The Trigger Point Therapy Workbook YOUR SELF-TREATMENT GUIDE FOR PAIN RELIEF Clair Davies, N.C.T.M.B. Foreword by David G. Simons, M.D. New Harbinger Publications, Inc.Publisher's Note "This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. Iti sold with the wx- derstanding that the publisher is not engaged in rendering medical, psychological, financial, legal, or other professional services. f expert as- sistance or counseling is needed, the services of a competent profesional should be sought Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book ‘and make no warranty, express or implied, with respect to the contents of the publication. Some drugs and metioal devices presented in this publication may have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. Its the responsibilty ofthe healthcare provider to ascertain the FDA status of each drug or device planned for use in their clinical practic Distributed in the U.S.A. by Publishers Group West; in Canada by Raincoast Books; in Great Britain by Aislift Book Company, tds in South Africa by Real Books, Ltd.; in Australia by Boobook; and in New Zealand by Tandem Press. Copyright © 2001 by Clair Davies New Harbinger Publications, Inc. 5674 Shattuck Avenue ‘Oakland, CA 94609 Cover design by SHELBY DESIGNS AND ILLUSTRATES ustrations by Clair Davies Eaited by Clancy Drake Text design by Michele Waters ISBN 1-57224-250-7 Paperback All Rights Reserved Printed in the United States of America New Harbinger Publications’ Web site address: www.newharbinger.com eB 2 oO wo 9 8 7 6 5 £ 3 2This book is dedicated to my daughter Amber Davies. I could not have written it without her steady faith in me. Her patience, constant encouragement, tactful criticism, and undying enthusiasm for trigger point therapy continually renewed my faith in myself and in the value of this project. Amber has been my number-one disciple. As a longtime sufferer of debilitating chronic pain, she was highly motivated to test and validate every new idea regarding self-treatment. My greatest reward has been in seeing her become relatively pain free and self-reliant due to our combined efforts. Amber has gone on to become a skilled massage therapist and is now devoted to helping bring the benefits of trigger point therapy to others.CHAPTER 1 CHAPTER 2 CHAPTER 3 CHAPTER 4 CHAPTER 5 CHAPTER 6 CHAPTER 7 CHAPTER 8 CHAPTER 9 CHAPTER 10 Contents Ilustrations Foreword Acknowledgments Introduction A New Life All about Trigger Points Massage Guidelines Head and Neck Pain Shoulder, Upper Back, and Upper Arm Pain Elbow, Forearm, and Hand Pain Chest and Abdominal Pain Midback, Low Back, and Buttocks Pain Hip, Thigh, and Knee Pain Lower Leg, Ankle, and Foot Pain Epilogue Resources Bibliography References Index vii xvii xix 15 35 7 125 154 177 209 247 251 253 257FIGURE 2.1 FIGURE 2.2 FIGURE 3.1 FIGURE 3.3 FIGURE 3.4 FIGURE 3.2 FIGURE 3.5 FIGURE 3.6 FIGURE 4.1 FIGURE 4.2 FIGURE 4.3 FIGURE 4.4-4.6 FIGURE 4.7 FIGURE 4.8 FIGURE 4.9 Ficure 4.10 FIGURE 4.11 FIGURE 4.12 FIGURE 4.13 FIGURE 4.14 FIGURE 4.15 FIGURE 4.16 FIGURE 4.17 FIGURE 4.18 Figure 4.19 Tliustrations Magnified contraction knots (trigger points) in muscle fibers Orientation of muscle fibers: (A) parallel; (B) parallel with tendinous inscriptions; (C) bipennate; (D) unipennate Key to pictorial devices Supported fingers Supported fingers nearly perpendicular to skin Supported thumb Thera Cane The Knobble massage tool Stemocleidomastoid muscles Stemocleidomastoid, sternal branch: trigger points and referred pain pattern Sternocleidomastoid, clavicular branch: trigger points and referred pain pattern Sternocleidomastoid massage between fingers and thumb ‘Trapezius number 1 trigger point and referred pain pattern: front view Trapezius number 1 trigger point and referred pain pattern: side view Trapezius number 2 trigger point and referred pain pattern ‘Trapezius number 3 trigger points and referred pain patiern Trapezius number 4 trigger points and referred pain pattern Massage of number 1 trigger point with fingers and thumb Trapezius massage with supported thumb against ball on the wall or bed Upper trapezius massage with Thera Cane Middle trapezius massage with Thera Cane over the opposite shoulder Lower trapezius massage with Thera Cane Lower trapezius massage with ball against wall Levator scapulee trigger points and referred pain pattern Suboccipital muscles’ trigger points 21 37 40 a ai 49 50 52 53 SRSRRRL88 56 59viii The Trigger Point Therapy Workhook FiguRE 4.20 FIGURE 4.21 FIGURE 4.22 FIGURE 4.23 FIGURE 4.24 FIGURE 4.25 FIGURE 4.26 FIGURE 4.27 FIGURE 4.28 FIGURE 4.29 FIGURE 4.30 FIGURE 4.31 FIGURE 4.32 FIGURE 4.33 FIGURE 4.34 FIGURE 4.35 FIGURE 4.36 FIGURE 4.37 FIGURE 4.38 FIGURE 4.39 FIGURE 4.40 Figure 4.41 FIGURE 4.42 FIGURE 4.43 FIGURE 4.44 FIGURE 4.45 FIGURE 4.46 FiGuRE 4.47 FIGURE 5.1 Figure 5.2 Figure 5.3 Figure 5.4 Figure 5.5 FIGURE 5.6 FIGURE 5.7 FIGURE 5.8 g, FIGURE 5.9 FIGURE 5.10 Suboccipitals’ referred pain pattern 59 Posterior neck massage with Thera Cane 59 Position of hands for posterior neck massage with ball or Knobble in hand. 60 Use this position while lying down First hand in place for posterior neck massage with supported fingers 60 Second hand in place for posterior neck massage with supported fingers 60 Splenius capitis trigger point and referred pain pattern 61 Splenius cervicis trigger point number 1 and referred pain pattern: through the 64 hhead to the back of the eye Splenius cervicis trigger point number 2 and referred pain pattern 61 Semispinalis capitis number 1 trigger points and referred pain pattern 61 Semispinalis capitis number 2 trigger points and referred pain. pattern 62 ‘Multifidi and rotatores trigger points and referred pain pattern 62 Masseter trigger points and referred pain pattern 63 Masseter massage with thumb and fingers (thumb inside the mouth) Medial pterygoid trigger points and referred pain pattern 65 Medial pterygoid massage with thumb 85 Lateral pterygoid trigger points and referred pain pattem 65 Lateral pterygoid massage with index finger in mouth Buccinator trigger point and referred pain pattern Obicularis oculi trigger points and referred pain pattern 67 Zygomaticus and levator labii trigger point and referred pain pattern 67 Zygomaticus and levator labii massage with fingertips 67 Kneading the zygomaticus between fingers and thumb 67 Diagastric trigger points and referred pain pattem 68 Posterior digastric massage with fingertips 68 Anterior digastric massage with fingertips 68 Longus colli massage with fingertips 69 Temporalis trigger points and referred pain pattern 69 Temporalis massage with supported fingers 70 Scalene trigger points 75 Scalene referred pain patter, front view 75 Scalene referred pain pattern, back view 75 Location of scalene muscles behind the stemocleidomastoid 76 Scalene massage behind the sternocleidomastoid with fingertips 7 Scalene massage behind the sternocleidomastoid attachment to the collarbone 78 Posterior scalene massage at the junction of the trapezius and the collarbone 78 Bones of the shoulder, front view 79 Bones of the shoulder, back view 79 Locating the superior angle of the shoulder blade 80Figure 5.11 FIGURE 5.12 FIGURE 5.13 FIGURE 5.14 Figure 5.15 FicurE 5.16 Ficure 5.17 FIGURE 5.18 FIGURE 5.19 FIGURE 5.20 FIGURE 5.21 FIGURE 5.22 Figure 5.23 FIGURE 5.24 FIGURE 5.25 FIGURE 5.26 FIGURE 5.27 FIGURE 5.28 FIGURE 5.29 FIGURE 5.30 FIGURE 5.31 FIGURE 5.32 Figure 5.33 FiGuRE 5.34 FiGuRE 5.35 FIGURE 5.36 FIGURE 5.37 FIGURE 5.38 FIGURE 5.39 FIGURE 5.40 FIGURE 5.41 FIGURE 5.42 FIGURE 5.43 FIGURE 5.44 FIGURE 6.1 FIGURE 6.2 FIGURE 6.3 Mustrations ix Rhomboid trigger points and referred pain pattern 81 Serratus posterior superior trigger points 82 Serratus posterior superior referred pain pattern 82 Serratus posterior superior massage with Thera Cane (hand at opposite 82 shoulder) Supraspinatus trigger points and referred pain pattern 84 Supraspinatus massage with the Thera Cane 85 Infraspinatus trigger points 86 Infraspinatus referred pain pattern 86 Axrow shows outward rotation for locating infraspinatus with isolated 87 contraction Infraspinatus massage with Thera Cane 88 Teres minor trigger points and referred pain pattern 88 Subscapularis trigger points and referred pain pattern 89 Position of the fingers for the subscapularis massage ot Position of the thumb for the subscapularis massage o Position of the arms for the subscapularis massage 91 Subscapularis massage with arm hanging down between legs 4 Deltoid trigger points 92 Posterior deltoid pain pattem 92 Lateral deltoid pain pattern 92 Anterior deltoid pain pattern 92 Teres major trigger points and referred pain pattern 94 Latissimus dorsi trigger points and referred pain pattern 94 Latissimus dorsi and teres major massage between fingers and thumb 94 Coracobrachialis trigger points and anterior referred pain pattern 95 Coracobrachialis posterior referred pain pattern 95 Coracobrachialis massage with thumb 95 Biceps trigger points and referred pain patter 96 Biceps massage with knuckles 96 ‘Triceps number 1 trigger point and referred pain pattern 97 Triceps number 2 trigger point and referred pain pattern 97 ‘Triceps number 3 trigger point and referred pain pattern 97 ‘Triceps number 4 trigger point and referred pain pattern 98 ‘Triceps number 5 trigger point and referred pain pattern 98 ‘Triceps massage with knuckles and ball 98 Avoid grasping with thumb and fingers 105 Bones of the forearm and hand: (A) radius; (B) ulna; (C) carpals; (D) 106 metacarpals; (E) phalanges ' ‘7 Brachialis ‘rigger points and referred pain pattern