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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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