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Neuromuscular Therapy – (Trigger point therapy TPT)
Definition
A trigger point is a hyper sensitive area in soft tissue, which when compressed is locally tender
Causes
• Being born, depending on delivery trauma
• Changes in climate (excessive exposure to hot & cold environments)
• Injury
• Trauma
• Repetitive movements
• Postural problems
• Lifestyle
• Overload in training and physical work
• Internal major organ issues
• Illness
• Rest and sleep issues
• Poor diet
Types
1. Latent – This causes weakness and taughtness in the muscle. Generally it doesn’t refer pain to other areas
2. Active – Always painful and will refer pain to other areas
Works on therapeutic pain scale
• Work around the 7 threshold
• Communicate process to client and encourage feedback
2 ways to treat
• Direct compression – straight on to area
• Pincer paltapation – Nipping muscle between 2 fingers
• There will always be a main site with several satellite sites close by
• These will impair the muscle function and cause postural problems. It will also have an effect on the lymphatic and blood circulation
Diagnostics
• Listen to the client. They may complain of a nagging aching pain, with no evidence of injury in the area.
• Gentle palpitation of the site in the area where you think the problem is
• Sensitivity. The area will be sensitive to the touch
• Twitching, the muscle fibers in the site may twitch due to muscle contraction and spasm
• Weakness, there is often muscle weakness in the site
• Muscle tightness, the point is often within a tight band of muscle
• Restriction, there is often localized muscle restriction within the muscle
Treatment
• Postural evaluation
• Sports massage to find cause and find out for yourself and diagnose
• Look at good and bad parts to analyse balance of body
• Condition of muscle tissue
How long do you apply pressure?
• 7 seconds (2-3 times on each site, not one after the other though)
• Or stay on the site until it fades 30-45 seconds (Must do each site at least twice)
Other considerations
• No oil required, to avoid slipping
• No massage prior or stretch prior to this to avoid desensitising
• Client must stretch afterwards – this reinforces new condition of the muscle (muscle memory)
• This is a remedial standalone treatment as it will leave pain possibly bruising.
• Do not do prior to an event
Aftercare
• Stretches – To assist with the removal of waste and to avoid DOMS (delayed onset muscles soreness) as you have worked deeply into the muscles
• Postural exercises – To increase flexibility of tight overworked muscles and build and stregthen un-worked muscles, as the muscles work in pairs.
• Write the above down for them – so that they remember the aftercare given and under stand the exercises, frequency, intensity and amount of work they are suppose to do
• This is to avoid re-occurrence and aid recovery (less treatments)
Muscles & common pain referrals patterns
| |Muscle |Pain and referral points | |Muscle |Pain and referral points |
| |Temporalis |Temporal region, around the jaw, | |Rectus abdominus |Abdominal region, pelvic region, groin |
| | |above the eye | | | |
| |Masseter |Ear, around the jaw | |Wrist extensors |Above elbow,dorsal aspect of forearm and wrist |
| |Sterocliedomastoid |Back of head, around the ear, | |Lower (lumbar) |Lumbar region, abdomen, posterior pelvic region |
| | |forehead, chin, anterior neck | |erector spinae | |
| |Peroneals |Lateral lower leg, around the | |Quadratus lumborum |Lumbar region, hip region, groin |
| | |lateral malleolus | | | |
| |Anterior scalene |Upper chest, upper arm | |Gluteals |Around iliac creast, lower lumbar region, posterior|
| | | | | |and lateral hip region, posterior and lateral upper|
| | | | | |and lower leg |
| |Upper clavicle, erector spinae |Occipital region, posterior neck, | | | |
| | |medial scapula region | | | |
| |Upper trapezius |Posterior neck, around the jaw, | |Tensor facia lata |Anterior and lateral thigh |
| | |temporal region, back of head | | | |
| |Levator scapulae |Lateral neck, medial scapula, | |Quadriceps |Anterior thigh, around patella |
| | |posterior shoulder | | | |
| |Lower trapezius |Posterior neck, shoulder region | |Hamstrings |Posterior thigh, knee and upper calf |
| |Rhomboids |Medial and superior aspects of | |Tibialis anterior |Shin region, dorsal region of foot |
| | |scapula | | | |
| |Supraspinatus |Top of shoulder, later upper arm | |Gastroncnemius |Calf region, heel region, medial foot |
| |Infraspinatus |Anterior shoulder, lateral upper | |Soleus |Heel region |
| | |arm, lateral forearm | | | |
| |Pectoralis major |Chest region, medial arm | |Spenius |Top of head |
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