Taking The Perfect Case History - What Really Matters?
Learning to Listen To Your Client - Dr. Jonathan Kuttner M.D.
Communication with your client can often be the key factor in helping them engage with their treatment and recovery
When conducting trigger point therapy, it is generally advisable to encourage the client to get involved in managing their own symptoms.
Where appropriate, and if it is within your scope of practice, you might want to include hints, tips, and advice using some of the following elements or components.
Strengthening
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.
If you do offer strengthening exercises, it is advisable to put them in context and where possible. It is always important for the client to understand the connection between the exercises and the treatment process.
Stretching
We find that clients who stick to a stretching program between therapy sessions, almost always respond faster and better to treatment.
Whilst the evidence supporting this is confusing and often contradictory, it is generally accepted by trigger point therapists 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.
Common Sense
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
Posture may well have a crucial role in maintaining trigger point activity. Faulty sitting and/or standing postures are both a pathogenic and a maintaining factor for trigger point activity.
Advice and exercises for posture is often the key to unlocking both central and satellite points.
Sleeping Posture
We almost always discuss sleeping posture with each client.
Clients frequently assume strange 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 - very few pay enough attention to this!
Work Posture
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 apart from at 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.
In summary, communication with your client can often be the key factor in helping them engage with their treatment and recovery.
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