This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2017. For the original video go to https://www.youtube.com/watch?v=01W9RCXKgys&t=614s
Bob: Today we're going to talk about the big lie about trigger points, which you might know as knots, and how to get rid of them. This is a big topic for a lot of people.
Brad: Right and we're talking seriously, we're using the three-letter word 'lie' so we have some attention here.
Bob: Right, we need to back this up.
Brad: There is a great bit of truth to this, so we're going to get into it.
Bob: Trigger points are also sometimes known as myofascial trigger points. It's very controversial as to what causes them. That's been the issue for like a century. Generally what it is, is a hyperirritable spot and a common spot is like in the upper trapezius. You're going to find a nodule and you push on that and it really is sore. It just feels like a knot right in the area. You can get them all over different spots here, you can even get them in the low back, in the buttock, so that's what we're going to be talking about.
Brad: Right and there's always a trigger point right about there on pretty much everyone.
Bob: Yeah you can feel a little bit normally there and that's because a lot of people have bad posture. So for years, people thought, and this is back in the early 1900s or 1900-1950. They thought it was in the muscle itself and they called it fibrositis. That was a common diagnosis. That kind of went away and now what we believe in our opinion, in most cases, even though you're having trouble in the muscle, is it's coming from the neck or the spine.
Brad: Right, another irritated tissue is causing the muscle to spasm or tighten up. A referral type of pain.
Bob: Yeah it's being referred from the neck and it goes into the muscle. There are three signs that you can look at to figure out if it is really muscle or if it is coming from the spine. So we'll talk about those. Number one, if it is in the muscle when you test the muscle or put resistance on the muscle, it'll hurt.
Brad: If it is a muscle issue, so this is not a good example but, if it's at the bicep and to stress that muscle you put it at mid-range.
Bob: And I push on it and if it doesn't hurt there's no lesion in the muscle. That nodule you're feeling is not for the muscle itself it's from somewhere else.
Brad: Right because we're stressing the irritated point if that's irritated the stress should cause more irritation.
Bob: Let's talk about a muscle that most people do have trouble with, the upper trapezius. Now a simple way to test it, if you want to be a purist you actually have to bring your head back to the side, turn away, and then bring it up. Then you push on it.
Brad: Okay so we're looking at this muscle, so this muscle is working to maintain that posture. I’m going to push here and that's going to make that muscle work even more and I’m pushing pretty hard.
Bob: There's no pain. Now a simple way to do it is just to bring it up. I mean you're probably getting mostly upper trapezius. If you bring it up like this and again someone pushes on it and there's no pain. Same way, you can test the other side.
Bob: You can test some of the lower trapezius and stuff like that by laying down. If I bring the arm up like this and you push on it.
Brad: If I put pressure here with your arms up, so we're working that lower trap right here. Thumb up by the way. Or if I go out to the side, I’m getting the middle trap.
Bob: So if none of those bother you, it's not the muscle. It's not hurting in the muscle so let's go to the next thing. Are the trigger points jumping around? I see this quite often in patients that at one moment it's over on the right, it's really pretty bad, and then you'll do a couple of things, you move around and it's on the left now. If that's the truth then obviously it can't be in the muscle.
Brad: Right and that’s very common with upper back or lower back pain. One day it hurts in one spot and the next it's somewhere else. The muscle is not going to move around.
Bob: The third thing is, can you create these trigger points by doing a movement? For example, if moving my neck makes one of the trigger points worse. That by far is probably the biggest indicator. Generally, if you find a movement that makes it worse, you can find a movement that makes it better. Let's talk about a few of those. So if you're getting trigger points up in the upper traps, one of the first things quite often you want to try is chin tucks. A lot of times people sit with a forward-head and rounded shoulders. This often brings on those trigger points because the neck's in this position.
Bob: So you want to do a chin tuck where you're not bringing your chin down, you're not bringing your chin up, you're just going straight back.
Bob: See if that makes things any better at all. Generally, that won't, but a lot of times what will start helping is if we start working on neck extension.
Brad: One thing that I do, is I may have someone with a problem over in the left shoulder blade, and I'll start them doing a chin tuck and it changes the trigger point pain or that knot pain. If doing a chin tuck changes how that feels or moves the location of it, it's telling me I’ve got to look at the neck. It's not in the muscle it's in the neck. The neck is causing that muscle pain.
Bob: So we're going to work on neck extension.
Bob: If this is painful when you do this, one again it probably is the cause of it, but two just try shorter arcs if it hurts. If it still hurts you may want to try the towel trick which Brad and I have done many times. So, the Bradley Heineck technique is to actually just put the towel down low, pull down, and then you can lean back and work on doing some extensions. Quite often that takes a lot of the stress off the neck.
Brad: I didn't have the other towel but the stretch strap works better than using the, what do they call it, the "selvage" of the towel.
Bob: Right, a lot of times there's a little edge on the towel, and a different way to do it is actually taking that edge and putting it up underneath your ears and you're going to pull up now and work on extending back. Do you see how my arms are moving along with my neck? With this selvage or stretch strap, you can go lower too and work on different levels. Again see if that changes the trigger points.
Brad: Now you're only going to do these if it helps and makes it feel better. If this irritates it you're just going to stop and you need to go approach it differently.
Bob: Right. One last neck exercise that often works is the chin tuck and the side bend. So if the pain or trigger point is on the right, a lot of times if you chin tuck and bend to that side it helps. Again, you can do these every hour as long as it's making things better and not worse. Eventually, people get to this point and then they give even a little stretch.
Brad: A light stretch, don't pull hard on it, it's just a gentle stretch.
Bob: One of the problems I see with trigger points, especially in the upper trap and the traps is I think they're coming from right here. I don't think they're coming from the neck per se unless it's really low neck or maybe a little bit of what we call the upper mid-back. That thoracic area is really hard to treat. That's why a lot of times people go "well the neck is not affecting my trigger points at all." They need to get into this area and it's really hard to do so.
Bob: I’m going to show you a couple of ways to try. One thing you can do is you can take a couple of tennis balls, I actually have two lacrosse balls, in a sock and you're going to roll on them. I want to show you on Brad where they are. So you put one tennis ball on each side of the spine and when you roll on this it'll help extend that part of the lower neck and upper mid-back. It can get some movement in there. Doing that every so often helps get that movement and takes away the trigger points.
Brad: Right and you can do this on the table but you can also do it against the wall.
Bob: I can tell you, my son was having trouble with this area and I worked on it manually. I mean, as a therapist I know how, but it's really hard to treat yourself sometimes and that's why these things stick around. Again all I have to do is take the two balls, and put one on each side of the spine and this actually works pretty well. I can roll onto it and I'm really working on that area. I'm not having to move too much.
Brad: The sock is there to hold the balls in the general right location. If you don't use that they're rolling all over the place.
Bob: We'll show the mid-back one and then we can go over to the wall real quick. The mid-back one, again if it's maybe even a little bit lower, it's good to get a ball like this and you can move it in different spots of the mid-back. Then you can do stretches up over the ball like this.
Brad: A little spongy of a ball, not like a basketball or something that would be too hard. You need a little give in it.
Bob: You can move it up and down and you can try to get that higher spot and it works. I can actually feel that it's going right into that upper area.
Brad: I'll have patients, if they respond well to this, I'll give a little overpressure. As long as it feels good and they'll say "oh that feels like a good stretch."
Bob: It does feel good. All right last thing, did you want to show it against the wall?
Brad: Absolutely, so this is actually kind of hard to do by yourself until you get used to it. You're going to get the balls behind you and lean against them. I've got one a little higher than the other, but I'll have to work that out.
Bob: It was easy to do it on the table, you just put a lot more weight on it then.
Brad: Right, now that I've got it lined up this is wonderful. You could do it on the floor, a tight carpet even a hard floor. So another good use for lacrosse balls or tennis balls. You know, you just have to have some fun with this stuff.
Bob: Remember folks we're not just pretty.
Brad: Yeah we're pretty ugly.
Bob: No, we're pretty helpful and handy.
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