Trigger points can appear in muscles that are overstrained
(too long) or overcontracted (too short). Physical therapy frequently
seeks to identify and strengthen overstrained muscles. Tandem Point
therapy identifies overcontracted muscles and releases the contractures,
thus reducing the pull on, and the pain in, overstrained muscles.
Physical therapy and Tandem Point therapy can complement each other
and reduce the patient's recovery time. I would strongly encourage
those of you who are physical therapists to incorporate these techniques
in your work. The first task is to identify the overcontracted muscles.
There are many different patterns of overcontracted and overstrained
muscles. Here are the two simplest.
Agonist pain: The patient usually knows what
she did and will tell you. Based on your understanding of the actions
of muscles, you will usually know which muscles she has injured.
Essentially, the pain is felt in an overworked agonist. Important
exception: A lumbar spine problem can appear to be an agonist problem
when it is actually an antagonist problem. The usual approach
is to release the agonist muscles first and then release the antagonists.
The release of the antagonists should involve a stress of the agonists.
Release the agonists again. Example: Patient presents with arm pain
and weakness following overuse of the biceps brachii. The approach
is to release the trigger points in the biceps brachii, and coracobrachialis,
then release the trigger points in the triceps brachii, then release
the trigger points in the biceps brachii and coracobrachialis again.
Antagonist pain: Aching muscle pain without
an obvious onset. The patient usually does not know what he did,
but may be willing to blame bad posture, sleeping poorly, stress,
overwork, or not getting enough exercise. Essentially, the pain
is felt in an overstrained antagonist to a chronically overcontracted
agonist. Determine the muscle that is hurting based on the Travell
and Simons patterns, confirm with palpation. Gently massage the
muscle to validate the patient's concern, but do not release it.
Go immediately to the muscle's antagonists and, where they are found
to be contracted, release them. Example: Patient presents with deep,
aching pain in the levator scapulae, the second most common pattern
seen in my practice. The approach is usually to release any trigger
points in the serratus anterior, triceps brachii, and anterior scalene,
then briefly release the levator scapulae, then release any trigger
points in the levator's antagonists once again (frequently other
antagonists of the levator will factor in this pattern).
In an older problem, a patient often has contractures
in all the muscles in a functional unit. It is sometimes necessary
to go back and forth from agonist to antagonist, releasing trigger
points at different levels as the muscles on all sides of the functional
unit lengthen and reveal new taut bands. However, I rarely release
trigger points in the quadratus lumborum, and virtually never in
a stretched position.
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