Simplified (muscle-only) Tandem Point approach
What muscle-only Tandem Point therapy looks like:
Clinician
- identifies which muscle may be causing a myofascial pain syndrome
- finds a trigger point in the muscle
- waits to feel a pulsation in the trigger point
- locates a second trigger point in the taut band or in the muscle's
referral pattern
- holds that second point until a pulsation appears in the second
point
- asks the patient to hold that second point
- holds a third point in the muscle
- waits for the pulsations in the first and third points to converge
in timing and amplitude (for the "points to balance")
- asks the patient to actively stretch the muscle
- waits for the points to balance again
- asks for the patient to stretch further, until full range of
motion is achieved
Example: Levator scapulae. The patient holds the C1 and C2 attachment
trigger points; clinician holds central trigger point and scapular
attachment trigger point. As the points release, the patient rotates
her head contralaterally and then tucks her chin, to stretch the
muscle. As noted above, in my practice, the levator is almost always
overstrained as the result of one or more overcontracted antagonists,
and those antagonists are addressed first.
Demonstration of the simplified approach: [A volunteer from
the audience, a physical therapist, presented with pain near the
lateral epicondyle of the humerus, which she called tendinitis.
She identified the supinator referred pain pattern from Travell
& Simons as resembling her pain pattern, although she had no referred
pain to the thumb. During the demonstration I held the central trigger
point of the supinator, she held one attachment trigger point, and
I held another attachment trigger point. After her points balanced
with her arm in a neutral position, she pronated her forearm to
stretch the supinator. She felt heat release from her trigger point,
and I felt heat release from the two points I was holding. After
her points balanced with her supinator in maximum stretch, we stopped
work, and she rubbed her forearm. She was unable to find any pain
in her forearm. Her comment: "The tendinitis is not palpable."]
Everyone in this room should be able to use this approach today.
All you need is a copy of Travell and Simons's book and good palpation
skills.
When I explained this approach to massage therapists, they were
able to implement it with their patients the next day. Anyone who
practices physical therapy, neuromuscular therapy or any other pressure
to trigger point approach could also implement this strategy immediately.
Important caution: This approach is effective in eradicating
trigger points. If the clinician eradicates the trigger points in
a muscle that is splinting against an overcontracted antagonist,
it could make the problem worse. Because this approach is effective,
it is extremely important that the clinician know where the problem
is, as opposed to where the pain is. This caution will be repeated
later. It is my greatest fear when I teach not that students will
fail to release trigger points, but that they will succeed in releasing
them in the wrong muscles. Especially, I tell students never to
release trigger points in the quadratus lumborum.
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