs, I do not care that Erik Dalton twists and turns and prods and does gentle spinal adjustments to clients in his seminars instead of doing the same work in 10 minutes of NMT.  I am not interested in learning how to break people down emotionally while performing John Barnes' MFR and Upledger's CST "unwindings.

Sorry, I apologize for the rant. 

 

Permalink Reply by Gordon J. Wallis on May 1, 2015 at 1:23am
Gosh, I don't know what both of you guys ( gals ) are talking about? Today I had a client with TMJ. She could not open her mouth very wide at all. I palpated both her left and right Masseters and found one painful spot on each one. I had her stick her tongue between her teeth as I pressed and tapped on her Digastic muscles or whatever they are called under her jaw for about 20 seconds. Repeated that a total of three times. After that the painful spots were noticibly down graded. Then manipulating LI 4, 5 on each hand for a few seconds, what was left of the painful spots completely vanished ( not there on re-palpation ). After that she opened her mouth. You should have seen the look on her face when it opened pain free all the way. She was truely stunned...Prior to me working on her she had been told to streatch her jaw. She had been doing that religiously for a very long time.. But that never worked. Now she knows she can place her tungue between her teeth and press up under the jaw to release that tension ( pain spot ) in her Masseters. She can do that several times a day and keep her Masseters relaxed, even if she clenches her jaw all night. I never dig on trigger points any more. But all I know is if you don't make the sore spot, trigger point, tender spot, or whatever you want to call it go away. You don't make the pain problem go away. Stretching her jaw did not make the sore spots go away.. It did not relieve the tension. But when I did the tongue between the teeth technique, her brain ( central nervous system? ) did not want to bite its own tongue off. So it did everything it could to make that not happen by weakening ( putting total slack ) in the very muscles that could do that.. Like the Massiter. You should have seen her face. She was truely stunned... lol It was cool.

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