Trigger Points - How to Avoid Overload and Overuse Injuries
Understanding Overload and Overuse Injuries
It's important to remember that it's not only athletes who suffer from overload and overuse injuries
Irrespective of wether your client is an athlete or lives a seemingly sedentary lifestyle, we as therapists need to communicate sufficiently with each client to understand their daily habits and practices - especially with regard to occupational and leisure activities.
Overuse injuries in particular will often emanate from work related activities which could be anything from standing, driving, or repeating just about any activity for long periods.
Here are some key points to bear in mind ...
Muscles are more susceptible to damage, fatigue, and injury when they are weak.
Weakness is often a contributory factor in the pathogenesis of myofascial trigger points. This is because the body overcompensates for the weakness and strains in the muscle, overloading and overstimulating the motor endplate.
One muscle should never be strengthened in isolation.
So, when recommending strengthening exercises, it is advisable to put them in context and where possible to provide the client with an overall strengthening and stretching program linked to the treatment that they are receiving.
Make sure to refer the client to a specialist if this area does not fall within your scope of practice.
We find that clients who stick to a stretching program between therapy sessions, almost always respond faster and better to treatment. This is especially true when treating trigger points.
Whilst the evidence supporting this is confusing and often contradictory, it is generally accepted by trigger point therapists (notably within elite sports and athletics) that stretching between sessions helps.
Stretching should be performed slowly, and without bouncing. Care must be taken to isolate the stretch to the specific muscle as far as possible.
As a rule, stretches should be performed three times, slightly deepening the stretch with an out-breath each time. This sequence should be performed several times per day, for approximately 15–20 minutes.
Chatting with the client about their injury and their lifestyle habits can often help us explore and eliminate any chemical or nutritional deficit.
We will also often help patients to analyze different lifestyle situations in the context of their injury, for instance, “Look at your driving position” or “Look at your everyday work set-up.”
When treating trigger points in the pectoralis major muscle for example, you may ask the patient about their stress or anxiety levels (rib breathing mechanics).
If the patient has large, heavy breasts, you may want to advise on a more appropriate bra or support.
Helping clients to understand their injury in the context of their lifestyle can both help accelerate recovery and prevent a re-occurrence.
Posture may well have a crucial role in creating trigger point activity.
Faulty sitting and/or standing postures are both a pathogenic and a maintaining factor for trigger points.
Advice and exercises for posture is often the key to unlocking both central and satellite trigger points.
We almost always discuss sleeping posture with each client.
Many of us will assume "awkward" postures at night. This will sometimes be done to reduce the pain from either active or stiff latent trigger points.
In such cases, patients often opt for a sleeping position that shortens the affected muscle.
For example, they sleep with either the hands above the head (supraspinatus), or the arms folded over the chest (pectoralis major). In other cases, it may be that the sleeping position is a pathogenic or a maintaining factor.
Ideal Work Posture for Avoiding Trigger Points
Some clients may have manual or repetitive activities in the workplace and these may well have a role to play in trigger point pathogenesis or maintenance.
More and more of our clients spend their time working with tech devices (tablets, phones, laptops) and we will almost always have a chat to these clients about posture at work.
Habitual Activity, Hobbies, and Sports
Similarly, it is important to ask the client if they perform any repetitive or habitual activities outside of work.
Standing for long periods of the day on one leg, for example, may well overload the TFL muscle.
Sitting in a cross-legged position may affect a range of muscles, such as the hip flexors (iliopsoas), the buttock muscles (gluteals and piriformis), and the thigh muscles (quadriceps).
We know from studies that heavy smokers may develop trigger points in the shoulder (deltoid) and arm (biceps brachii) muscles.
Certain hobbies and sports may also lead to an increased incidence of trigger point pathogenesis.
It is important to enquire carefully about such activities. What is the clients level of competence? Do they warm up, and cool down? How competitive are they? Is their level of activity realistic for their age? Posture? Body type? Physical health? You may want to explore these areas further.
There's no doubt that good communication with your client can often be the key factor in helping them engage with their treatment and recovery. For most of us it's also fun!
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Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.
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Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.
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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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