Musicians Clinic

Trigger points, also known as trigger sites or muscle knots, are hyper-irritable spots or areas in skeletal muscle that are associated with nodules and tight zones in muscle fibres.

• Trigger points are small zones of contracted muscle knots and are a common cause of pain.
  
  
• Compression of a trigger point may cause sensations of  local tenderness, referred pain, or local twitch response.
  
  
• The trigger point model states that pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself.

• Trigger points exist all over the body, many hundreds of them, from your jaw to your heel, from your pectoralis minor to your peronius tertius. All of which can produce symptoms which are amenable to my approach, one of multiple techniques all blended into one.
  
  
• Trigger points have a number of qualities. They may be classified as potential, active or latent and primary or secondary.
  
  
• There are more than 100 potential trigger points in the lower upper limb and hands.
  
  
• These trigger points, when they become active or latent, show up in similar places in muscles in every person.
  An active trigger point is one that actively refers pain either locally or to another location.
  A latent trigger point is one that exists, but does not yet refer pain actively, but may do so when pressure or strain is applied to the myoskeletal structure containing the trigger point.
  
  
• The trigger points are generally located at the muscle origin, middle of the muscle, at the myotendinous junction
  ( where the contractile portion of a muscle becomes the non-contractile tendon portion ), in the middle of the tendon and final insertion points of the tendon.
  
  
• Great attention must be taken to the ranges of movement of the carpal bones of the wrist, for if they are lacking in their full range, symptoms will occur. This needs the ability to articulate and to manipulate the carpal bones. There are many of us who have such joint adhesions especailly of the scaphoid, lunate and hamate bones where they join with the forearm bones, the radius and ulna.
  
  
• Elbow joint problems can also be at the root of apparent RSI, these need to be manipulated as above. The radial head is a common site of irritation, often with the patient feels the pain elsewhere, farther down the top of the forearm.
  
  

Trigger points are self-evident when one has truly explored a myriad of painful syndromes presented over many years. The trick is not only to find the points and areas but to change them, physically. This is usually easily acheived but must be done in the 'right' way. It is definitely a fine art and a supreme skill combined.

On our first day at college we were told that over the next four years we would learn the entire anatomy of the body 7 times and forget it only 6 times.

We thought this was a joke but it definitely turned out to be true except for the bit about forgetting it 6 times. We studied General medicine, differential diagnosis, the 3 divisions of the nervous system, Histology, Pathology, Orthopedics, Osteopathic treatment techniques, and, of course, detailed Anatomy.

There are two levels of anatomical study of the muscles, that of the superficial layers and that of all 850 muscles. Most physical therapists such as masseurs, physiotherapists, acupuncturists and other variations and mini-specialisations learn only the superficial layer of muscles. This lessens their abilities dramatically. We were taught the origin, insertion, function, blood supply and nerve supply to every muscle in the body.