The following instructions are for general trigger point therapy (TPT) and should be the basis for it's use anywhere in the body. Specific body regions will have added instructions but these are the basics.
Trigger Points (TPs) are NOT normal. There should be NO trigger points in normal muscle tissue.
A Trigger Point (TP) is felt by the patient, NOT the examiner. Only very big TPs can be felt by the most sensitive practitioner's hands. All the smaller ones are too small and deep to feel. The definition of a TP is "A spot in the muscle which has abnormal pain or discomfort when pressed upon with firm pressure and begins to change for the better when that firm pressure is maintained for 60 seconds or less". The question arises - Who feels the pain and who feels the change for the better?
Firm pressure means firm pressure. The amount of pressure should be such that when pressing on any location it is felt as slight discomfort but NOT as pain. Using the same pressure on a TP will cause pain. The key is to apply the same pressure to various locations in the immediate area and find the specific spots where the same pressure causes a noticeable worsening of the pain or discomfort with the same amount of firm pressure.
When applying firm pressure to a TP do not apply so much that you can't stand the pain. Less pressure that still causes the discomfort or acceptable level of pain is OK.
To make sure it is a TP don't try to massage it. Simply hold the firm pressure for up to 60 seconds and try to notice a change in the pain. Occasionally a person doing TPT on their own body may find it takes up to 2 minutes for the noticeable change to occur. No one knows why. It's one of those mysteries. If it doesn't change in 2 minutes get off of it. It's not a TP.
The noticeable change in pain is NOT that it goes away. This will never happen while you are working on the TP. Noticeable change is:
a. A decrease in the intensity of the pain, or
b. A change from a sharp pain to a dull ache, or
c. A pain the seems to be spread out but becomes smaller in area.
Only hold the firm pressure until you notice the change. DO NOT try to do a little extra therapy by holding it longer or pressing harder to get rid of the TP. That doesn't work. All you do is cause more pain and can damage yourself by bruising.
Unless you have a severe skin condition that bruises at the slightest bump TPT should not cause bruising. The pressure is not enough to damage the skin.
When doing TPT on a specific muscle region try to have a mental picture of where the muscle is located from end to end - not just the middle of the muscle. Take the time to review a basic anatomy book to see how far a muscle extends. TPs can be in any part of the muscle and in muscles surrounding the one you are working on. You need to try to get them all.
When trying to get all the TPs. Only worry about getting the most painful ones in the first few sessions. When they begin to be less painful and change quicker than in the beginning start looking for smaller ones in the same region.
When looking for TPs press and hold contact with the skin and do a "tissue slack roll". This means keep contact with the surface but slide the skin around over the underlying structures. Do this slowly so you can feel if there is a TP under where you are pressing.
When you must move your hand, fingers, or tool to a new spot only move it about 1/4 to ½ inch from the last spot. If you move farther you will miss those in between.
Expect to take about 10 minutes per body region.
If you have multiple regions to work on only do the two worst regions until they begin to feel generally better during the day. If you try to work on too many regions at the same time you can actually cause more pain as you ask the body to recover more than it's capable of.
Treat at least once a day for the first week or two. When you find that doing it again the next day doesn't seem to find many TPs change to doing it every other day. When you find this finds very few TPs change to twice a week. Then again to once a week. When you can't find many at once a week try once every two weeks. If you still can't find many you are essentially done.
Once you've had TPs it's a good thing to check every month or two and do a little TPT if you find any before they begin to get bad again.
Use this basic guide to test for how bad the condition is: Pay attention to how long you feel better before the pain or discomfort begins to return. If you find it returning in 1 hour or less it's bad and will take a 3 to 6 months of the above treatment regimen to eliminate the TPs. If it last a few hours before it begins to return you probably have 1 ½ to 3 months. If it lasts until the next day that's good. It will probably only take 3 to 6 weeks.
It is tempting to try to do multiple TPs at one time but if you do it's difficult to know which one diminishes and which one is continuing. Work on only one TP at a time.
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